To self-disclose or not self-disclose?: A systematic review of clinical self-disclosure in primary care

Abstract

Background: There is a debate in medicine about the value of self-disclosure by the physician as a communication tool. Aim: To review the empirical literature of selfdisclosure in primary care. Design and setting: Systematic review of empirical literature relating to self-disclosure by primary care physicians (including US paediatricians) from seven electronic databases (MEDLINE®, Scopus, PsycINFO, Embase, Social Sciences Citation Index, EBSCOhost, and Cochrane Central Register of Controlled Trials [CENTRAL]). Method: Databases were searched for empirical studies on self-disclosure and primary care published from 1946 to 28 November 2014, as well as references from primary studies. The search was extended to include working papers, theses, and dissertations. Results: Nine studies were identified, with response rates ranging from 34% to 100%, as well as several not reported. Self-disclosure occurred in 14-75% of consultations, the most from paediatricians. Self-disclosure had intended benefit; however, one standardised patient study found that 85% of self-disclosures were not useful as reported by the transcript coders. Conflicting data emerged on the self-disclosure outcome. Conclusion: This is the first systematic review of selfdisclosure in primary care and medicine. Selfdisclosure appears to be common and has the potential to be helpful when used judiciously. Few studies examined the impact on patients, and no studies considered the individual patient perspective nor the content which results in benefit or harm. No evidence was found of any training into how to deal with self-disclosure.