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Professionalism in the Digital Age

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Arash Mostaghimi at Brigham and Women's Hospital
Arash Mostaghimi
Bradley H Crotty at Medical College of Wisconsin
Bradley H Crotty
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Abstract

The increased use of social media by physicians, combined with the ease of finding information online, can blur personal and work identities, posing new considerations for physician professionalism in the information age. A professional approach is imperative in this digital age in order to maintain confidentiality, honesty, and trust in the medical profession. Although the ability of physicians to use online social networks, blogs, and media sites for personal and professional reasons should be preserved, a proactive approach is recommended that includes actively managing one's online presence and making informed choices about disclosure. The development of a "dual-citizenship" approach to online social media that separates public and private personae would allow physicians to both leverage networks for professional connections and maintain privacy in other aspects. Although social media posts by physicians enable direct communication with readers, all posts should be considered public and special consideration for patient privacy is necessary.
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Professionalism in the Digital Age
Arash Mostaghimi, MD, MPA, and Bradley H. Crotty, MD
The increased use of social media by physicians, combined with the
ease of finding information online, can blur personal and work
identities, posing new considerations for physician professionalism
in the information age. A professional approach is imperative in this
digital age in order to maintain confidentiality, honesty, and trust in
the medical profession. Although the ability of physicians to use
online social networks, blogs, and media sites for personal and
professional reasons should be preserved, a proactive approach is
recommended that includes actively managing one’s online pres-
ence and making informed choices about disclosure.
The development of a “dual-citizenship” approach to online
social media that separates public and private personae would allow
physicians to both leverage networks for professional connections
and maintain privacy in other aspects. Although social media posts
by physicians enable direct communication with readers, all posts
should be considered public and special consideration for patient
privacy is necessary.
Ann Intern Med. 2011;154:560-562. www.annals.org
For author affiliations, see end of text.
The old art cannot possibly be replaced by, but must be
incorporated in, the new science.
—Sir William Osler
The omnipresence of the Internet at work, at home, and
via mobile devices has led to the birth of the modern
information age. Physicians, like other professionals, are
expanding their use of Internet-based resources at work
while simultaneously developing individual digital lives
marked by sharing thoughts, journals, and media online.
Unlike previous advances in communication, such as the
telephone and e-mail, the inherent openness of social me-
dia and self-publication, combined with improved online
searching capabilities, can complicate the separation of
professional and private digital personae. Together, these
changes create challenges and opportunities in terms of
online behavior that require physicians to consider the evo-
lution of professionalism in a digital era.
The American Medical Association’s recent policy on
Professionalism in the Use of Social Media (1) addresses
some of these challenges and provides a starting point for
moving forward. As more providers and trainees use social
networks and blogs, health care professionals must be
aware of what is being posted online and how it is pre-
sented. Furthermore, the use of online rating sites and
search engines by patients requires physicians to under-
stand and manage their online identities and personal
brands. Together, these challenges demand that physicians
proactively review and maintain their digital lives.
THE PHYSICIAN IDENTITY
How can physicians maintain a professional image
when search engines juxtapose official biographies with Face-
book profiles, political donations, and newspaper clippings
(2)? Research suggests that physician characteristics, such
as obesity, can affect the confidence that patients have in
their providers (3). Should we, as physicians, be concerned
whether the personal habits and views that we reflect in
online posts and photographs do not match our profes-
sional recommendations to patients? These challenges are
magnified for medical students and trainees who are
“growing up online” and may have left “digital footprints”
reflecting behavior and ideals that they would not openly
share as professionals.
Despite concerns about individual privacy, social me-
dia offer opportunities for professional use, including con-
necting with colleagues or public health outreach. Physi-
cians can leverage social network profiles for professional,
personal, or combined purposes, and their decisions about
online disclosure should reflect these choices. Most physicians
currently do not maintain clear separation between these on-
line “worlds,” and the first Facebook “friend” request from a
patient can be an awkward exercise in boundaries (4).
Ultimately, a physician’s online presence will vary and
be guided by personal preferences and personality. Unlike
physician disclosure during office visits, we know little
about how online disclosure affects the patient–physician
relationship at present (5, 6).
THE PHYSICIAN AND SOCIAL MEDIA
Regardless of physician preference, clear limits exist
about what physicians and other providers can share
online. Recent studies detail the online posting of un-
professional content by medical students and the prev-
alence of publicly viewable Facebook accounts among
medical students and residents (7, 8). Nurses and ancil-
lary staff also have been reprimanded for inappropriate
online posts (9–11). A review of physician blogs re-
vealed that 17% contained information that could iden-
tify the patient or his or her physician, including 3 blogs
with identifiable photographs (12).
