When patients ask personal questions

[redbandit]

How do you all respond when patient's ask personal questions? In an inpatient setting, I've had patients ask me where I went to medical school, what town I live in, whether I'm married or not, how old I am, what my ethnicity is, etc. A lot of times, I can divert it by asking why they're asking me that question, or that inquiry is not really relevant in my evaluation. I've had one patient respond by saying "well, you're asking me all these personal questions about me..." Obviously, I am not going to disclose my personal information as it has no bearing on their treatment, but to what extent is it okay to share some information? just want to see what the consensus is on this, and how you all approach this situation / scenario.

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[birchswing]

I doubt there's a consensus. Some people are very buttoned up; some will go on about their personal problems to patients. Some are in between. If I were to guess based on my own pattern of asking questions, it's that patients ask questions to feel safer. If you are a blank slate to the patient and imposed on them as in an inpatient situation, the situation is asymmetrical and there isn't really a shared intersubjectivity. You can probably proactively offer information about yourself in an effort to fill that need. It doesn't have to be your demographic information; it can be information demonstrating personhood. People put others at ease by making a remark on a room ("look at that sunshine" or "is it cold in here or is it just me?" or "how was the Jello?") which tells the person something about you by just showing you are human.

 

[futuredo32]

What brings that up ? is my usual response. I think where you went to med school and did residency is a fair question (I look that up before seeing a physician) and though I live in a DO friendly state I do sometimes educate patients on the difference.

 

[Bartelby]

Questions about your qualifications (where you trained, your educational background, etc.) are fair game. It is also unlikely to be problematic for you to tell those things.

Questions about religion, political beliefs, etc. are typically best left unanswered. I agree with futuredo, a "what brings that up" may help uncover a question behind the question. For example, someone recently asked me whether I believe in God, and when I asked them what brought that up they said that they wanted to see if I understood why they believed their past actions damn them to Hell. I briefly explained that I typically do not disclose my own personal beliefs in these settings because it can detract from the focus of the treatment (them), and then we took up his thoughts about damnation.

If someone explains that they need you to disclose your personal information to them in order to feel comfortable disclosing their personal information to you, they may need education about how therapy / psychiatric evaluation works. They may also be knowingly testing your boundaries. Either way, disclosure is a mistake.

 

[Bartelby]

To add to that, I (and all of us) disclose some personal information. I wear a wedding ring, so that is an obvious disclosure to every patient I meet. I may also disclose other life experiences or personal beliefs *only if* I believe it furthers the patient's treatment and I feel comfortable with their knowing it.

 

[splik]

As mentioned above, your qualifications etc are not personal questions and patients have a right to ask about that.

As for what counts as a personal question, it drives me nuts when people in our field refuse to answer basic questions or make it out to be an issue of boundaries. It is natural for patients to want to ask some questions about their doctors. In terms of what is appropriate to answer, consider 3 things:
1. do I feel comfortable disclosing this? There may be somethings you personally do not feel comfortable disclosing that someone else might. Similarly there might be things you don't want to disclose to one patient but not another. You should decide what feels right to you.
2. Why is the patient asking this? You could get at that by inquiring but you can also reflect about whether the patient is asking a question to deflect from the evaluation, to dominate the interview, as an act of hostility, to seek intimacy, or because they have no frame of reference for the patient-therapist relationship.
3. What will be gained by me answering this question? There are some questions which however you answer no good can come of it. There are other questions it is just better to answer.

Usually inexperienced psychiatric trainees can be overly rigid about self-disclosure. Conversely, I see a lot of masters level or other less trained staff in mental health "over share" or disclose too much information. There is a balance between being human and making this all about you.

Personally, I am not impressed when people avoid or deflect questions. Much better to address anything head on, which could include "We only have so much time and I want to make sure we focus on you" to "I'm not going to answer that" to "I think you're trying to get a reaction out of my by asking the provocative question" to "I'm wondering what is making you ask this."

For outpatients/therapy pts (of which I have very few) I usually end the first session by saying "I've asked you lots of questions about yourself, is there anything you want to know about me." That is their only opportunity to do so. I find it much better to ask patients what they want to know up front. Please note inviting questions does not mean you have to answer anything you do not want to. I find when you provide patients the opportunity to ask personal questions they are much less likely to ask about anything.

