Limits to truth-telling: neurologists' communication in conversion disorder.
OBJECTIVE
Neurologists face a dilemma when communicating with their conversion disorder patients - whether to be frank, and risk losing the patient's trust, or to disclose less, in the hope of building a therapeutic relationship. This study reports how neurologists in the UK described dealing with this dilemma in their practice.


METHODS
Practicing consultant neurologists from an NHS region were recruited by snowball sampling. Twenty-two of 35 consultants in the region were interviewed in depth, and the interviews qualitatively analysed.


RESULTS
The neurologists were reluctant to disclose conversion disorder as a differential diagnosis until they were certain. They were guided by the receptivity of their patients as to how psychological to make their eventual explanations, but they did not discuss their suspicions about feigning. They described their communications as much easier now than they had seen in training.


CONCLUSIONS
Neurologists adapt their disclosure to their patients, which facilitates communication, but imposes some limits on truth-telling. In particular, it may sometimes result in a changed diagnosis.


CONCLUSIONS
An optimum strategy for communicating diagnoses will need to balance ethical considerations with demonstrated therapeutic benefit.
Kanaan
Richard
R
King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK. r.kanaan@iop.kcl.ac.uk
Armstrong
David
D
Wessely
Simon
S
D000328:Adult; D003142:Communication; D003291:Conversion Disorder / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000941:ethics*; D010817:Physician-Patient Relations; D014342:Truth Disclosure / Q000941:ethics*; D006113:United Kingdom