We’ve all been there. A patient comes in requesting advice for a condition that you’ve suffered from yourself. You know what has worked for you, but it won’t necessarily work for everyone. Should you share your story? Or is it best to keep quiet about your own experiences and stick to the facts?
It is easy to see why, in an evidence-based profession, the latter may seem the most sensible option. After all, what value does a single experience hold compared to an objective review of the available evidence?
But the other side of the coin is that patients may value your personal – if subjective – opinion. As a pharmacist, I have frequently been asked questions such as: “What would you do? What would you take?” And I am always delighted when a member of staff with personal experience of quitting smoking becomes involved in a cessation service because I believe they can offer a level of understanding that I – as someone who has never smoked – simply don’t possess.
A paper published in the British Journal of General Practice in September suggests that my experience is not uncommon. Based on interviews with 16 GPs in New Zealand, the researchers concluded that doctors were by and large happy to take part in the practice they called “self-disclosure”. All of the GPs involved in the study said they were happy to reveal information about their hobbies and activities if it aided a patient consultation, and most felt comfortable discussing their families and non-invasive issues such as the use of crutches following a broken bone. Interestingly, some were also open to talking about more personal topics – for example, their experiences with cancer, mental illness and divorce. So could self-disclosure actually improve patient care, and at what point does it go too far?
“I suffer from migraines so I feel I can empathise with someone who comes in asking for something for that, but it really depends on the customer... if, when I ask my usual open-ended questions, I get closed-down, single-word answers, I won’t divulge anything personal”
A grey area
The topic appears highly divisive. Essex GP Keith Hopcroft remembers receiving conflicting views on whether to give out personal information while he was training back in the late 1970s and early 1980s. “As a medical student, I remember being encouraged to share personal experience because it could be helpful but, as a GP trainee, I was strongly told not to due to patients not liking it,” he reveals.
And it remains a grey area now that Dr Hopcroft has taken on the role of GP trainer. “It is interesting that, although the training GPs go through contains a huge amount of information on communication and consultation skills, this topic isn’t brought up at all. It happens a lot, and it really should be,” he says.
Given the lack of guidance, Dr Hopcroft tends to err on the side of caution when it comes to disclosing personal information. He says the patient’s reaction could go either way.
“On the one hand, there is a danger that some patients could find it dismissive if, for example, I said to a patient, ‘don’t worry, I have that condition too’. It could make them feel undermined and belittle the reason for them being there in the first place,” he explains.
But, if healthcare professionals “judiciously” reveal information about themselves, Dr Hopcroft believes this can display empathy. Crucially, this can increase the patient’s engagement levels. “Saying ‘I’ve experienced some of what you are describing’ might make the patient feel you understand what they are going through,” he says.
What would GPs reveal?
Certain aspects of their lives are easier to talk about than others, the New Zealand study of 16 GPs revealed.
Number who would talk about:
A physical illness
A mental illness
A serious mental illness
Source: Physician self-disclosure in primary care, British Journal of General Practice, September 2015
A problem shared
This concept of empathy is the main benefit of self-disclosure. Dr Hopcroft believes this tactic can work particularly well in patients who are struggling to adhere to therapies. He cites the example of asthma patients. “Slipping in the information that I also suffer from the condition is a good way of reinforcing things that the patient maybe doesn’t want to say – or doesn’t know – they are doing wrong,” he tells C+D.
Dr Hopcroft tends to address problems with inhaler technique by adding in elements of his experience such as “one thing I sometimes find tricky is this” or “I used to forget to do that”. This, he feels, is much less confrontational and much more effective than asking the question: “Is your asthma not well-controlled because you aren’t using your inhalers correctly?”
Empathy is also a running theme throughout pharmacists’ experiences of self-disclosure. Tony Schofield, owner of Flagg Court Pharmacy in South Shields, finds it can be a means of reassuring worried patients. People often feel vulnerable when they are unwell, Mr Schofield says, and want to know that they are not alone. “Knowing that what is happening to them has happened to you or someone else you know can be very comforting, even if it isn’t rooted in hard evidence,” Mr Schofield points out.
Raymond Anderson, owner of Andersons Pharmacy in Portadown, echoes the value of displaying understanding. He runs a prescribing clinic in collaboration with his GP practice – an initiative that won the C+D Award for GP Partnership of the Year 2015 – and is used to having in-depth conversations with patients.
He uses his judgment to determine whether a patient would benefit from hearing about his own experience. “I suffer from migraines so I feel I can empathise with someone who comes in asking for something for that, but it really depends on the customer in front of me,” Mr Anderson says. “If, when I ask my usual open-ended questions, I get closed-down, single-word answers, I won’t divulge anything personal.”
It’s all subjective
It is hard to argue against this sensible approach to self-disclosure. After all, anything that reassures the patient and demonstrates your understanding of their condition can only improve care. But there are pitfalls to avoid – and one is presenting your own experience as fact.
Mr Schofield remembers noting this problem among pharmacy staff in the past – something he was quick to ensure didn’t happen in his business. “I know my staff are well-trained, so I trust them to talk to patients and get relevant information out of them using questioning protocols such as WWHAM rather than by asking leading questions based on their own personal experiences of common conditions,” he says.
Crucially, Mr Schofield stresses that healthcare professionals should not base their advice on “subjective views”, and instead be guided by a “sound evidence base”, as well as their knowledge and skills.
GPs are keen to follow the same mantra, if the New Zealand study is anything to go by (see What would GPs reveal? above). Participants in the research primarily used self-disclosure to demonstrate empathy or reinforce the value of evidence-based treatment, rather than to guide their advice. For example, one GP said he used his mother as a case study to relieve patients’ fears over taking warfarin: “I say, look, my mother’s been taking it for five years, you know what she’s like.” Another GP said he will “relate back to times of stress and anxiety in general practice” as a means of empathising with patients suffering from similar issues.
“As a medical student, I remember being encouraged to share personal experience because it could be helpful but, as a GP trainee, I was strongly told not to due to patients not liking it”
But does disclosing such personal information risk jeopardising the professional status of the healthcare provider? This was the main concern among GPs in the New Zealand study – 12 out of the 16 interviewed said they were wary of crossing the boundaries of a professional relationship.
This need not be the case, though. Leila Collins, psychotherapist and counselling psychologist, says you should be able to reveal personal information without overstepping the mark. “As long as you conduct yourself properly by setting and establishing boundaries between yourself and your patients, there is no danger of blurring personal and professional boundaries,” says Ms Collins, who is an associate member of the British Psychological Society.
Her advice to professionals is to ensure they are sharing information for professional reasons. If it’s just chit-chat, or for your benefit rather than the patient’s, you should steer clear. If it could genuinely benefit the patient, then you are acting professionally by sharing the information.
Ultimately, self-disclosure should be just another way of communicating with patients. Pharmacists regularly use their skills and judgment to determine when to listen to patients, when to give advice and when to ask questions. And they should equally feel confident to determine when to reveal information about themselves – it may just be vital to getting that patient on side.