This article is the result of exploratory research on the communication/relationship between physicians and patients conducted in Argentina, Brazil, India and the United States. The study sheds light on the different strategies, 109 physicians from these four countries use when they tell a patient that s/he has leukaemia. Results from the United States suggest that the American physicians, on an average, tend to tell patients directly and explicitly that s/he has leukemia. In Argentina, Brazil and India, however, data indicate that physicians tend to share the same news with a patient in small doses over time and/or tell a family member before telling the patient. A physician in Brazil referred to this strategy as using ‘halftruths’ strategies when communicating bad news to their patients. The notion of ‘truth’ in physician– patient interaction is analyzed in this article focusing on disclosure, deception, legal, ethical and cultural implications to the topic.
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References
1.
Brown, P. and S. Levinson . (1987). Politeness: Some Universals in Language Usage. Cambridge: Cambridge University Press .
2.
Buller, D. and J. Burgoon . (1996). Interpersonal Deception Theory . Communication Theory, 6(3): 203–42 .
3.
Charlton, R.C. (1992). Breaking Bad News . The Medical Journal of Australia, 157: 615–21 .
4.
Christakis, N.A. and E.B. Lamont . (2000). Extent and Determinants of Error in Doctors' Prognoses in Terminally Ill Patients: Prospective Cohort Study . British Medical Journal, 320(7233): 469–73 .
5.
Davis, H. (1991). Breaking Bad News . The Practitioner, 235(1503): 522–26 .
6.
Field, D. and Gina Copp . (1999). Communication and Awareness About Dying in the 1990s . Palliative Medicine, 13(6): 459–68 .
7.
Fried, T.R. , E.H. Bradley and J. O'Leary . (2003). Prognosis Communication in Serious Illness: Perceptions of Older Patients, Caregivers and Clinicians . Journal of the American Geriatrics Society, 51(10): 1398–403 .
8.
Gambosi, J.R. and E.B. Ray . (1990). Professional Ideology and Physicians’ Perceived Disclosure Patterns Toward Cancer Patients . Communication Research Reports, 7(2): 132–38 .
9.
Gaskins, S. , P. Miller and W. Corsaro . (1992). Theoretical and Methodological Perspectives in the Interpretive Study of Children. In W. Corzaro and P. Miller (eds), Interpretive Approaches to Children's Socialization, pp. 5–23. San Francisco: Jossey-Bass Publishers .
10.
Gillotti, C. and J. Applegate . (2000). Explaining Illness as Bad News: Individual Differences in Explaining Illness Related Information. In B.B. Whaley (ed.), Explaining Illness: Research, Theory, and Strategies, pp. 101–22. Mahwah, NJ: Lawrence Erlbaum Associates Publishers .
11.
Glaser, B.G. and A.L. Strauss . (1965). Awareness of Dying. Chicago, IL: Aldine Publishing Company .
12.
Glass, E. and D. Cluxton . (2004). Truth-Telling. Ethical Issues in Clinical Practice . Journal of Hospice and Palliative Nursing, 6(4): 232–42 .
13.
Goffman, E. (1959). The Presentation of Self in Everyday Life. New York: Doubleday .
14.
Goncalves, F.A. Marques , S. Rocha , P. Leitão , T. Mesquita and S. Moutinho . (2005). Breaking Bad News: Experiences and Preferences of Advanced Cancer Patients at a Portuguese Oncology Centre . Palliative Medicine, 19(7): 526–31 .
15.
Gongal, R. , P. Vaidya , R. Jha , O. Rajbhandary and M. Watson . (2006). Informing Patients About Cancer in Nepal: What People Prefer?Palliative Medicine, 20(4): 471–76 .
16.
Gordon, E.J. and C.K. Daugherty . (2003). Hitting You Over the Head: Oncologists’ Disclosure of Prognosis to Advanced Cancer Patients . Bioethics, 17(2): 142–68 .
17.
Grassi, L. , T. Giraldi , K. Magnani , E. Valle and G. Cartei . (2000). Physicians’ Attitudes to and Problems with Truth-Telling to Cancer Patients . Support Care Cancer, 80(2000): 40–45 .
18.
Hall, E.T. (1990). The Silent Language. New York: Doubleday .
19.
Harden, R.M. (1996). Twelve Tips on Teaching and Learning How to Break Bad News . Medical Teacher, 18(4): 275–78 .
20.
Hofstede, G. (1984). Culture's Consequences: International Differences in Work Related Values. Beverly Hills, CA: Sage .
21.
Kakai, H. (2002). A Double Standard in Bioethical Reasoning for Disclosure of Advanced Cancer Diagnoses in Japan . Health Communication, 14(3): 361–76 .
22.
Katz, J. (1984). The Silent World of Doctor and Patient. New York: The Free Press .
23.
Katz, J. (1995). Informed Consent: Ethical and Legal Issues. In J.D. Arras and B. Steinbock (eds), Ethical Issues in Modern Medicine (fourth edition), pp. 87–97. Mountain View, CA: Mayfield Publishing Company .
24.
Kaufert, J.M. and R.W. Putsch . (1997). Communication Through Interpreters in Healthcare: Ethical Dilemmas Arising From Differences in Class, Culture, and Power . The Journal of Clinical Ethics, 8(1): 71–78 .
