Weighing the Consequences of Self-Disclosure as an Undocumented Clinician

The Trump Administration’s approach to immigration has caused some turbulence for undocumented immigrants. For clinicians who are undocumented or who are part of the DACA program, the choice of whether to disclose immigration status can be challenging.

A recent case and commentary by Isha Marina Di Bartolo, MD, a primary care resident at the University of Pennsylvania Medical Center in Philadelphia, published in the AMA Journal of Ethics, weighed the benefits and consequences of disclosing status.¹

“Physicians have grappled with the question of how to approach types of self-disclosure and whether there is an optimal amount of self-disclosure that is appropriate within the patient encounter,” Dr Di Bartolo noted. “Disclosing details about one’s own life, family, relationships, and interests is a natural part of human relationships… [However], because being undocumented carries a negative stigma, it would not be unreasonable to assume that this disclosure could negatively impact the patient-physician relationship.”

Although in some cases describing personal experiences can help strengthen the physician-patient relationship, it is advisable to mostly stay away from disclosure in general.

In fact, sharing personal anecdotes can often have a negative effect from a patient’s perspective. One study found that patients thought that 85% of the personal information physicians shared was not helpful.² Another study found that patients reported feeling less comfortable with physicians who self-disclosed too much.³ In this case, sharing these personal experiences can actually make the patient feel that they are not being heard.

If undocumented clinicians are speaking out about their status outside of the office, however, it’s possible that patients might find out through a Google search. In that case, physicians should prepare to answer any questions that might come up.

All in all, the ultimate decision lies with the clinician.

“Physicians should not feel obligated to disclose their immigration status to their patients,” Dr Di Bartolo concluded. “As the number of undocumented or ‘DACA-mented’ immigrants in residency programs increases beyond the more than 50 medical schools accepting applications from DACA recipients, academic institutions and hospitals should become equipped to address legal, logistical, and mental health issues that can be associated with the stressors of being a practicing physician with fragile documentation.”

References

1. Di Bartolo IM, Sisti D. Are clinicians obligated to disclose their immigration status to patients? AMA J Ethics. 2019;21(1):E38-E43.
2. Candib LM. What doctors tell about themselves to patients: implications for intimacy and reciprocity in the relationship. Fam Med. 1987;19(1):23-30.
3. 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):1321-1326.