Last week I heard an interesting piece on NPR radio. A physician from the University of Rochester School of Medicine had just published a study entitled “The Value of Physician Self-disclosure.” I must confess that I am not certain that is the exact title and I have not read the scientific article which was published in ? The Archives of Internal Medicine (I wasn’t listening all that carefully and I was on vacation anyway). Apparently, the author and her colleagues recruited 100 physicians who were willing over a one-year period to see two actors posing as patients. The fake patient visits would be taped and reviewed by the investigators for the quality of the physician interview technique. The physicians would not know who the intruders were.
Apparently, the investigators found that so-called “physician self-disclosure” or MDSD was rampant and took up valuable patient time and was often distracting- by MDSD the investigators meant physician talk about his own life that had nothing to do with the patient’s problems at hand. The NPR interviewer asked if the results suggested that many physicians were just lonely and starving for friendly conversation. The interviewee seemed to think that was a reasonable hypothesis.
What do I think?
I had a number of concerns with the study design and the conclusions but I wanted to wait until I was back in my office and seeing patients again before I took to the website. I am now ready to offer some comments on the study. First, I believe the study design made it almost impossible to assess in any meaningful way if the MDSD was in fact a distraction or a useful part of the interview. Without video, there was no way to tell if the chitchat was during part of the physical examination as a way of allaying possible patient anxiety, or as a way of responding to some patient body language during the interviewing process. Deciding that a physician comment was not relevant to the interview process in some way would have to be highly subjective and I suspect there was an initial biais even before the data were analyzed that physicians waste a lot of patient time. In summary, I would caution people to consider the serious flaws in this University of Rochester study when they think about physician-patient interactions. I do believe that physicians waste quite a bit of patient time but that is mostly while the patient sits in the waiting room for what seems like an eternity before they actually get to see the doctor who often is in such a rush that the patient would have liked more time and maybe even some idle chitchat.
In my experience, the interview process is a very complicated one and there is a real art trying to get the patient to have confidence in the physician’s skills while trying to get as much necessary information as possible, while trying to allay patient anxiety, and while trying to get the patient to follow the treatment plan (if any) with enthusiasm. That last sentence was quite a mouthful but it’s really what the physician-patient interaction is all about. I don’t think that audio tapes from fake patient visits can assess that complicated process very well. I would hate for some researcher to listen in on my patient visits, particularly those with patients I have been seeing for many years. There is rarely much discussion about anything medical and I surely display a great deal of MDSD (usually because the patient has asked me about my grandchildren or something else of no medical relevance). These patients see me because I am a friend and confidante, and maybe because I am also a medical expert. They rarely need me to give them any specific medical advice; most know just what to do and need mainly encouragement to “keep at it.” Like I said, the physician-patient interaction is very complex. I’d limit those tape recordings to good music.
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