Physicians must also be aware of unintentional online
disclosure of patient information. Online posts can create a
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Annals of Internal MedicineIdeas and Opinions
560 © 2011 American College of Physicians
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sense of community between writers and their regular au-
dience, but participants should not expect privacy or exclu-
sivity within this network. Physician authors should expect
that patients and their families have access to published
materials, even if the physicians exclude names or a post is
subsequently deleted. A recent survey of medical school
deans about unprofessional online behavior underscored
this possibility by reporting that 2 out of 46 incidents were
first identified by the patient or a family member of the
patient (7).
Beyond these gross transgressions, subtle oversteps of
boundaries raise concerns for professional reputation and
responsibility. Most hospital elevators have large signs re-
minding staff not to discuss patients in public settings.
Even if a patient’s name is not used, details or the tone of
the discussion may alarm others in the elevator. In this
fashion, social networks may be considered the new mil-
lennium’s elevator: a public forum where you have little to
no control over who hears what you say, even if the mate-
rial is not intended for the public.
Although identifiable patient details should certainly
be off limits, what about open complaints online? If com-
plaining about one patient in front of another patient is
considered poor form, what about complaining about one
patient in front of thousands? The “hidden curriculum” of
these interactions may influence how patients perceive
physicians and health care overall.
APROACTIVE APPROACH TO PROFESSIONALISM
We fundamentally believe in preserving the ability of
physicians to use online media, social networks, blogs, and
video sites for personal and professional reasons. Any effort
to block or discourage use of these media would be unen-
forceable and counterproductive. Physicians should know
how information flows online and that the context sur-
rounding personal information or social media may be lim-
ited. Medical educators and institutional policymakers
should develop curricula and progressive social media pol-
icies that enable physicians to engage with their friends,
families, and patients in safe and productive ways (Table).
Formal guidelines for such professionalism are cur-
rently in development. Hospitals have begun to embrace
social media at the institutional level. As of October 2010,
830 hospitals nationwide had active accounts on YouTube
(n⫽395), Facebook (n⫽639), Twitter (n⫽635), or
blogging sites (n⫽92) (13). However, hospitals and med-
ical schools are still developing clear policies for individual
providers (14, 15). For example, Vanderbilt University
Medical Center has created a social media policy for faculty
and students that does not discourage use of these media
but provides boundaries if a person self-identifies as a med-
ical center employee (16).
We recommend that physicians perform routine “elec-
tronic self-audits” of their online identity by using search
engines to determine the amount and type of personal in-
formation that they share online. Although most informa-
tion probably will be professional (for example, an office
location or an official biography), many searches will reveal
personally identifiable information (17, 18).
Physicians who wish to maintain a professional iden-
tity online and a private identity among friends and family
may pursue “dual citizenship” by creating a separate online
profile that is intended to appear among the first results
when someone queries a search engine about a physician.
Physicians can accomplish this through a professional
home page; an online curriculum vitae; or services, such as
Google Profiles (www.google.com/profiles). The dual-
citizenship approach is particularly advantageous for pre-
professionals in transition, because profiles can redirect
traffic away from other content that may no longer be
under one’s direct control.
Physicians who desire an outward, professional pres-
ence on social networking sites, such as Facebook, may
choose to create a “public figure” in order to better control
information. This method also obviates the need to accept
or deny a friend request from a patient or other person.
Physicians alternatively can use professional social net-
working sites, such as LinkedIn and Sermo.
Despite these techniques, absolute separation of pro-
fessional and personal identities is nearly impossible. Al-
Table. Challenges and Recommendations Associated With Use of Social Media by Physicians
Challenge Recommendation
Managing your identity and professional image Perform “electronic self-audits” to monitor your online presence
Maximize online privacy settings for personal profiles and social networking sites
Develop “dual citizenship” online with separate professional (public) and personal (private) networking
profiles
Develop a professional biography for patients and others to preferentially find when using search engines
Using social media in a professional manner Understand that all posted content should be considered public and permanent
Encourage online behavior of physicians, nurses, physician extenders, and office staff to mirror the standards
of behavior maintained in the office
Refrain from posting potentially identifiable vignettes online unless you obtain patient consent
Communicating with patients electronically and
professionally
Preferentially use secure messaging for electronic communication with patients or, where not available,
provide informed consent for e-mail
Avoid direct communication with patients via third-party platforms (e.g., Twitter, Facebook)
Recognize that patients may have unequal access to electronic resources
Ideas and OpinionsProfessionalism in the Digital Age
www.annals.org 19 April 2011 Annals of Internal Medicine Volume 154 • Number 8 561
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though using a pseudonym may reduce the chances of in-
cidental disclosure, patients who are motivated to identify
information about their physicians probably will succeed.
