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Can I share my personal life with patients? A literature review of self-disclosures.

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A revolutionary change that has come about in dental and medical education is the focus on the patient-doctor relationship. A newfound interest in training health professionals to become caring and respectful human beings in addition to knowledgeable and competent doctors has changed medical education for the better. Even medical school interview formats and medical student acceptance rates are associated with personality traits, such as agreeableness and extraversion, that promote positive patient-doctor relationships.

In some institutions, the same focus on the doctor-patient relationship has made its way into the dental profession. Dentistry, like primary care, is a profession in which the patient-doctor relationship is of utmost importance. Motivating patients to improve their oral hygiene is an important step in maintaining the health of the dentition and periodontal tissues, and has much in common with lifestyle modifications that primary care physicians encourage in their patients. The success of the physician and dentist are both arguably rooted in the strength of their patient-doctor relationships. Additionally, dentists often administer treatment that requires substantial patient trust, as 80% of the adult population in the United States admits to some level of dental anxiety. This demonstrates that providing optimal dental care is dependent on good rapport between the patient and dentist.

Given the growing interest in the patient-doctor relationship, strategies to properly develop this relationship must be delineated. One well-documented method of developing trust and forming a relationship is “self-disclosure.” Some literature suggests that this may actually be one of the best ways to develop a relationship in which a health professional can deliver optimal care and begin to help his or her patient effect positive life changes.

A recent article in the New York Times documented one doctor’s experience with the struggle to determine whether or not to self-disclose with her patients. In this article, Dr. Danielle Ofri recounts an experience in which self-disclosure resulted in a patient feeling unsatisfied with her own life in comparison to the doctor’s. While the desire to share details of one’s own life with patients can be almost reflexive, Dr. Ofri considers whether this “reflex” can do more harm than good.

An article published in Annals of Internal Medicine entitled “Enough about Me, Let’s Get Back to You”: Physician Self-disclosure during Primary Care Encounters“Enough about Me, Let’s Get Back to You”: Physician Self-disclosure during Primary Care Encounters reviews the literature on self-disclosure and makes recommendations to physicians on how to approach this concept in practice. It relates that self-disclosure is often unhelpful and possibly risky in clinical practice. It can distract the patient and overstep boundaries. The article relates a disturbing set of statistics. “…40% of physician self-disclosures were unrelated to patients’ preceding remarks. Most self-disclosures (85%) did not seem to address patients’ medical concerns or promote relationship-building, and 11% seemed disruptive, in that they interrupted patient histories, were competitive, or raised potentially troubling emotional issues. The article goes on to suggest that physicians consider the relevance of their self-disclosures prior to sharing them with patients.

            On the other hand, the same article indicates that self-disclosures by the physician can help patients adhere to physician recommendations, given that the disclosures are relevant to the recommendation being provided. Additionally, patients and doctors alike believe that self-disclosures can increase intimacy, decrease a sense of hierarchy, and improve the overall doctor-patient relationship. Thus, authors of the article suggest that physicians engage in self-disclosures that emphasize empathy and understanding of the patient’s concerns without shifting the attention to the physician.

            In light of all this, dental professionals should take care to provide adequate empathy and support for their patients without sharing details of their personal lives that distract from patient care. They should consistently question their reflexive desire to self-disclose, yet share personal sentiment when it will bolster the patient-doctor relationship in a way that is relevant and appropriate. Hopefully, as dental institutions continue to stress positive communication between the patient and dental provider, and as literature on the topic expands, dentists and dental students will be better informed on how best to establish a constructive relationship with their patients.

 

Jerant AGriffin ERainwater J, et al. Does applicant personality influence multiple mini-interview performance and medical school acceptance offers? Acad Med. 2012 Sep;87(9):1250-9.

Getka, E., & Glass, C. Behavioral and cognitive-behavioral approaches to the reduction of dental anxiety. Behavior Therapy. 1992; 23(3): 433-448.

 

Collins NLMiller LC. Self-disclosure and liking: a meta-analytic review. Psychol Bull. 1994 Nov;116(3):457-75.

 

The New York Times Company. When Doctors Share With Their Patients. http://well.blogs.nytimes.com/2013/11/12/when-doctors-share-with-their-patients/. Accessed November 24, 2013.

Morse D, McDaniel S, Candib L, Beach MC. “Enough About Me, Let’s Get Back to You”: Physician Self-disclosure during Primary Care Encounters. Ann Intern Med. 2008 December 2; 149(11): 835–837.

 

Morse D, McDaniel S, Candib L, Beach MC. “Enough About Me, Let’s Get Back to You”: Physician Self-disclosure during Primary Care Encounters. Ann Intern Med. 2008 December 2; 149(11): 835–837.