Limits to truth-telling: neurologists' communication in conversion disorder.
Limits to truth-telling: neurologists' communication in conversion disorder.
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DOI：
10.1016/j.pec.2009.05.021
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发表时间：
2009-11
影响因子：
3.5
通讯作者：
Wessely, Simon
中科院分区：
文献类型：
--
作者：
Kanaan, Richard;Armstrong, David;Wessely, Simon
神经科医生在与转换障碍患者沟通时面临着两难境地——是否要坦诚相待，冒着失去患者信任的风险，还是少透露一些信息，以期建立治疗关系。这项研究报告了英国的神经科医生如何描述在他们的实践中处理这种困境的情况。来自 NHS 地区的执业神经科医生顾问是通过滚雪球抽样招募的。该地区 35 名顾问中的 22 名接受了深入访谈，并对访谈进行了定性分析。神经科医生在确定之前不愿透露转换障碍作为鉴别诊断。他们以患者的接受程度为指导，决定如何从心理角度做出最终的解释，但他们没有讨论他们对假装的怀疑。他们表示，现在的沟通比训练中的要容易得多。神经科医生会根据患者的情况调整他们的披露，这促进了沟通，但对说实话施加了一些限制。特别是，有时可能会导致诊断改变。传达诊断的最佳策略需要平衡伦理考虑与已证实的治疗益处。
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. 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. 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. 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. An optimum strategy for communicating diagnoses will need to balance ethical considerations with demonstrated therapeutic benefit.
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