Jane McCredie: What about me?

FACING a distressed teenage patient crying “You don’t understand!”, paediatrician Dr Kelly Curran was tempted to prove otherwise by sharing her own medical history.

The 14-year-old girl had just been told her colonoscopy results were abnormal after enduring months of bloody diarrhoea. Dr Curran was postoperative and waiting on the results of a biopsy to determine whether she had Crohn’s disease.
    
In the end, Dr Curran chose to hold back, deciding, as she explains in the New England Journal of Medicine, that the risks of such a disclosure were too great.

“My motives at this time aren’t completely altruistic”, she writes. “For several months, I have been swallowing down this painful, intensely personal secret, and here it is, burning to be spoken.”

She craves a confidante, she realises, “and even if it’s only a small part of my motivation, wanting that recognition from a patient — and one I’ve only just met — is inappropriate and selfish”.

At first glance, the idea of sharing personal information to create a bond between doctor and patient might seem appealing, but research suggests Dr Curran may have been right to be cautious.

One study used actors presenting as patients to US family physicians (the doctors had consented to be part of the study but did not know which patients were actors).

Personal disclosures by the doctors were relatively common — happening in about a third of consultations — and around 40% of them were unrelated to the supposed patient’s symptoms or feelings.

There was no evidence of benefit from the disclosures, the researchers concluded, and in some cases they were actually disruptive.

Another US study found an intriguing difference in patients’ responses depending on the specialty of the doctor revealing the personal information.

When a surgeon shared information, patients were more likely to feel reassured afterwards (60% v 45% with no surgeon disclosure) and to be very satisfied with the consultation (88% v 75%).

But when a family physician did the sharing, the opposite was true: only 42% of patients felt reassured (v 55% of those who didn’t receive a disclosure) and 74% were very satisfied with the consultation (v 83%).

There’s no doubt a doctor sharing a personal story can sometimes aid a consultation — I’ve experienced it myself — but, as Dr Curran noted, the urge to disclose may not always be an entirely altruistic one.

We humans have a powerful desire to talk about ourselves: it’s been estimated 30%˗40% of our everyday speech is devoted to the absorbing topic of ME.

Recent research from Harvard University suggests such sharing may stimulate pleasurable feelings not unlike those we obtain from food and sex.

Functional magnetic resonance imaging showed self-disclosure was strongly associated with increased activation in the brain’s mesolimbic dopamine system, otherwise known as the “reward centres” of the brain.

In fact, self-disclosure was so rewarding that participants in this study chose it over hard cash.

Offered a choice between talking about themselves, talking about other people or answering factual questions, participants tended to opt for self-disclosure even when there was a financial incentive to choose one of the other options.

“Just as monkeys are willing to forgo juice rewards to view dominant group mates and college students are willing to give up money to view attractive members of the opposite sex, our participants were willing to forgo money to think and talk about themselves”, the researchers wrote.

It’s a finding that might help to explain our willingness to divulge private information in relatively public forums such as Facebook and Twitter.

Perhaps it’s time to consider choosing to drink the juice instead.
 

Jane McCredie is a Sydney-based science and medicine writer.