Concealing bad news: clinicians’ lived experience of a cultural dilemma

Abstract

Abstract Introduction When asked to conceal bad news from patients, clinicians face a professional dilemma. In many geographical settings, patients’ relatives commonly ask doctors to hide serious diagnoses. Although well-intentioned, the practice is known to create suffering, impacting on the patient, their caregivers and the healthcare team. Our study deepens existing understanding through uncovering clinicians’ lived experience, with the goal of informing training to tackle this professional challenge. Methods Recognising that this practice varies significantly internationally, we recruited clinicians who had experienced two cultures: medical students receiving a UK curriculum, in Malaysia and the UK, and UK-based international medical graduates (IMGs). Twenty-six medical students and sixteen IMGs participated. Drawing on phenomenology, we used focus groups and semi-structured interviews. Results For our participants, concealing diagnoses created three major sources of suffering: moral discomfort, dilemma and powerlessness. Sympathetic distress at the impact on the patient was marked. However, conflicting personal values created uncertainty, in part rooted in misplaced fear that diagnostic disclosure may harm the patient. Even when our participants wanted to disclose bad news, feeling under-equipped for communication challenges and facing coercion, they experienced a sense of powerlessness. Discussion The crucial initial step is for medical education to acknowledge that requests to conceal bad news happen. We need to provide a communication strategy for tackling this phenomenon, which upholds the patient’s right to knowledge while maintaining collaboration and trust with the family. Above all, this dilemma highlights the need for globalised education to revitalise medical ethics, expanding cultural humility and curriculum decolonisation.