25.
Kawakami, S. , G. Arai , K. Ueda , Y. Murai , H. Yokomichi , M. Aoshima and K. Takagi . (2001). Physician's Attitudes Towards Disclosure of Cancer Diagnosis to Elderly Patients: A Report from Tokyo, Japan . Archives of Gerontology and Geriatrics, 33(2001): 29–36 .
26.
Kirk, P. , I. Kirk and L.J. Kristjanson . (2004). What do Patients Receiving Palliative Care for Cancer and Their Families Want to be Told? A Canadian and Australian Qualitative Study . MBJ, 328: 1343–347 .
27.
Lamont, E.B. and N.A. Christakis . (2001). Prognostic Disclosure to Patients with Cancer Near the End of Life . Annals of Internal Medicine, 134(12): 1096–105 .
28.
Lund, C.C. (1995). The Doctor, the Patient, and the Truth. In J. Arras and B. Steinbock (eds), Ethical Issues in Modern Medicine, pp. 55–57. Mountain View, CA: Mayfield Publishing Company .
29.
Margolis, D. R. (1998). The Fabric of Self: A Theory of Ethics and Emotions. Yale University Press: New Haven .
30.
Markus, H.R. and K.D. Kitayama . (1991). Culture and the Self: Implications for Cognition, Emotion, and Motivation . Psychological Review, 98(2): 224–53 .
31.
Marwit, S.J. and S.L. Datson (2002). Disclosure Preferences About Terminal-Illness: An Examination of Decision-Related Factors . Death Studies, 26(1): 1–20 .
32.
Miles, M.B. and A.M. Huberman . (1994). Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage Publications .
33.
Mitchell, J.L. (1998). Cross-Cultural Issues in the Disclosure of Cancer . Cancer Practice, 6(3): 153–60 .
34.
Miyata, H. , M. Takahshi , T. Saito and I.K. Tachimori . (2005). Disclosure Preferences Regarding Cancer Diagnosis and Prognosis: To Tell or Not to Tell?Journal of Medical Ethics, 31(8): 447–57 .
35.
Nelson, J. (1989). Phenomenology as Feminist Methodology: Explicating Interviews. In K. Carter and C. Spitzack (eds), Doing Research on Feminist Communication, pp. 221–41. Norwood: NJ: Ablex .
36.
Penman, R. (1994). Facework in Communication: Conceptual and Moral Challenges. In S. Ting-Toomey (ed.), The Challenge of Facework. Cross-Cultural and Interpersonal Issues, pp. 15–46. New York: Sate University of New York Press .
37.
Ptacek, J.T. , J.J. Ptacek and N.M. Ellison . (2001). I'm Sorry to Tell You….: Physicians’ Reports of Breaking Bad News . Journal of Behavioral Medicine, 24(2): 205–17 .
38.
Rao (2003). ‘Half-Truths’ in Argentina, Brazil and India: An Intercultural Analysis of Physicians–Patient Communication. In L. Samovar and R. Porter (eds), Intercultural Communication: A Reader (tenth edition) pp. 309–19. Belmont, CA: Wadsworth Publishing Company .
39.
Roter, D. (2000). The Enduring and Evolving Nature of Patient–Physician Relationship . Patient Education and Counseling, 39(1): 5–15 .
40.
Roter, D. , M. Steward , S. Putnam , M. Lipkin , W. Stiles and T. Inui . (1997). Communication Patterns of Primary Care Physicians . Journal of American Medical Association, 277(4): 350–56 .
41.
Samovar, L.A. and R.E. Porter . (2001). Cultural Diversity in Perception: Alternative Views of Reality. In L.A. Samovar and R.E. Porter (eds), Communication Between Cultures, pp. 52–88. Stamford, CT: Wadsworth Thomson Learning .
42.
Schutz, A. (1962). The Problem of Social Reality. The Hague: Martinus Nijhoff .
43.
Schutz, A. (1967). The Phenomenology of the Social World. Evanston, IL: Northwestern University Press .
44.
Silverman, D. (1987). Communication and Medical Practice: Social Relations in the Clinic. London: Sage Publications .
45.
Sontag, S. (1989). Illness as Metaphor and Aids and its Metaphors. New York: Anchor Books Doubleday .
46.
Tae-Seop, L. (1994). Facework and Interpersonal Relationships. In S. Ting-Toomey (ed.), The Challenge of Facework. Cross-Cultural and Interpersonal Issues, pp. 209–30. New York: State University of New York Press .
47.
The, A. , T. Hak , G. Koëter and G. van der Wal . (2000). Collusion in Doctor–Patient Communication About Imminent Death: An Ethnographic Study . British Medical Journal, 321: 1376–381 .
48.
Ting Toomey, S. and A. Kurogi . (1998). Facework Competence in Intercultural Conflict: An Updated Face Negotiation Theory . International Journal of Intercultural Relations, 22(2): 186–226 .
49.
Veatch, R. (1991). The Patient–Physician Relation: The Patient as Partner, Part 2. Bloomington, IN: Indiana University Press .
50.
Yeung, L.N. , T. Levine and K. Nishiyama . (1999). Information Manipulation Theory and Perceptions of Deception in Hong Kong . Communication Reports, 12(1): 1–11 .
