The Effect of Physician Self-Disclosure: Surgeons vs Primary Care Physicians

An article in the J Gen Intern Med. 2004 Sep;19(9):905-10 titled “Is physician self-disclosure related to patient evaluation of office visits?” by MC. Beach et al describes a study about how patients,reporting after either a primary care visit or surgical visit, felt about the visit in which the physician self-disclosed “a personal experience that had medical and/or emotional relevance for the patient.” The study involved 1,265 patients who visited 59 primary care physicians and 65 surgeons. Self-disclosure was not found to be rare since “physician self-disclosure occurred in 15.4% of routine office visits, and there was no statistically significant difference in the prevalence of self-disclosure at the visit level between surgery and primary care (17%[102/589] of primary care visits and 14%[93/676] of surgical visits). “

The results showed statistically that “fewer patients reported feelings of warmth/friendliness (37% vs 52%; P =.008) and reassurance/comfort (42% vs 55%; P =.027), and fewer reported being very satisfied with the visit” following self-disclosure by a primary care physician. On the other hand, “following visits in which a surgeon self-disclosed, more patients reported feelings of warmth/friendliness (60% vs 45%; P =.009) and reassurance/comfort (59% vs 47%; P=.044), and more reported being very satisfied with the visit (88% vs 75%; P =.007)”

The conclusion was “Physician self-disclosure is significantly associated with higher patient satisfaction ratings for surgical visits and lower patient satisfaction ratings for primary care visits. Further study is needed to explore these intriguing findings and to define the circumstances under which physician self-disclosure is either well or poorly received.”

Of course, read the article for details but if verified the question is why should surgeons have better patient responses to self-disclosure? The authors suggest “Facing an invasive procedure with an unknown outcome and inherent risk, surgical patients may be more acutely anxious and vulnerable than primary care patients. Within this context, every form of self-disclosure seemed to be appreciated by patients, but especially evident was the higher satisfaction of surgical patients (in contrast to primary care patients) when the disclosure was characterized as reassuring. Self-disclosure from a surgeon may function as a sign of personal interest and emotional support.” On the other hand , primary care physicians “are more involved in chronic disease management in which cure is often not a realistic goal.” In view of this difference in outcome, “it is not hard to imagine that reassurance in the primary care context, while well-intentioned, might be heard as premature and promising something that cannot easily be delivered. Perhaps in the context of chronic illness, reassuring disclosures appear dismissive or to invalidate a patient's concerns.”

What is your ideas as to the reason for the differences? ..Maurice.