Handbook of Health Communication

By Teresa L. Thompson; Alicia M. Dorsey et al. | Go to book overview

8
Medical Disclosure
and Decision-Making:
Excavating the Complexities
of Physician-Patient
Information Exchange
Catherine M. Gillotti
Purdue University Calumet

Words are the most powerful tool a doctor possesses, but words, like a two-edged sword, can maim as well as heal.

(Lown, 1996, p. 61)

When it comes to communication, the (sometimes faulty) assumption is that the messages we exchange are true. In the health care setting, the truth is sometimes concealed for the patient's benefit, distorted in an attempt to compassionately deliver bad news, or not processed by the patient because of its ramifications. In spite of most people's attempts to cover up the truth, whether their intention is noble or malicious, usually the truth is eventually revealed (Thomasma, 1994).

According to Thomasma (1994), there are four types of truth and five reasons why the truth is sometimes concealed in the health care context. The four types are direct truth, factual truth, personal truth, and interpretative truth. Direct truth includes answers to yes/no questions, factual truth is concerned with objective reality, personal truth is selfdisclosure, and interpretative truth involves the interpretation of the reasons behind the communication. Thomasma argued that interpretative or hermeneutical truth is the most complex kind of truth and is particularly relevant in the health care context.

Thomasma questioned why the truth is still withheld in the health care context despite the complexity of interpretations of truth and the motivations of the communicators to be honest. He noted that the values of individual well-being and survival of the community and some people's inability to absorb the truth can result in “necessary paternalism” and suppression of the truth (p. 377). Although Thomasma provided several compelling case studies in which paternalism seemed necessary, he also reminded us that we are entitled to the truth in order to make informed decisions. In the end, he argued that withholding

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