Physicians who are aware of their digital identities will be
best able to address any questions that a search may reveal.
Beyond physician identity, we discourage using social
media, such as Facebook and Twitter, as a form of com-
munication between patients and providers, primarily be-
cause the social media companies have ultimate control
over the information without a guarantee of security. Mes-
sages sent via social media are best used for general an-
nouncements, such as influenza vaccine availability or
other broadcast alerts related to public health.
Physicians who blog must be aware of the purpose,
scientific or storytelling nature, and audience of their posts.
Patients may be alarmed if they identify their stories online
despite their physicians’ careful attempts to protect the pa-
tients’ identities, even if their stories are used for educa-
tional purposes. For all posts that discuss specific patients,
a process similar to informed consent in which the physi-
cian discusses the nature of the post with the patient
and requests the patient’s permission might be most
appropriate.
The digital revolution of the past 25 years has just
begun to influence medicine. Social networking and online
communication remain in their infancy. Physicians should
take advantage of these tools for personal and professional
use but must be aware of the potential effect of their online
actions. As a profession, we must seek to identify common
standards and develop resources to teach current physicians
and trainees a basic set of principles to guide electronic
interactions now and in the future.
From Beth Israel Deaconess Medical Center and Harvard Medical
School, Boston, Massachusetts.
Grant Support: By an Institutional National Research Service Award
T32HP12706 (Dr. Crotty) and the Division of General Medicine and
Primary Care at Beth Israel Deaconess Medical Center.
Potential Conflicts of Interest: Disclosures can be viewed at www
.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum⫽M10
-2672.
Requests for Single Reprints: Bradley H. Crotty, MD, Division of
General Medicine, Beth Israel Deaconess Medical Center, 330 Brookline
Avenue, Boston, MA 02215; e-mail, bcrotty@bidmc.harvard.edu.
Current author addresses and author contributions are available at www
.annals.org.
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Ideas and Opinions Professionalism in the Digital Age
562 19 April 2011 Annals of Internal Medicine Volume 154 • Number 8 www.annals.org
Downloaded From: http://annals.org/ by Arash Mostaghimi on 03/07/2016
Current Author Addresses: Dr. Mostaghimi: Beth Israel Deaconess
Medical Center, 330 Brookline Avenue W/D311, Boston, MA 02215.
Dr. Crotty: Division of General Medicine, Beth Israel Deaconess Med-
ical Center, 330 Brookline Avenue, Boston, MA 02215.
Author Contributions: Conception and design: A. Mostaghimi, B.H.
Crotty.
Drafting of the article: A. Mostaghimi, B.H. Crotty.
Critical revision of the article for important intellectual content: A. Mo-
staghimi, B.H. Crotty.
Final approval of the article: A. Mostaghimi, B.H. Crotty.
Administrative, technical, or logistic support: A. Mostaghimi, B.H.
Crotty.
Annals of Internal Medicine
www.annals.org 19 April 2011 Annals of Internal Medicine Volume 154 • Number 8 W-197
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... I have decided not to limit the research to any single platform for several reasons. First, the deployment of several platforms is currently being advocated in the literature as a strategy in online professionalism (Mostaghimi and Crotty, 2011) yet there is little in the way of empirical research that explores the strategic use of multiple platforms (Van Dijck, 2013). Secondly, the last part of the research involves participants considering their online traces which most likely will take in a range of social media forms and I would like the research to reflect current practice. ...
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... The frequent use of social media combined with convenience of finding information online eventually might distort one's personal and work identity (Mostaghimi & Crotty, 2011). This subsequently brought up the issue whether the employees really utilize the Internet for work purposes or for other purposes as well. ...
