BOUNDARIES:

HOW MUCH TO SHARE

How much of their personal lives should physicians share with patients, in person and/or through social media? What is the emotional experience of navigating complexities of self-disclosure in clinical settings?

BOUNDRIES V3-2_edited.jpg
 

A myriad of implicit and explicit boundaries inform the doctor-patient relationship. These boundaries are designed to protect the privacy and dignity of both parties, keep patient care at the forefront of encounters, cement trust and promote objectivity in medical decision making (1,2). Certain boundaries, however, are softer than others. One such "soft" boundary relates to physician self-disclosure. Generally speaking, clinicians are taught to refrain from sharing intimate details about their personal lives with patients (1). While some forms of relatively superficial self-disclosure are natural in conversation (e.g., discussion of movies recently watched) or simply unavoidable (e.g., a physician’s accent or publicly available educational history), deliberate revelation of more personal/private life history is “highly controversial” in clinical spheres (3,4). Simultaneously considered a potential therapeutic tool and a professional lapse, the practice of such self-disclosure is subjective, selective and situation-specific. Practitioners may reasonably feel conflicted when considering how, or even if, to share details constituting their identities with their patients (e.g., history of a certain illness). On the one hand, controlled, brief, patient-centered disclosure can sometimes deepen alliance and normalize uncomfortable or distressing experiences (5). Unchecked sharing, on the other hand—even through linking on social media—can accomplish just the opposite: it can "distort" clinical behavior, invert the therapeutic relationship (such that patients feel responsible for their providers), permit "exploitation of psychologically vulnerable patients," and subvert the trust and balance required for healing (5-7).


Recent studies have probed the frequency and nature of physician self-disclosure in various clinical settings. Across a range of standardized and real encounters, physicians were noted to self-disclose in fifteen to thirty-four percent of interactions (7,8). One study found that a significant proportion of disclosures were unrelated to patient experiences, with only twenty percent "return[ing] to the patient topic preceding the disclosure"(8). These data suggest that physician self-disclosure is common but highly variable in content and impact (8). When curated to pointedly address patient needs and avoid extraneous focus on the physician, disclosures can certainly support "reassurance, counseling and rapport building" (7,8). But such curation is easier said than done. It requires significant self-awareness, planning and internal structuring on the provider’s part—all in the setting of multidimensional and often time-pressured clinical work.  

Illustrative scenarios:

  • A physician struggled with breast cancer ten years ago. She is currently treating a patient with breast cancer, and wonders whether or not to share her personal story.

  • A physician struggles with anxiety, and takes an anti-anxiety medication with good effect. He is considering prescribing the same medication to one of his patients, but this patient is reluctant to try a “pill for crazy people.” Does the physician share his story?

  • A physician's mother recently passed away, and the physician is struggling to focus at work. She accidentally calls a patient by the wrong first name multiple times. Does she share her story—and grief—as part of her apology?

 

References

  1. Brewster A and Adler J. Boundary Crossing: When Doctors And Patients Get Personal For Better Health. WBUR. January 1, 2015.

  2. Boundary Issues. OKHPP. https://okhpp.org/boundary-issues/

  3. Mann B. Doctor Self-Disclosure in the Consultation. J Prim Health Care. 2018;10(2):106–109.

  4. Chang H. The Pros and Cons of Clinician Self-Disclosure. Closer. Johns Hopkins Medicine. January 18. 2021.

  5. Lussier MT. Self-disclosure during medical encounters. Can Fam Physician. 2007 Mar; 53(3): 421–422.

  6. Tilahun B. Can I Share Personal Information with Patients? Benevolence and nonmaleficence in self-disclosure. Consult QD. Cleveland Clinic.

  7. Beach MC, Roter D, Larson S et al. What Do Physicians Tell Patients About Themselves? A Qualitative Analysis of Physician Self-disclosure. J Gen Intern Med. 2004 Sep; 19(9): 911–916.

  8. McDaniel SH, Beckman HB, Morse DS et al. Physician self-disclosure in primary care visits: enough about you, what about me? Arch Intern Med. 2007;167(12):1321-6.