ROBERT SIEGEL, host:
Now, an interesting story about the practice of medicine. We're not talking about health care cost, your drug prescriptions, or cutting edge medical research. Researchers at the University of Rochester School of Medicine conducted a study of what they call - in language befitting the Archives of Internal Medicine - the value of physician's self-disclosure, MDSD, in creating successful patient-physician partnerships.
Dr. Susan McDaniel, a psychologist at Rochester, is the lead author and joins us in. Just to translate a bit here, many of us have probably experienced MDSD at the doctor's office.
Dr. SUSAN McDANIEL (Psychologist, University of Rochester School of Medicine): Right. That's when the physician is talking about him or herself. I think the intent is to build a relationship and to make a connection with the patient.
SIEGEL: And how did you go about studying that?
Dr. McDANIEL: It's a very interesting methodology. We had 100 physicians in the area agree to have two actors or standardized patients come to their practice unannounced and undetected, and be audiotaped. They wouldn't know about that, in the coming year.
SIEGEL: Well, after listening to hours or reading the reams of transcripts of conversations between doctors and patients, what did you find about MDSD?
Dr. McDANIEL: Somewhat to our surprise, there was a lot of it. One in three visits contain a sufficient self-disclosure in primary care. The vast majority of it was on the level of social chit-chat, but took up valuable patient time. A small percentage was disruptive. And a small percentage perhaps helpful to the patient to hear, for example, that the physician's children had lice, too, and not to worry about it. But most of it, really, was distraction.
SIEGEL: I saw a description of one the visits that you recorded where the entire patient-doctor conversation was all about repairing furniture.
Dr. McDANIEL: Yes. And the physician only realized later that they hadn't really gotten to the physical exam.
SIEGEL: Do you think when doctors - I'll get into your lingo here - self-disclose a great deal, that they're doing so because they feel that's a way of establishing rapport with the patient, or is it simply because they're sort of lonely and want to have someone to listen to them?
Dr. McDANIEL: You know, I think sometimes we felt it was one and sometimes the other and maybe sometimes both. That in these days of high productivity and health care physicians have to see so many patients, that I think we really need a system for physicians to be able to talk to each other about the stress and strengths of practice and just to make a connection.
SIEGEL: Doctors are authority figures. We're talking to somebody who, I mean, for all we know, he could say that spec on your forehead, did your father have a spec like that in his forehead? Because this could be curtains for you?
Dr. McDANIEL: Right.
SIEGEL: So it's a very charged moment when people speak with the doctor.
Dr. McDANIEL: Yes. Yes. And I think it is important to have a humane and almost intimate kind of connection with your physician. We just want to make sure that there's space for the patient's concerns to come forward.
SIEGEL: Your actor patients were wired.
Dr. McDANIEL: Yes.
SIEGEL: So I assumed they didn't get as far as the physical examination in that case.
Dr. McDANIEL: Most of them just got a physical exam, maybe listening to their heart. And the wire was often in some kind of satchel or purse. There was one standardized patient who got a sigmoidoscopy.
(Soundbite of laughter)
SIEGEL: Just gratis (unintelligible).
Dr. McDANIEL: No. The physician felt like based on symptoms, the standardized patient needed that and so the poor guy went through with it.
SIEGEL: Well, Dr. McDaniel, thank you very much.
(Soundbite of laughter)
Dr. McDANIEL: Thank you.
SIEGEL: For talking for this about the…
Dr. McDANIEL: I enjoyed it.
SIEGEL: …your study. It's Dr. Susan McDaniel, a psychologist at University of Rochester Medical School, who is lead author of the study in the Archives of Internal Medicine. The study is titled "Physician Self-Disclosure in Primary Care Visits." And the subtitle is "Enough About You, What About Me?"
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