For those patients who insist on trying to asking lots of irrelevant personal questions and note that you're asking them lots of questions, I usually make a joke and say "I hate answering personal questions which I why I became a psychiatrist. It's much more fun to ask them" or something like that.

 

[Crayola227]

How do you all respond when patient's ask personal questions? In an inpatient setting, I've had patients ask me where I went to medical school, what town I live in, whether I'm married or not, how old I am, what my ethnicity is, etc. A lot of times, I can divert it by asking why they're asking me that question, or that inquiry is not really relevant in my evaluation. I've had one patient respond by saying "well, you're asking me all these personal questions about me..." Obviously, I am not going to disclose my personal information as it has no bearing on their treatment, but to what extent is it okay to share some information? just want to see what the consensus is on this, and how you all approach this situation / scenario.

I see no reason not to answer a question like where you went to medical school, what part of town you live in (safety concerns aside, assume this is a fairly not creepy patient and let's assume we're talking LA and you answer Culver City, you've hardly made yourself easy to stalk).

I consider these things in the realm of normal social small talk that you could have with a not creepy person on the public bus, so unless there's something in particular about the interaction that it's not a good idea to answer, I just answer those types of questions.

Touchier things, like your romantic life, you can answer if you want depending on factors. If you're married with 2 kids, I don't see an issue saying so depending on the context, for me personally. Otherwise I think it's fine to say, "I'm not offended and I don't mean offense, but there's certain topics I don't discuss at work as a policy, like my romantic life. I hope you can understand." "I want to keep the focus on you and how I can help you. I know it's pretty one-sided since I ask you these things, but I want to understand you and your life better so I can help with what's troubling you. I want to make this about you and not me."

The idea of quid pro quo being brought up by a patient is a huge red flag to me for a lot of reasons. Likely it's just a defense mechanism but that is not something I would play into. Again, I just reiterate "Helping you is my job, on that I value a great deal (so it doesn't seem like I'm making it sound like I'm put out by them, just reminding them wtf we're trying to do here). I do that by asking questions about your life so I can understand you and your challenges. I've found that answering personal questions about myself to patients while I am working can have negative or unintended consequences. I hope that you can understand why I am asking you these questions and not reciprocating information about my life. I'm here to help you.

Sometimes they need to be reminded that this isn't a casual social interaction, and why the data flow is most appropriate in one direction.

 

[deleted736562]

I feel it's always safer to err on the side of too much boundaries than too little. I'd keep self disclosure to a minimum, especially at the start of the treatment, cause it can be a slippery slope and you don't know where that will get you.

 

[NickNaylor]

I haven't had a problem with patients asking me overtly inappropriate personal questions, particularly in a therapy session. I don't mind disclosing the answers to the questions I've been asked, so I will typically ask them what makes the answer to that question important to them, hear their response, and then answer it.

If I were asked a question that I'm uncomfortable answering it, I would explain the importance of boundaries in therapy and use that as an excuse to not answer a question.

I've never had this problem in a medication management setting.

 

[SourceOfDenial]

I think psychiatry training and medical education in general does a poor job of talking about boundaries, especially early on(MS3/4 and PGY1/2). There is the sense that 'boundaries' means no/limited personal info, and ignores the concept that medicine is relational.

Asking a personal question is often a bid for connection. Having connection and building trust is at the core of good therapy.

 

[whopper]

I've had a lot of patients bring up politics with me.

I don't cut them off and address it for the following reasons:
1) Politics do tick people off. It could be their stressor.
2) Studies show that political/world turmoil does correlate with depression and suicide. Suicide rates, for example, usually goes up when a country goes to war.
3) The political issue could affect their coverage such as Medicare or Medicaid being changed.

But this said, I try not to give my opinion on it, address it in a matter-of-fact way without trying to dredge up any narratives that are partisan. I also tell patient's that despite my political views it's not my job to judge them over theirs and they should feel welcome when they come to my office.

In general, I also tell people not to get too much involved in politics and the news especially these days. It can become very emotionally engaging in a very negative way. Of course we should be informed, but like any diet, we shouldn't take in the toxic stuff too much especially if taking it in isn't causing any meaningful change.

