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“Enough about Me, Let's Get Back to You”: Physician Self-disclosure during Primary Care Encounters

Diane S. Morse, MD; Susan H. McDaniel, PhD; Lucy M. Candib, MD; and Mary Catherine Beach, MD
[+] Article and Author Information

From the University of Rochester School of Medicine and Dentistry, and Hebrew University of Jerusalem (Fulbright Program), Rochester, NY 14642; University of Rochester, Rochester, NY 14620; Family Health Center of Worcester and University of Massachusetts Medicine Center, Worcester, MA 01610; and Johns Hopkins University, Baltimore, MD 21210.


Acknowledgment: The authors thank Ronald Epstein, MD, and Janine Roberts, PhD, for their review of the manuscript.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Diane S. Morse, MD, University of Rochester Medical Center, Box Psych, 300 Crittenden Boulevard, Rochester, NY 14642; e-mail, diane_morse@urmc.rochester.edu.

Current Author Addresses: Dr. Morse: Departments of Internal Medicine and Psychiatry, University of Rochester Medical Center, Box Psych, 300 Crittenden Boulevard, Rochester, NY 14642.

Dr. McDaniel: Departments of Family Medicine and Psychiatry, University of Rochester, 777 South Clinton Avenue, Rochester, NY 14620.

Dr. Candib: Department of Family Medicine, Family Health Center of Worcester, 26 Queen Street, Worcester, MA 01610.

Dr. Beach: Department of Internal Medicine, Johns Hopkins University, 2024 East Monument Street, Baltimore, MD 21210.


Ann Intern Med. 2008;149(11):835-837. doi:10.7326/0003-4819-149-11-200812020-00015
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Patients want a relationship with a physician with whom they can talk freely, and physicians vary in how they engage with patients. One form of engagement is self-disclosure, in which the physician reveals something personal about himself or herself. Historically, self-disclosure has been considered unacceptable in both psychiatry and medicine. Freud advocated that psychotherapists act as blank slates, and Osler advised physicians to maintain aequanimitas or impartiality (1). Recent psychodynamic literature stresses boundaries, calling clinician self-disclosure risky, potentially motivated by projection, and distracting to patients (25).

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Can We Talk?
Posted on December 22, 2008
Ralph Rosenberg
University of Connecticut Health Center
Conflict of Interest: None Declared

To the Editor:

Morse et. al. (1) write of the pitfalls of "Physician Self Disclosure," going as far as to suggest that it is in fact "risky." Despite this risk, they state that primary care physicians talk about themselves to their patients 25-30% of the time.

I suggest Morse has it all wrong. We physicians and our patients have a great deal in common, and I believe it is both healthy and appropriate to share our humanity. It is just this intimacy that makes primary care so special.

Primary care has lost much of its attraction for a myriad of reasons. Perhaps if we encourage rather than discourage self disclosure, medical students might again see how wonderful it is to be part of a patient's life, and for patients to be a small part of ours.

References

1) Morse D, McDaniel S, Candib L, Beech M, "Enough About Me, Let's Get Back to You": Physician Self Disclosure During Primary Care Encounters. Annals of Internal Medicine, 2008; 149:11: G35-G37.

Conflict of Interest:

None declared

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