ABSTRACT
Sometimes willfully, and at other times without awareness, patients fail to disclose important personal information to health caregivers. Physicians in rural south Georgia, for example, used to be puzzled by the fact that so many of their patients experienced severe anemia. The medical professionals came to understand that rural Southern culture views the habit of eating kaolin, white clay or dirt, as “relatively harmless,” and so, patients seldom disclosed the practice to their caregivers (Beasley, 1993, p. B2). Some Hispanic, Arabic, South Asian, and Chinese communities use lead in folk medicine, and many Mexican American households cook with lead-glazed pottery (Trotter, 1990). Again, patients are unlikely to disclose these practices to health caregivers because these actions are simply part of the daily routine. The behaviors may contribute to lead poisoning, however, and patients’ failure to talk about these practices and others associated with health risk, disease, and illness inhibits health caregivers’ ability to diagnose and efficaciously treat patients. Politeness theory (P. Brown & Levinson, 1978) and an impression management (Goffman, 1959) framework suggest why patients may hesitate to be fully disclosive during medical interaction and how health caregivers might encourage patients’ honest disclosure, balancing the caregivers’ need to know with efforts to safeguard patients’ identities.
