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Related Experiment Videos

Diagnostic disclosure: a tale in two cultures.

P McDonald-Scott1, S Machizawa, H Satoh

  • 1Department of Adult Psychiatry, National Institute of Mental Health, Ichikawa, Japan.

Psychological Medicine
|February 1, 1992
PubMed
Summary

Psychiatrists in Japan and North America disclose diagnoses differently, especially for schizophrenia. Cultural views on patienthood influence diagnostic communication and family notification practices.

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Area of Science:

  • Psychiatry
  • Cross-cultural psychology
  • Medical ethics

Background:

  • Diagnostic communication practices between physicians and patients are believed to vary significantly across cultures.
  • Understanding these cross-cultural differences in disclosing psychiatric diagnoses is crucial for effective patient care and ethical practice.

Purpose of the Study:

  • To investigate and compare diagnostic disclosure practices for psychiatric patients between Japanese and North American psychiatrists.
  • To explore cultural influences on the communication of diagnoses, particularly for severe mental illnesses like schizophrenia.

Main Methods:

  • A questionnaire survey was administered to practicing psychiatrists in Japan (N=166) and North America (N=112).
  • The survey included six case vignettes to assess diagnostic disclosure decisions.
Keywords:
Empirical ApproachMental Health TherapiesProfessional Patient Relationship

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  • Data were analyzed to compare disclosure rates and preferred communication strategies between the two cultural groups.

    • Main Results:

    • High disclosure rates (>90%) for affective and anxiety disorders were observed in both Japan and North America.
    • Significant differences emerged for schizophrenia/schizophreniform disorders: 70% of North American psychiatrists disclosed the diagnosis, compared to less than 30% of Japanese psychiatrists.
    • Japanese psychiatrists favored vague diagnoses (e.g., neurasthenia), while North Americans discussed differential diagnoses.
    • Family notification was common in both cultures, but North Americans required patient consent.

    Conclusions:

    • Diagnostic disclosure is culturally influenced, particularly for conditions with uncertain prognoses or significant stigma, such as schizophrenia.
    • Effective treatments correlate with higher disclosure rates across cultures.
    • Culturally constructed views of patienthood significantly shape diagnostic disclosure practices.