Sharing the Pain or Over-Sharing?

Health care professionals live by certain unwritten rules when it comes to sharing information about ourselves with our patients. We simply don’t do it. The medical and psychiatric literature is pretty clear about the boundaries that should exist between our patients and ourselves.

Physician self-disclosure is for the most part considered inappropriate. Patients come to the exam room with their own agendas. They can wait for months for their appointments. No one wants that precious time hijacked by a needy or self-absorbed clinician.

While the fields of medicine and psychology have argued for strict boundaries between patients and their caregivers, other professional bodies have begun to recognize the value of sharing narrative, of breeching that divide on occasion. The field of nursing has long recognized the concept of “therapeutic use of self” in caring for patients.

But what does this therapeutic use of self look like in real practice? I am a pediatrician and the mother of a son who sustained a traumatic brain injury ten years ago when he was a teenager. He was hit by a drunk driver while walking his girlfriend home after a study date. She did not survive her injuries. He carries this with him to this day. He suffers from memory loss and anxiety. He has difficulties concentrating, and his executive function is flawed. He took anti-seizure medications for weeks and anti-depressants for years. He sees a therapist even now.

Ethical ways to share your story

In my practice, I occasionally meet a teenaged patient who rolls her eyes at my admonitions against underage drinking and drunk-driving.

“I don’t drive drunk; I just drive buzzed,” they’ll tell me. That’s when I’ll play the crash card — judiciously sharing some of my family’s experience, and then shifting right back to my original message. Eyes widen and swaggers dissolve with a few personal details.

So what advice is out there for professionals who are looking for guidance in this whole tricky navigation between the personal and the professional? In 2008, a family physician from Worcester, Massachusetts, named Lucy Candib published an article in the Annals of Internal Medicine titled, “Enough About Me, Let’s Get Back to You: Physician Self-disclosure During Primary Care Encounters.” In the piece, she offers some practical advice.

First she encourages professionals to consider our motivations for sharing our stories very carefully before we ever share a word with our patients. We need to make absolutely sure that our disclosures serve the patients’ needs and not our own. Influencing patient behavior may be one motivation. In my case, I share my story to encourage my young patients to avoid underage drinking and to appreciate the dangers of drunk-driving.

Enhancing the doctor-patient relationship may be another motivation. Some years ago a Boston area internist named Anne Brewster shared a patient encounter on a local health blog. One of her patients had recently been diagnosed with multiple sclerosis. Dr. Brewster also carries a diagnosis of MS and shared this with her patient in an effort to comfort and encourage her. In the blog post, the physician shared her conflicted feelings about the interaction, given that our training has traditionally taught us that sharing is wrong. Interestingly, there were dozens, maybe even hundreds of responses to that post and not one reader thought her disclosure was inapt.

If we have examined our motivations for sharing our story with patients and deemed them sound, Dr. Candib has some practical tips for how to share. She advises keeping the disclosure brief, then turning the focus right back to the patient. This isn’t about us. It’s about them: our patients and their families.

“My son was hit by a drunk driver when he was your age, and it was a long road to recovery for him. So tell me about your drinking,” I might say to my adolescents.

Disclosure must serve the patient’s needs

The last point in Dr. Candib’s article is a cautionary one. We must make sure we are not using our patients as a support for ourselves. Again, disclosure needs to serve the patient’s needs, not our own. One way to guard against this is to spend time taking care of the caregivers —  ourselves. We in the helping professions do hard work every day. It’s physically hard. It’s emotionally hard. We love our work but it can be exhausting. We need to remember to fill up the well with rest, relaxation, family and friends, to keep our relationships therapeutic and our disclosures helpful and not self-serving.

In the end, we know our patients and the depths and limits of our relationships with them. With practice and experience, sensing if and when the time is right to share our humanness with them will come more naturally to all of us.