title: Limits to truth-telling: neurologists' communication in conversion disorder.
abstract: 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.
authors: King's College London, Department of Psychological Medicine, Institute of Psychiatry, London, UK. r.kanaan@iop.kcl.ac.uk
authors: Richard
authors: R
authors: Kanaan
authors: David
authors: D
authors: Armstrong
authors: Simon
authors: S
authors: Wessely
mesh_terms: 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