Denial and minimization in telephone contacts with patients.

This paper defines and demonstrates mechanisms of denial, disavowal, and minimization as they operate in telephone contacts between patient or family member and the physician. The physician needs to be cognizant that such mechanisms, operating in both physicians and patients, distort patient's reports of their observations of their illnesses or those of family members. These distorted diagnoses affect proposed treatment plans and ultimate outcome. Examples of situations in which distortions contribute to dangerous consequences are developed in the paper. Specific techniques are elaborated to deal with patients who deny, including expert questioning, direct confrontation, and/or interpretation of the hidden motives leading to the denial. Physicians need to be alert to their own tendency to deny or block out crucial factors secondary to conflicting personal and professional priorities, fear of loss of self-esteem, and unresolved psychological conflicts regarding particular medical syndromes.