Truth and lies: Disclosure and the power of diagnosis

The moment at which a diagnosis is delivered to a patient, particularly when it is serious, is an important social moment. It not only dictates the clinical pathway, it also rewrites the patient narrative, shifts their identity, predicts potential outcomes, and foregrounds mortality. It may provide a sense of relief, or one of despair. Over time, and across cultures, there have been many different approaches used to palliate the potential impact of the diagnostic utterance on the patient. France, as one example, provides an interesting case study. Until the turn of the century, cancer diagnoses were often concealed from patients. However, recent legislation now requires full diagnostic disclosure according to prescribed protocols. Using Zerubavel's social patterning methodology, and transcultural historical methods, I seek to understand beliefs about the potential impact of the diagnostic moment by identifying common features across cultural and historical social contexts. I examine writings of French oncologists, and physicians in related fields, from the pre- and post-legislation era who discuss if and how a cancer diagnosis should be disclosed to the patient. While the approach to diagnostic disclosure has changed significantly, medical representations of diagnostic power have not. The diagnostic utterance is still cast by medical professionals as a terrifying and life-disrupting moment.