Knowing me, knowing you: a qualitative study of the effects on patients of doctors’ self-illness disclosures
Laura Bolger 1 , Katherine Helen Hall 1 2 , Martyn Williamson 11 Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago Faculty of Medicine, Dunedin 9054, New Zealand
2 Corresponding author. Email: katherine.hall@otago.ac.nz
Journal of Primary Health Care 11(4) 327-333 https://doi.org/10.1071/HC19061
Published: 18 December 2019
Journal Compilation © Royal New Zealand College of General Practitioners 2019 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: Very little is known how patients react to learning about their own doctors’ illnesses. Doctors can be uncertain if and when such disclosures can be helpful, and in what way, to patients. This paper attempts to bridge this gap by providing an in-depth analysis of one group of patients’ experiences with this type of disclosure.
AIM: To understand from patients’ perspectives, the effects on them of doctors disclosing their own illnesses, to provide guidance concerning the uses of this disclosure for general practitioners.
METHODS: This qualitative study was an exploration of 13 patients’ reactions to receiving such information, using semi-structured interviews and thematic analysis.
RESULTS: The major themes were the emotional dimensions of illness and patienthood, the doctor–patient relationship and patients’ concerns about disclosures. Disclosures can have profound effects on patients with both negative and positive consequences.
CONCLUSION: We present suggestions about how to use such disclosures in primary care to minimise potential harms and emphasise potential benefits, based on these patients’ perspectives and the current literature.
KEYwords: ethics; general practitioners; physician self-disclosure; reflective practice
References
[1] Dahan R, Yoeli N, Karkabi K, Hermoni D. Patients’ attitudes towards physician self-disclosure during the patient-physician encounter. Eur J Gen Pract (Abstr). 2007; 13 109[2] Beach MC, Roter D, Larson S, et al. What do physicians tell patients about themselves? J Gen Intern Med. 2004; 19 911–6.
| What do physicians tell patients about themselves?Crossref | GoogleScholarGoogle Scholar | 15333054PubMed |
[3] Beach MC, Roter D, Rubin H, et al. Is physician self-disclosure related to patient evaluation of office visits? J Gen Intern Med. 2004; 19 905–10.
| Is physician self-disclosure related to patient evaluation of office visits?Crossref | GoogleScholarGoogle Scholar | 15333053PubMed |
[4] Allen E-CF, Arroll B. Physician self-disclosure in primary care: a mixed methods study of GPs’ attitudes, skills, and behaviour. Br J Gen Pract. 2015; 65 e601–8.
| Physician self-disclosure in primary care: a mixed methods study of GPs’ attitudes, skills, and behaviour.Crossref | GoogleScholarGoogle Scholar |
[5] Klitzman R, Weiss J. Disclosures of illness by doctors to their patients: a qualitative study of doctors with HIV and other serious disorders. Patient Educ Couns. 2006; 64 277–84.
| Disclosures of illness by doctors to their patients: a qualitative study of doctors with HIV and other serious disorders.Crossref | GoogleScholarGoogle Scholar | 16860516PubMed |
[6] Hall K, Michael J, Jaye C, Young J. General practitioners’ ethical decision-making: does being a patient themselves make a difference? Clin Ethics. 2018; 13 199–208.
| General practitioners’ ethical decision-making: does being a patient themselves make a difference?Crossref | GoogleScholarGoogle Scholar |
[7] Holmes G, Harrington N, Parrish A. Exploring the relationship between pediatrician self-disclosure and parent satisfaction. Commun Res Rep. 2010; 27 365–9.
| Exploring the relationship between pediatrician self-disclosure and parent satisfaction.Crossref | GoogleScholarGoogle Scholar |
[8] Zink KL, Perry M, London K, et al. “Let me tell you about my…”: provider self-disclosure in the emergency department builds patient rapport. West J Emerg Med. 2017; 18 43–9.
| “Let me tell you about my…”: provider self-disclosure in the emergency department builds patient rapport.Crossref | GoogleScholarGoogle Scholar | 28116007PubMed |
[9] Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000; 9 287–90.
| Physician disclosure of healthy personal behaviors improves credibility and ability to motivate.Crossref | GoogleScholarGoogle Scholar | 10728118PubMed |
[10] Zerubavel N, Wright M. The dilemma of the wounded healer. Psychotherapy (Chic). 2012; 49 482–91.
| The dilemma of the wounded healer.Crossref | GoogleScholarGoogle Scholar | 22962968PubMed |
[11] Fox F, Harris M, Taylor G, et al. What happens when doctors are patients? Qualitative study of GPs. Br J Gen Pract. 2009; 59 811–8.
| What happens when doctors are patients? Qualitative study of GPs.Crossref | GoogleScholarGoogle Scholar | 19861026PubMed |
[12] Opel DJ. Physician, patient, parent: where exactly is the line? Hastings Cent Rep. 2012; 42 14–8.
| Physician, patient, parent: where exactly is the line?Crossref | GoogleScholarGoogle Scholar | 23138366PubMed |
[13] Bird S. Managing professional boundaries. Aust Fam Physician. 2013; 42 666–8.
| 24024230PubMed |
[14] Gabbard GO, Nadelson C. Professional boundaries in the physician-patient relationship. JAMA. 1995; 273 1445–9.
| Professional boundaries in the physician-patient relationship.Crossref | GoogleScholarGoogle Scholar | 7723159PubMed |
[15] Spielman B. Expanding the boundaries of informed consent: disclosing alcoholism and HIV status to patients. Am J Med. 1992; 93 216–8.
| Expanding the boundaries of informed consent: disclosing alcoholism and HIV status to patients.Crossref | GoogleScholarGoogle Scholar | 1497019PubMed |
[16] Furrow BR. Must physicians reveal their wounds? Camb Q Healthc Ethics. 1996; 5 204–13.
| Must physicians reveal their wounds?Crossref | GoogleScholarGoogle Scholar | 8718726PubMed |
[17] McDaniel SH, Beckman HB, Morse DS, et al. Physician self-disclosure in primary care visits. Arch Intern Med. 2007; 167 1321–26.
| Physician self-disclosure in primary care visits.Crossref | GoogleScholarGoogle Scholar | 17592107PubMed |
[18] Morse DS, McDaniel SH, Candib L, Beach MC. “Enough about me, let’s get back to you”: physician self-disclosure during primary care encounters. Ann Intern Med. 2008; 149 835–7.
| “Enough about me, let’s get back to you”: physician self-disclosure during primary care encounters.Crossref | GoogleScholarGoogle Scholar | 20440869PubMed |
[19] Lussier M-T, Richard C. Self-disclosure during medical encounters. Can Fam Physician. 2007; 53 421–2.
| 17872674PubMed |
[20] Braun V, Clarke V. Successful Qualitative Research. London: Sage; 2014.