I hurt like you

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Post by Howard Chang
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The American Medical Student Association and the ABIM Foundation partnered to launch the Building Trust Essay Contest. Medical students were asked to reflect on a time where they built, lost, or restored trust in a health care setting.

How would your trust in your physician change if they disclosed that they had the same health condition as you?

Physician self-disclosure – wherein the physician tells the patient something personal about themselves – is an understudied phenomenon in healthcare communication. Yet, it occurs so frequently and innocuously within clinical encounters, especially in the form of “small-talk” (family or hobbies, for example) that its impact is often unnoticed.1

But what if the physician reveals a personal illness? What risk does this pose to the archetypal patient-physician relationship, in which the “sick” and “healthy” roles are plainly differentiated? What gains in rapport may arise from such self-disclosures? 

These questions first captivated me a decade ago, when I dealt with a medical issue that brought me to a provider who had recovered from the same condition. He possessed unique expertise largely because he understood the problem from the perspective of both patient and healer. I found him to be a kindred spirit. The therapeutic alliance we built over a mutual tribulation manifested in the ways he anticipated my doubts before I even uttered them, the optimistic attitude accompanying his pearls of wisdom, and his ability to instill in me an enduring sense of hope in the midst of uncertainty. My trust in him, which made me confident in his treatment recommendations, ultimately proved integral to my healing. 

This novel experience of self-disclosure affected me so profoundly that I decided, after getting well, that I too would care for others struggling with similar health concerns. This commitment eventually drew me to medicine, where I could walk closely with patients in the loneliness of their pain and suffering. 

In medical school, I sought to learn how patients perceive physician self-disclosure. Was my experience normative? Does revelation of shared illness typically enhance the therapeutic alliance? Or does self-disclosure actually do more harm than good? 

Guided by my research mentor, I explored these queries by surveying 924 patients with chronic pain. I asked them to imagine that they were seeing a physician who had chronic pain themselves. Would they want their physician to reveal this to them?

Sixty percent of patients said “yes.” Among those who responded affirmatively, a prevailing theme was trust.

“I would trust their opinion more, because they lived with pain,” wrote one patient. “Part of the challenge with chronic pain is feeling believed; I think that if a provider has experienced chronic pain, sharing [this] can create an innate trust that they do understand,” wrote another.

Chronic pain is a deeply isolating affliction. Corroborating the published data, our respondents often recounted having their pain minimized or dismissed by others, including their physicians, whom they counted on to validate their struggle more than anyone.2

I discovered that patients did not desire sympathy, but empathy. They longed not to hear “I hurt for you,” but instead “I hurt with you.” 

After reading nearly a thousand comments from patients with chronic pain, I appreciated anew how truly delicate it is for patients to entrust their lives to people they barely knew. I also gleaned that when delivered without the patient’s utmost wellbeing in mind, physician self-disclosure can deteriorate trust.

While the majority of patients we surveyed wished to know about their physician’s ailment, seven percent did not, and 33 percent were unsure. Chief among patients’ misgivings was that their singular narrative would be overridden by the imposition of their physician’s subjective experience. They also feared that self-disclosure would divert the focus away from them and onto their physician. Principally, patients yearned to be heard as unique persons, not be told that they were just like anyone else. 

Our respondents imparted to me a clear imperative: to earn and never assume the trust of my future patients; handle it always with the tenderest care; and disclose the details of my journey only when conducive to these intentions.

The physician-as-patient occupies a cherished space in modern medicine. Historically, the predominant view within the medical profession was that divulging personal information to patients would blur professional boundaries and imperil the integrity of patient-centered care.3 In certain contexts, this may invariably be true. But Western ethos has increasingly respected the humanness of the physician, particularly in light of a pandemic that has touched everyone, especially healthcare workers.4

I believe that the more we acknowledge and celebrate our bondedness – one teeming with all the familiar joys and sorrows of the human condition – the more patients will become empowered when they hear from their perceptibly unbreakable healers: “I hurt like you.” 


Howard is an LA-native who is currently a fourth year medical student at the Johns Hopkins University School of Medicine. He intends to pursue a career in neurology and is broadly interested in optimizing functionality and quality of life in individuals with neurodegenerative disorders. He hopes to discover and employ ways to improve patient-physician relationships through communication, trust-building, and shared decision-making. Outside of medicine, he loves reading, writing, basketball, and bubble tea.  

References

1. Beach MC, Roter D, Larson S, Levinson W, Ford DE, Frankel R. What Do Physicians Tell  Patients About Themselves?: A Qualitative Analysis of Physician Self-Disclosure. J Gen Intern  Med. 2004;19(9):911–6.

2. Buchman DZ, Ho A, Illes J. You Present like a Drug Addict: Patient and Clinician Perspectives  on Trust and Trustworthiness in Chronic Pain Management. Pain Med. 2016;17(8):1394-406.  

3. Candib LM. What should physicians tell about themselves to patients? Am Fam Physician.  2001;63(7):1440–1442.

4. Søvold LE, Naslund JA, Kousoulis AA, Saxena S, Qoronfleh MW, Grobler C, Münter L.  Prioritizing the Mental Health and Well-Being of Healthcare Workers: An Urgent Global Public  Health Priority. Front Public Health. 2021;9:679397.

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