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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.

Information

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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References

Referemces

Asahi Shimbun (1989 a). ‘Ishi no gan kokuchi’ iken nibun. (Divided opinion on doctors informing the patient that he has cancer.) 3 April, 1989.Google Scholar
Asahi Shimbun (1989 b). Dokusha ga kangaeru: oishasan. (The ‘readers’ think about ‘doctors’.) 23 October, 1989.Google Scholar
Asahi Shimbun (1990). Byoki: ‘shinjitsu tsugeru’ juyosa kyocho. (Illness: the importance of telling the truth emphasized. Symposium on informed consent.) 27 May, 1990.Google Scholar
Atkinson, J. M. (1989). To tell or not to tell the diagnosis of schizophrenia. Journal of Medical Ethics 15, 21–24.CrossRefGoogle ScholarPubMed
Economic Planning Agency. (1985). White Paper on National Life. Government Printing Office: Tokyo.Google Scholar
Good, M. D., Good, B. J., Schaffer, C. & Lind, S. E. (1990). American oncology and the discourse on hope. Culture, Medicine and Psychiatry 14, 59–79.CrossRefGoogle Scholar
Japan Medical Association, Seimei Rinri Kondankai (Bioethics Roundtable) (1990 a) ‘Setsumei to doi’ ni kansuru anketo. Shukei kekka hokokusho. (Questionnaire on ‘informing and [obtaining] consent’: tabulation and report of results.) Japan Medical Association: Tokyo.Google Scholar
Japan Medical Association, Seimei Rinri Kondankai (Bioethics Roundtable) (1990 b) ‘Setsumei to doi’ ni tsuite no hokoku. (Report on ‘informing and [obtaining] consent’.) Japan Medical Association: Tokyo.Google Scholar
Kiefer, C. W. (1987). Care of the aged in Japan. In Health, Illness, and Medical Care in Japan (ed. Norbeck, E. and Lock, M.), pp. 89–109. University of Hawaii Press: Honolulu.Google Scholar
Klerman, G. L. (1990). The psychiatric patient's right to effective treatment: implications of Osheroff v. Chestnut Lodge. American Journal of Psychiatry 147, 409–418.Google ScholarPubMed
Lebra, T. (1976). Japanese Patterns of Behavior. University of Hawaii Press: Honolulu.CrossRefGoogle Scholar
Lin, T. Y. (1982). Bunretsubyo wa Naoru ka. (Can Schizophrenia Be Cured?) Kobundo: Tokyo.Google Scholar
Lock, M. (1987). Health and medical care as cultural and social phenomena. In Health, Illness, and Medical Care in Japan (ed. Norbeck, E. and Lock, M.), pp. 1–23. University of Hawaii Press: Honolulu.Google Scholar
Long, S. & Long, B. (1982). Curable cancer and fatal ulcers: attitudes toward cancer in Japan. Social Science and Medicine 16, 2101–2108.CrossRefGoogle ScholarPubMed
Machizawa, S., Satoh, H. & Sawamura, M. (1990). Seishinshogai ni taisuru taido sokutei: kanjagun, kanja kazokugun, ippangun no hikaku. (The measurement of attitudes toward psychiatric disorder: a comparison among patients, patients' families, families, and general residents.) Japan Journal of Clinical Psychiatry 19, 511–520.Google Scholar
Minami Nihon Shimbun (1990). Shindan ni shogeki, musuko jisatsu: chichi oya, ken ni baisho shinkyu. (Shocked by diagnosis, son commits suicide: father seeks compensation from prefecture.) 17 January, 1990.Google Scholar
Munakata, T. (1986). Japanese attitudes toward mental illness and mental health care. In Japanese Culture and Behavior (ed. Lebra, T. and Lebra, W.), 369–378. University of Hawaii Press, Honolulu.CrossRefGoogle Scholar
Munakata, T. (1989). The socio-cultural significance of the diagnostic label ‘neurasthenia’ in Japan's mental health system. Culture, Medicine, and Psychiatry 13, 203–213.CrossRefGoogle Scholar
Novack, D. H., Detering, B. J., Arnold, R., Forrow, L., Ladinsky, M. & Pezullo, J. C. (1989). Physicians' attitudes toward using deception to resolve difficult ethical problems. Journal of the American Medical Association 261, 2980–2985.CrossRefGoogle ScholarPubMed
Ota, K. (1989) ‘Gensoku kokuchi’ wo kihon ni (Making ‘informing as principle’ a standard.) Asahi Shimbun, 3 April 1989.Google Scholar
Samuma, K. (1978). The Japanese family in relation to people's health. Social Science and Medicine 12A, 469–478.Google Scholar
Stone, A. A. (1990). Law, science and psychiatric malpractice: a response to Klerman's indictment of psychoanalytic psychiatry. American Journal of Psychiatry 147, 419–427.Google ScholarPubMed
Wall Street Journal (1988). Japan appears at standstill as concerns over Hirohito's health preoccupy nation. 27 September, 1988.Google Scholar