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June 14, 1995

Denial in the Medical Interview

Author Affiliations

Florence, Tex

JAMA. 1995;273(22):1734. doi:10.1001/jama.1995.03520460016009

To the Editor.  —Drs Ness and Ende1 discuss denial in the medical interview as if only patients used it. Denial can occur on either side of the desk: physicians are not immune to this defense mechanism. Usually it is an individual defense, protective of an individual physician, patient, or opinion, but occasionally physician denial affects most of the profession. Forty years ago, most physicians did not recognize child abuse as a common cause of childhood injury. Instead, the victims were labeled as physically weak (weak bones, easy bruising) or emotionally disturbed (accident-prone).Physician denial interacts with patient denial to undermine the correct diagnosis and best treatment of patients' problems. Addressing patient denial alone leaves an irrational influence in the decision chain. Physicians must learn to recognize their own sources of denial and adjust for them. Medical organizations and medical schools should be aware that physician denial exists and help

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