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June 14, 1995

Denial in the Medical Interview

Author Affiliations

University of Colorado Denver
Miles Institute for Health Care Communication West Haven, Conn

JAMA. 1995;273(22):1734-1735. doi:10.1001/jama.1995.03520460016010

To the Editor.  —Drs Ness and Ende1 present a fine analysis of the phenomenon of denial in their recent article. We appreciate their recommendations that there are times when we should let the patient stay in denial and other times when we might use techniques of clarification, confrontation, and interpretation. We would like to suggest a few additional considerations.All too often we use denial as a pejorative label for our patients' beliefs when we have too little understanding of how things look to them. Kleinman2 believes we work hard to understand our patients' diseases, but do a poor job of understanding their illnesses. All too often we physicians do more denying than our patients, hearing little of what really matters to them because their thoughts don't fit our models of reality.Denial often seems to be an artifact of doctoring. Our patients really see things differently. We

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