SOCIAL MEDIA USE INTENSITY AT WORKPLACE AMONG HUMAN RESOURCES EXECUTIVES OF A GOVERNMENT AGENCY HEADQUARTERS IN KUALA LUMPUR, MALAYSIA
Article
Full-text available
  • May 2020
Browsing social media is a common daily activity for most people all around the globe nowadays regardless of age and gender. Although the frequency, duration and motive of browsing social media differs from one person to another, the existence of employees who have social-media mania and keep browsing social media all the time even during their working hours causes the employers to monitor their employees‘ social media use intensity at workplace from time to time. This study looks at the level of social media use intensity at workplace among Human Resources executives of a government agency headquarters in Kuala Lumpur, Malaysia. Questionnaires were used to collect data on the sample. Due to its quite small population size, total population sampling method is applied. Out of 68 executives, only 30 completed the questionnaires (response rate = 44.12%). Findings revealed that the sample have high level of social media use intensity at workplace. However, there was no statistically significant difference between social media use intensity and gender. Other than that, it was found that the main motive behind using social media at workplace is interpersonal. As for the implications of this study, it contributes to the corpus of knowledge in the area of social media use intensity at workplace in local organization context and provides empirical data to assist organization in conducting appropriate policy to control social media use intensity at workplace among their employees. Keywords: Social Media Use Intensity, Motives Behind Using Social Media, Government Agency
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CYTOKINES AS POTENTIAL MARKERS OF COVID-19 SEVERITY AND OUTCOMES
Article
Full-text available
  • Mar 2022
The continual propagation of SARS-CoV-2 has changed health care systems globally. Ranging degrees of clinical severity in COVID-19 patients have been noted in numerous literature sources. Cytokines play a crucial role in the development of key immunological processes in COVID-19. SARS-CoV-2 causes imbalance of the immune system and might culminate in cytokine storm and multiple organ involvement. The prevailing role of some special cytokines might serve as indicators of disease severity. Further stratification of patients in the context of specific cytokines can be beneficial for diagnosing disease stages. It can prevent critical states owing to timely diagnosis and targeted therapy. Targeting peculiar cytokines can markedly reduce complications. The aim of this article is to comprehensively overview the role of the main cytokines in COVID-19 pathogenesis and distinguish prognostic factors. Insights into specific cytokine involvement in COVID-19 pathogenesis may open new avenues for diagnosing hyperinflammatory COVID-19, predicting its outcomes and providing individualized cytokine-targeted therapeutic approaches.
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Social Media Use and Community-Based Cardiovascular Health-care Professionals: Perception versus Reality
Article
  • Oct 2020
  • Heart Views
Social media use has dramatically increased in the past two decades. This growth has been seen in the health-care field as well. Social media is being used for a variety of activities including networking, education, public health, and marketing. Health-care professionals in cardiology participate in social media to varying degrees and in different ways. Current studies have focused primarily on physicians who have an established presence on social media. To learn more about the social media habits of community-based cardiology providers, we queried attendants at a cardiovascular conference held by our health-care system. The purpose of this article is to: Highlight the social media habits of a range of community-based cardiology providers and distinguish between producing and consuming social media. There is a predominance of social media content consumers compared to producers Outline important considerations when assessing the risks and benefits of social media use and the perceived concerns of cardiology health-care professionals Emphasize the need to incorporate guidelines for social media use into institutional policies and provide training on social media use to the health-care community.
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Content of Weblogs Written by Health Professionals
Article
Full-text available
  • Oct 2008
  • J GEN INTERN MED
Medical weblogs ("blogs") have emerged as a new connection between health professionals and the public. To examine the scope and content of medical blogs and approximate how often blog authors commented about patients, violated patient privacy, or displayed a lack of professionalism. We defined medical blogs as those that contain some medical content and were apparently written by physicians or nurses. We used the Google search term "medical blog" to begin a modified snowball sampling method to identify sites posting entries from 1/1/06 through 12/14/06. We reviewed five entries per blog, categorizing content and characteristics. We identified 271 medical blogs. Over half (56.8%) of blog authors provided sufficient information in text or image to reveal their identities. Individual patients were described in 114 (42.1%) blogs. Patients were portrayed positively in 43 blogs (15.9%) and negatively in 48 blogs (17.7%). Of blogs that described interactions with individual patients, 45 (16.6%) included sufficient information for patients to identify their doctors or themselves. Three blogs showed recognizable photographic images of patients. Healthcare products were promoted, either by images or descriptions, in 31 (11.4%) blogs. Blogs are a growing part of the public face of the health professions. They offer physicians and nurses the opportunity to share their narratives. They also risk revealing confidential information or, in their tone or content, risk reflecting poorly on the blog authors and their professions. The health professions should assume some responsibility for helping authors and readers negotiate these challenges.
