My attempt to answer the question I left you with a few days ago.
He who conceals his disease cannot expect to be cured. Why would someone conceal their disease? How should a doctor handle this scenario? What is the most important ethical principle?
‘Denial is an important defence mechanism’. Patients may conceal their disease from a doctor for a number of reasons such as shyness, embarrassment and denial. Denial is one of the commonest reasons for the patient to hide a suspected disease. It may be an important coping mechanism.
The doctor needs to show great respect, empathy and sensitivity to win the patient’s confidence. Being non judgemental is an important principle in medical ethics. Gentle exploration of a patient’s symptoms and understanding should take place, preferably conversation should be patient led. At an early stage the doctor should regard building a rapport and gaining trust to be the most important process. However the doctor should inform the patient that nearly everything is easier to treat in its early stages. He should inform the patient that ‘his door is always open’ if he should wish to reconsider.
Beneficence must be balanced with autonomy. Patients often fear a power imbalance in the doctor-patient relationship and feel that they may be forced to do something they do not want. It must always be stressed that nothing will be done without their consent and they will be helped to make an informed judgement in all cases. Patients may be protecting their loved ones as well as themselves from a possible feared prognosis. As long as the patient has capacity the doctor should respect the patient’s views and try and understand their fears. Patients have the right not to know as well as to know about themselves. Autonomy in this situation is the most important principle.