Reluctance to disclose difficult diagnoses: a narrative review comparing communication by psychiatrists and oncologists.
BACKGROUND
National guidance in most medical specialties supports the full and open disclosure of diagnoses to patients.


RESULTS
Surveys show that most patients want to know their diagnosis, whether it is medical or psychiatric, and a substantial proportion want to know detailed prognostic information. In the past, oncologists have been criticised for failing to reveal a diagnosis of cancer to patients in a sensitive and timely manner. Over the last 30 years, there is evidence that this practice has improved. Yet, clinicians still have difficulty when the diagnosis is not certain, when the prognosis is unfavourable, and when relatives request "not to tell." All of these influences are present in mental health settings.


CONCLUSIONS
Psychiatrists and general practitioners may be equally reluctant to reveal difficult diagnoses and prognoses of conditions such as schizophrenia and dementia. The reluctance to reveal a difficult diagnosis may be a routine, but little acknowledged the aspect of medical care that should be incorporated into undergraduate and postgraduate education and openly discussed during peer group supervision.
Mitchell
Alex J
AJ
Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, Osbourne Building, Leicester LE1 5WW, UK. Alex.Mitchell@leicspart.nhs.uk
D003142:Communication; D019992:Databases as Topic; D006801:Humans; D008495:Medical Oncology; D008603:Mental Health; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology; D010348:Patient Care Team; D010817:Physician-Patient Relations; D011379:Prognosis; D011570:Psychiatry; D012934:Social Isolation; D014342:Truth Disclosure