Letters

Telling patients with schizophrenia their diagnosis

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7257.384/a (Published 05 August 2000) Cite this as: BMJ 2000;321:384

Patients should be informed about their illness

  1. R A Clafferty, consultant psychiatrist (r.clafferty{at}virgin.net),
  2. Elaine McCabe, staff grade psychiatrist,
  3. Keith W Brown, consultant psychiatrist
  1. Forth Valley Primary Care NHS Trust, Westbank Clinic, Falkirk, Scotland FK1 5RQ
  2. Keyham, Leicestershire LE7 9JS

    EDITOR—McGrath and Emmerson's review of the treatment of schizophrenia has ignited a lively exchange of views in the BMJ, many of which cast doubt on the concept of schizophrenia or the value of giving this diagnosis.1 2

    A recent survey posted to all consultant psychiatrists in Scotland in May 1997 determined 211 consultant psychiatrists' views on whether to tell patients with schizophrenia their diagnosis. It showed that 200 (95%) respondents agreed that the consultant psychiatrist was the best person to do this, but only 124 (59%) stated that it was their usual practice to tell patients their diagnosis after the first established episode, and only 187 (89%) said it was their usual practice to tell patients their diagnosis after a second or subsequent episode of illness.3 Thirty one (15%) would not use the term “schizophrenia” when giving the diagnosis, instead using other, often confusing, terminology. An essential part of the treatment of people who have schizophrenia must be to inform them of their diagnosis. Not to do so reverts to a time of medical paternalism (as in previous cancer care) where patients were not allowed the basic ethical right to take part in decisions about their health care. Doctors often have to break bad news to patients and should be well aware of the negative and positive effects of this. The symptoms and signs of schizophrenia are more likely to be stigmatising than its name alone.

    Not to speak of the diagnosis may simply alarm the patient, who in many cases will already have some idea of what their symptoms indicate. It leaves patients open to discovering their diagnosis in inappropriate ways or to seeking further information from dubious sources. Patients may be at a disadvantage when applying for benefits or housing, and not telling them the diagnosis may prevent them from accessing self help and support from voluntary organisations. It may also leave doctors at risk of legal challenge if they do not tell patients of their duty to inform the Driver and Vehicle Licensing Agency about their fitness to drive. Patients should be given information about their illness; in not doing so their doctors may not be “treating” them well.

    References

    1. 1.
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    3. 3.

    Patients expect a diagnosis

    1. Martin Fisher, retired general practitioner
    1. Forth Valley Primary Care NHS Trust, Westbank Clinic, Falkirk, Scotland FK1 5RQ
    2. Keyham, Leicestershire LE7 9JS

      EDITOR—Bracken and Thomas say they manage perfectly well without using the diagnosis of schizophrenia.1 How do the patients manage?

      In their relationship with a doctor, patients expect the doctor to make a diagnosis, and they also expect to be entitled to share it. A diagnosis lets them know what the doctor is doing. It enables them to consider their own predicament and to form an opinion of the doctor's worth. Given a diagnosis, they can question it and the treatment that flows from it, and they can reassure themselves that they are getting the best treatment. They can assess the effects of treatment and come to their own conclusions about its value.

      Bracken and Thomas state that a person who is given the diagnosis of schizophrenia may be devastated.1 This may be true, but many more people who receive this sad diagnosis are relieved of having no diagnosis at all. At least it explains what has been happening and is a pointer to the future and to ways of cure. It confers power on the patient and allows the possibility of making informed choices.

      Bracken and Thomas assert, on no evidence, that the negative connotations of a diagnosis of schizophrenia have increased recently.1 The opposite may just as easily be said. What is true is that with the arrival of care in the community the media and public have taken more interest in schizophrenia (and other serious mental illnesses). They have become more knowledgeable, understanding, and responsible, and they look after their mentally ill fellow citizens in their midst better.

      References

      1. 1.