I did have 1 case where the person's political views did beg me to think about their mental health but only because there was so much cognitive dissonance it clearly showed something was going on that needed further explanation.
The person, in this situation, was very much angry and hateful against those on government assistance such as Medicaid, kept reiterating that he loved, "Rush," (why bring that up 5x in a session?) and the guy himself was on Medicaid, unemployed, and living off of his girlfriend's generosity-not for a temporary period of a few weeks to months, but had been for years and saw no problem with it. Clearly there's something going on there in the subconscious, and not because of his political views in and of themselves but anger and judgment against those that fit a very similar situation to himself. Turned out the issue never was addressed cause he couldn't afford to see me anymore. While my workplace accepted Ohio Medicaid it didn't accept Kentucky Medicaid, nor did KY Medicaid pay for Buprenorphine (which is what he wanted) and he had the latter. We informed him of this and that any further meetings he'd have to pay out of pocket so he stopped showing up.

I generally keep my information private concerning my personal life but in my private practice where I've known some of my patients over a year now and know they have no personality disorders, and mild mental health problems I might mention superficial things.

 

[Ceke2002]

How do you all respond when patient's ask personal questions? In an inpatient setting, I've had patients ask me where I went to medical school, what town I live in, whether I'm married or not, how old I am, what my ethnicity is, etc. A lot of times, I can divert it by asking why they're asking me that question, or that inquiry is not really relevant in my evaluation. I've had one patient respond by saying "well, you're asking me all these personal questions about me..." Obviously, I am not going to disclose my personal information as it has no bearing on their treatment, but to what extent is it okay to share some information? just want to see what the consensus is on this, and how you all approach this situation / scenario.

Be grateful, you could have had me as a patient.

My former Psychiatrist: "Okay, we've got another 5 minutes left, is there anything else you'd like to talk about?
Me (suddenly super over enthused): Yes, can you explain how objections relation theory relates back to the works of Freud?

But amusing anecdotes aside, I do think the idea of being able to work strictly in 'tabula rasa' only is a tad unrealistic. I mean even if you're not saying stuff, there are gonna be patients who will still pick stuff up from you by reading shifts in facial expression, tone, body language, and so on. I personally think the best approach is the 'why am I telling' one - tell if a disclosure will a) not put you at any ethical/personal/physical risk (of course), and b) tell only if you are absolutely sure and honest with yourself that by doing so you are somehow benefiting the patient and/or the therapeutic relationship.

 

[justfolks]

Just a patient, but one thing to bear in mind is Google. Meaning, people can find out things about you on their own. So, as Ceke2002 noted, tabula rasa is unrealistic. That's certainly not a reason to add to the info people have by disclosing, just don't be surprised if people end up knowing more than you would have intended.

 

[WisNeuro]

Just a patient, but one thing to bear in mind is Google. Meaning, people can find out things about you on their own. So, as Ceke2002 noted, tabula rasa is unrealistic. That's certainly not a reason to add to the info people have by disclosing, just don't be surprised if people end up knowing more than you would have intended.

Indeed, if the patient forums are any indication, stalking is fairly commonplace. I only had it come up explicitly once, patient with borderline PD, so it wasn't all that unexpected. Luckily, I don't engage in social media or have any salacious things in my history. It also helps that there are several athlete, US and international with my name, so I tend to get crowded out in google searches.

 

[thoffen]

I'm probably more buttoned-up than most, although if any question catches you off-guard, any response you provide will have caveats. Patients will notice your reaction, and those most attuned to it are most likely to ask questions that might brush up against a therapeutic boundary. If you casually answer one of those questions, more are likely to follow.

Important, though, is not to invalidate the patient's desire to know. Either it is appropriate to know for your treatment or not, but the desire is always appropriate and potentially very meaningful. So if you are going to say no, I find it important to say why. Or if you want to know why they asked, perhaps something like "I will answer your question, but before I do please share what makes you curious" is more appropriate. Leaving the question unaddressed completely establishes that there are some topics or feelings which don't have a place in your treatment relationship. That may be a critical problem.