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Social Media Policies at US Medical Schools
Article
Full-text available
Today's medical students are learning in a social media era in which patient confidentiality is at risk yet schools' social media policies have not been elucidated. The purpose of this study is to describe the presence of medical schools on top social media sites and to identify whether student policies for these schools explicitly address social media use. Websites of all 132 accredited US medical schools were independently assessed by two investigators for their presence (as of March 31, 2010) on the most common social networking and microblogging sites (Facebook and Twitter) and their publicly available policies addressing online social networking. Key features from these policies are described. 100% (n=132) of US medical schools had websites and 95.45% (126/132) had any Facebook presence. 25.76% (34/132) had official medical school pages, 71.21% (94/132) had student groups, and 54.55% (72/132) had alumni groups on Facebook. 10.6% of medical schools (14/132) had Twitter accounts. 128 of 132 medical schools (96.97%) had student guidelines or policies publicly available online. 13 of these 128 schools (10.16%) had guidelines/policies explicitly mentioning social media. 38.46% (5/13) of these guidelines included statements that defined what is forbidden, inappropriate, or impermissible under any circumstances, or mentioned strongly discouraged online behaviors. 53.85% (7/13) encouraged thoughtful and responsible social media use. Medical schools and their students are using social media. Almost all US medical schools have a Facebook presence, yet most do not have policies addressing student online social networking behavior. While social media use rises, policy informing appropriate conduct in medical schools lags behind. Established policies at some medical schools can provide a blueprint for others to adopt and adapt.
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Greysen SR, Kind T, Chretien KC. Online professionalism and the mirror of social media
Article
Full-text available
  • Nov 2010
  • J GEN INTERN MED
The rise of social media--content created by Internet users and hosted by popular sites such as Facebook, Twitter, YouTube, and Wikipedia, and blogs--has brought several new hazards for medical professionalism. First, many physicians may find applying principles for medical professionalism to the online environment challenging in certain contexts. Second, physicians may not consider the potential impact of their online content on their patients and the public. Third, a momentary lapse in judgment by an individual physician to create unprofessional content online can reflect poorly on the entire profession. To overcome these challenges, we encourage individual physicians to realize that as they "tread" through the World Wide Web, they leave behind a "footprint" that may have unintended negative consequences for them and for the profession at large. We also recommend that institutions take a proactive approach to engage users of social media in setting consensus-based standards for "online professionalism." Finally, given that professionalism encompasses more than the avoidance of negative behaviors, we conclude with examples of more positive applications for this technology. Much like a mirror, social media can reflect the best and worst aspects of the content placed before it for all to see.
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The Availability and Nature of Physician Information on the Internet
Article
Full-text available
  • Nov 2010
  • J GEN INTERN MED
Although patients are commonly using the Internet to find healthcare information, the amount of personal and professional physician information and patient-generated ratings freely accessible online is unknown. To characterize the nature of online professional and personal information available to the average patient searching for physician information through a standardized web search. We studied 250 randomly selected internal medicine physicians registered with the Massachusetts Board of Registration in Medicine in 2008. For each physician, standardized searches via the Google search engine were performed using a sequential search strategy. The top 20 search results were analyzed, and websites that referred to the study subject were recorded and categorized. Physician rating sites were further investigated to determine the number of patient-entered reviews. Number and content of websites attributable to specific physicians. Websites containing personal or professional information were identified for 93.6% of physicians. Among those with any web sites identified, 92.8% had professional information and 32.4% had personal information available online. Female physicians were more likely to have professional information available on the Internet than male physicians (97.5% vs. 91.7%, p=0.03), but had similar rates of available personal information (32.5% vs. 32.5%, p=ns). Among personal sites, the most common categories included social networking sites such as Facebook (10.8% of physicians), hobbies (10.0%), charitable or political donations (9.6%), and family information (8.8%). Physician rating sites were identified for 86.4% of providers, but only three physicians had more than five reviews on any given rating site. Personal and professional physician information is widely available on the Internet, and often not under direct control of the individual physician. The availability of such information has implications for physician-patient relationships and suggests that physicians should monitor their online information.
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“Enough about Me, Let’s Get Back to You”: Physician Self-disclosure during Primary Care Encounters
Article
Full-text available
  • Dec 2008
  • ANN INTERN MED
Although the medical profession frowns on physicians who tell patients about their own health problems (self-disclosure), the practice is probably common. The authors use simulated dialogue and draw on theory and evidence to discuss the effectiveness of physician self-disclosure and offer recommendations for improving or replacing self-disclosure.
