A brief review of the literature

Enough about you

In the interest of developing therapeutic patient-physician bonds, it can be tempting for physicians to share personal information with their patients. Self-disclosure with patients might include discussion of personal emotions, families, or relationships, and professional or personal experiences with others with the same diagnoses as patients have. Does self-disclosure by physicians help or hinder the development of successful patient-physician partnerships?

In a recent study, a group of researchers analyzed transcripts of 113 unannounced, undetected, standardized patient visits to primary care physicians. In 38 of the 113 visits, physicians disclosed information about themselves or their families to the new patients. Seventy-three episodes of self-disclosure were recorded.

Ten episodes (14%) of self-disclosure were in direct response to a patient question; 29 (40%) were unrelated to the topic being discussed. Most disclosures were not considered useful to patients by the research team. In almost 80% of visits where self-disclosure occurred, the discussion never returned to the patient topic preceding the disclosure. As well, 8 self-disclosures were deemed by the researchers as disruptive to the visits. In analyzing the transcripts, the researchers found that there was no evidence of positive effects of physician self-disclosure.

Source: McDaniel SH, Beckman HB, Morse DS, Silberman J, Seaburn DB, Epstein RM. Physician self-disclosure in primary care visits: enough about you, what about me? Arch Intern Med 2007;167(12):1321–6.

Bottom line

• Physician self-disclosure does not appear to have positive effects in clinical encounters and might be disruptive.

• Other behaviours, such as expression of empathy, might be more helpful in developing therapeutic patient-physician bonds.

Dress for success

Venous leg ulcers can be challenging to treat. The criterion standard for treatment is multi-layer compression bandaging with dressings placed over the ulcers to promote healing and to prevent the bandages from sticking to the wounds. There are many dressings available that contain hydrocolloids, foams, alginates, and hydrogels, as well as simple non-adherent dressings. As some of these dressings can be quite expensive, researchers from the United Kingdom decided to review the evidence for the effectiveness of these dressings in treating venous leg ulcers.

The researchers undertook a systematic review and meta-analysis of the literature. They reviewed all randomized controlled trials evaluating dressings for the treatment of venous leg ulcers that they found through hand searches of journals and searches of electronic databases, conference proceedings, and bibliographies up to April 2006. In addition, they contacted dressing manufacturers for unpublished trials. Of 254 studies identified, 42 were selected for inclusion in the study. Inclusion criteria included methodologic rigour and clinically important outcome measures.

The meta-analysis revealed some interesting findings. Hydrocolloids were no more effective than simple low-adherent dressings used beneath compression bandaging. There was insufficient evidence available to allow firm conclusions to be drawn for other comparisons. None of the comparisons, however, showed evidence that a particular class of dressings healed more ulcers. The researchers were not able to draw conclusions about the relative cost effectiveness of different dressings.

Source: Palfreyman S, Nelson EA, Michaels JA. Dressings for venous leg ulcers: systematic review and meta-analysis. BMJ 2007;335(7613):244. DOI: 10.1136/bmj.39248.634977.AE.

Bottom line

• There is insufficient evidence to recommend one dressing over another in the treatment of venous leg ulcers.

• Hydrocolloid dressings are not more effective than simple low-adherent dressings used beneath compression bandaging.

• Cost and physician and patient preferences should be taken into account in the choice of dressings.

Additional resources

A patient handout about venous leg ulcers is available from the Registered Nurses’ Association of Ontario at www.rnao.org/bestpractices/PDF/Fact_Sheet_venous_leg_ulcers.pdf.