Faculty Bibliography

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