The right to know one's diagnosis

As physicians we set great store by diagnosis. We feel that making the diagnosis is possibly the most important aspect of the consultation or medical interaction. And we feel that patients need a diagnosis, not only to ensure that they can be treated but also that the possession of a diagnosis somehow empowers them to face the medical establishment. As if, armed with their diagnosis, the patient can be viewed as an ally of the doctor, with the condition a common enemy that they can fight together. But it is not always so. Some diagnoses are bleak, incurable and unmanageable, and some do not reflect pathology at all, but just an alternative way of being. The timing of the diagnosis and even the way in which it is made, and by whom, can be as important as the diagnosis itself.

Giving a diagnosis

The following story from my early days as a gynaecology SHO may help to illustrate the importance of timing and how a diagnosis is given.

Baby Jane's mum

I met the mother of Baby Jane during my elective as a neonatal SHO on the Special Care Baby Unit. She was 39, had been pregnant before and had three teenage boys. She was surprised, but not distressed, to be pregnant again and if this pregnancy seemed “different” from the others she assumed that it was because she was so much older.