ABSTRACT
Sometimes willfully, and at other times w ithout awareness, patients fail to disclose im portant personal inform ation to health caregivers. Physicians in rural south G eorgia, for example, used to be puzzled by the fact that so many o f their patients experienced severe anemia. The medical professionals came to understand that rural Southern culture views the habit o f eating kaolin, white clay or dirt, as “ relatively harm less,” and so, patients seldom disclosed the practice to their caregivers (Beasley, 1993, p. B2). Some Hispanic, A rabic, South Asian, and Chinese communities use lead in folk medicine, and many M exican 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 effica ciously treat patients. Politeness theory (P. Brown & Levinson, 1978) and an impression m anagem ent (Goffm an, 1959) fram ework suggest why patients may hesitate to be fully disclosive during medical interaction and how health careg ivers m ight encourage p a tien ts’ honest disclosure, balancing the caregivers’ need to know with efforts to safeguard patients’ identities.