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Chretien KC, Greysen SR, Chretien JP, Kind T. Online posting of unprofessional content by medical students
Article
Full-text available
  • Sep 2009
  • J Am Med Assoc
Web 2.0 applications, such as social networking sites, are creating new challenges for medical professionalism. The scope of this problem in undergraduate medical education is not well-defined. To assess the experience of US medical schools with online posting of unprofessional content by students and existing medical school policies to address online posting. An anonymous electronic survey was sent to deans of student affairs, their representatives, or counterparts from each institution in the Association of American Medical Colleges. Data were collected in March and April 2009. Percentage of schools reporting incidents of students posting unprofessional content online, type of professionalism infraction, disciplinary actions taken, existence of institution policies, and plans for policy development. Sixty percent of US medical schools responded (78/130). Of these schools, 60% (47/78) reported incidents of students posting unprofessional online content. Violations of patient confidentiality were reported by 13% (6/46). Student use of profanity (52%; 22/42), frankly discriminatory language (48%; 19/40), depiction of intoxication (39%; 17/44), and sexually suggestive material (38%; 16/42) were commonly reported. Of 45 schools that reported an incident and responded to the question about disciplinary actions, 30 gave informal warning (67%) and 3 reported student dismissal (7%). Policies that cover student-posted online content were reported by 38% (28/73) of deans. Of schools without such policies, 11% (5/46) were actively developing new policies to cover online content. Deans reporting incidents were significantly more likely to report having such a policy (51% vs 18%; P = .006), believing these issues could be effectively addressed (91% vs 63%; P = .003), and having higher levels of concern (P = .02). Many responding schools had incidents of unprofessional student online postings, but they may not have adequate policy in place.
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The Relationship Status of Digital Media and Professionalism: It's Complicated
Article
  • Nov 2009
The rising popularity of digital applications, such as social networking, media share sites, and blogging, has significantly affected how medical trainees interact with educators, colleagues, and the public. Despite the increased popularity and use of such applications amongst the current generation of trainees, medical educators have little evidence or guidance about preventing misuse and ensuring standards for professional conduct. As trainees become more technologically savvy, it is the responsibility of medical educators to familiarize themselves not only with the advantages of this technology but also with the potential negative effects of its misuse. Professionalism, appropriateness for public consumption, and individual or institutional representation in digital media content are just some of the salient issues that arise when considering the ramifications of trainees' digital behavior in the absence of established policies or education on risk. In this commentary the authors explore the rising use of digital media and its reflection of medical trainees' professionalism. To address possible issues related to professionalism in digital media, the authors hypothesize potential solutions, including exploring faculty familiarity with digital media and policy development, educating students on the potential risks of misuse, and modeling professionalism in this new digital age.
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Practicing Medicine in the Age of Facebook
Article
  • Sep 2009
  • NEW ENGL J MED
Social-networking sites facilitate communication, but also create new challenges for those who work in clinical settings. Dr. Sachin Jain describes receiving a “friend request” from a former patient on Facebook. Despite certain reservations, he clicked “confirm.”
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Is Physician Self‐disclosure Related to Patient Evaluation of Office Visits?
Article
  • Oct 2004
CONTEXT: Physician self-disclosure has been viewed either positively or negatively, but little is known about how patients respond to physician self-disclosure. OBJECTIVE: To explore the possible relationship of physician self-disclosure to patient satisfaction. DESIGN: Routine office visits were audiotaped and coded for physician self-disclosure using the Roter Interaction Analysis System (RIAS). Physician self-disclosure was defined as a statement describing the physician’s personal experience that has medical and/or emotional relevance for the patient. We stratified our analysis by physician specialty and compared patient satisfaction following visits in which physician self-disclosure did or did not occur. PARTICIPANTS: Patients (N=1,265) who visited 59 primary care physicians and 65 surgeons. MAIN OUTCOME MEASURE: Patient satisfaction following the visit. RESULTS: Physician self-disclosure occurred in 17% (102/589) of primary care visits and 14% (93/676) of surgical visits. Following visits in which a primary care physician self-disclosed, 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 (74% vs 83%; P=.031). 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). After adjustment for patient characteristics, length of the visit, and other physician communication behaviors, primary care patients remained less satisfied (adjusted odds ratio [AOR], 0.45; 95% confidence interval [CI], 0.24 to 0.81) and surgical patients more satisfied (AOR, 2.22; 95% CI, 1.12 to 4.50) after visits in which the physician self-disclosed. CONCLUSIONS: 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.
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