Disclosures of illness by doctors to their patients: a qualitative study of doctors with HIV and other serious disorders.
OBJECTIVE
To examine issues concerning doctor's disclosures of their illness to their patients.


METHODS
We interviewed 50 health care providers who had serious illnesses concerning their experiences with disclosures of their illness to patients.


RESULTS
With regard to their diagnoses, these doctors struggled with whether, when, how and what to tell patients. These issues were prominent, and had broader implications for doctor-patient communication and interactions among doctors with HIV, but arose among doctors with other diagnoses as well. Particularly with HIV, questions emerged concerning whether to: tell patients without being asked, respond only if asked, tell the truth, lie or misrepresent the information. Patients appeared to face dilemmas of whether to ask about a doctor's diagnosis, and whether they had a right to know. Some patients hesitated to ask or felt ambivalent about knowing, as the illness could threaten the doctor-patient relationship. At times, patients learned of a doctor's illness only after the latter had died. Disclosures could strengthen or skew the doctor-patient relationship. We present a model and framework--concerning the complexities of these communications--that can be useful in exploring other key aspects of doctor-patient interactions.


CONCLUSIONS
These data raise larger questions of what information patients should be told about physicians. Medical education needs to address these issues better.


CONCLUSIONS
Physicians should realize that patients may be anxious about these concerns, and may view the pros and cons of physicians' disclosures of illness differently than do these physicians themselves.
Klitzman
Robert
R
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY 10032, USA. rlk2@columbia.edu
Weiss
Jonathan
J
D000223:Adaptation, Psychological / Q000941:ethics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D003219:Confidentiality / Q000941:ethics / Q000523:psychology; D003220:Conflict, Psychological; D008192:Deception; D003657:Decision Making / Q000941:ethics; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010815:Physician Impairment / Q000523:psychology*; D010817:Physician-Patient Relations / Q000941:ethics; D011361:Professional Competence; D036301:Qualitative Research; D012650:Self Disclosure; D013240:Stereotyping; D011795:Surveys and Questionnaires; D035502:Trust / Q000523:psychology