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Diagnostic disclosure: a tale in two cultures

Published online by Cambridge University Press:  09 July 2009

Patricia McDonald-Scott ,
Shizuo Machizawa  and
Hiroyuki Satoh
Patricia McDonald-Scott*
Affiliation:
Department of Adult Psychiatry, National Institute of Mental Health, Ichikawa, Japan
Shizuo Machizawa
Affiliation:
Department of Adult Psychiatry, National Institute of Mental Health, Ichikawa, Japan
Hiroyuki Satoh
Affiliation:
Department of Adult Psychiatry, National Institute of Mental Health, Ichikawa, Japan
*
1 Address for correspondence: Dr P. McDonald-Scott, Institute of Statistical Mathematics, 4–6–7 Minami Azabu, Minato-ku, Tokyo, Japan 106.
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Synopsis

Diagnostic communication between doctors and patients is thought to differ radically between Japan and Western countries. To understand diagnostic disclosure to psychiatric patients, a questionnaire with six case vignettes was sent to practising psychiatrists in Japan (N = 166) and North America (N = 112). While over 90% of both groups would inform patients with affective and anxiety disorders of their diagnoses, only 70% of North Americans and less than 30% of Japanese would similarly inform patients with schizophrenia or schizophreniform disorders. The Japanese preferred alternative was to give a vague alternative diagnosis such as neurasthenia. North Americans would discuss differential diagnoses with the patient instead. Nearly all in both groups would inform the family, but North Americans would do so only with patient consent. For disorders for which there are effective treatments, diagnostic disclosure is common to both cultures; when prognosis is uncertain or the diagnosis is feared, as in schizophrenia, culturally constructed views of patienthood govern disclosure practice.

Type
Original Articles
Information
Psychological Medicine , Volume 22 , Issue 1 , February 1992 , pp. 147 - 157
Copyright
Copyright © Cambridge University Press 1992

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