Research Article| Volume 2, ISSUE 3, P247-251, July 2013

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To tell or not to tell? Revealing the diagnosis in multiple sclerosis

  • A. Raphael
    Corresponding author. Tel.: +44 7411990948.
    Institute for Science, Ethics and Innovation, Centre for Social Ethics and Policy, School of Law, University of Manchester, Oxford Road, Manchester M13 9PL, UK
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  • C.H. Hawkes
    Neuroscience Centre, Blizard Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London E1 2AT, UK
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  • J.L. Bernat
    Department of Neurology, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire 03756, USA
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Published:February 04, 2013DOI:


      We review briefly (1) the history of patient-physician relationship and its evolution from a physician-centered to patient-centered model; (2) the impact of the McDonald Criteria for Multiple Sclerosis (MS); (3) why it is important to tell patients of their diagnosis; (4) how physicians should disclose the diagnosis to patients; (5) dealing with suspected MS; and (6) prognosis and treatment. For the majority of clinically definite MS patients we advocate disclosure, identify steps for physicians to communicate the diagnosis and propose a framework to follow when revealing a diagnosis of MS.


      • We review the evolution of patient-centered medicine and the disclosure of diagnosis in MS.
      • Third revision of McDonald diagnostic criteria accelerates confirmation of diagnosis.
      • Patient's autonomy and availability of disease modifying treatments encourage early diagnosis.
      • Communications techniques were identified to help physicians revealing a diagnosis of MS.


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        • Baile W.F.
        • Buckman R.
        • Lenzi R.
        • Glober G.
        • Beale E.A.
        • Kudelka A.P.
        SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer.
        The Oncologist. 2000; 5: 302-311
        • Bernat J.L.
        Ethical Issues in Neurology.
        3rd ed. Lippincott Williams & Wilkins, Philadelphia2008
      1. Brazier M. Medicine, Patients and The Law 1st ed. Penguin; 1987

        • Bronnum-Hansen H.
        • Stenager E.
        • Hansen T.
        • Koch-Henriksen N.
        Survival and mortality rates among Danes with MS.
        The International MS Journal. 2006; 13: 66-71
        • Brooks N.A.
        • Matson R.R.
        Social-psychological adjustment to multiple sclerosis: a longitudinal study.
        Social Science & Medicine. 1982; 16: 2129-2135
      2. Buckman R, Kason Y. How to break bad news: a guide for health care professionals: JHU Press; 1992.

        • Buckman R.
        Breaking bad news: why is it still so difficult?.
        British Medical Journal (Clinical research ed). 1984; 288: 1597
        • Comi G.
        • Filippi M.
        • Barkhof F.
        • Durelli L.
        • Edan G.
        • Fernández O.
        • et al.
        Effect of early interferon treatment on conversion to definite multiple sclerosis: a randomised study.
        The Lancet. 2001; 357: 1576-1582
        • Comi G.
        Shifting the paradigm toward earlier treatment of multiple sclerosis with interferon beta.
        Clinical Therapeutics. 2009; 31: 1142-1157
      3. Compston A, Confavreux Ch, Lassman H, McDonald I, Miller D, Noseworthy J, et al. McAlpine's multiple sclerosis; 2005 4th ed. UK

        • Dias L.
        • Chabner B.A.
        • Lynch Jr, T.J.
        • Penson R.T.
        Breaking bad news: a patient's perspective.
        The Oncologist. 2003; 8: 587-596
        • Elian M.
        • Dean G.
        To tell or not to tell the diagnosis of multiple sclerosis.
        The Lancet. 1985; 326: 27-28
        • Fallowfield L.
        • Jenkins V.
        Communicating sad, bad, and difficult news in medicine.
        The Lancet. 2004; 363: 312-319
        • Fallowfield L.
        Giving sad and bad news.
        The Lancet. 1993; 341: 476-478
        • Ford H.
        • Johnson M.
        Telling your patient he/she has multiple sclerosis.
        Postgraduate Medical Journal. 1995; 71: 449-452
      4. Freedman B. Offering truth: one ethical approach to the uninformed cancer patient. Archives of Internal Medicine. 1993;153(5):572.

        • Granberg T.
        • Martola J.
        • Kristoffersen-Wiberg M.
        • Aspelin P.
        • Fredrikson S.
        Radiologically isolated syndrome – incidental magnetic resonance imaging findings suggestive of multiple sclerosis, a systematic review.
        Multiple Sclerosis. 2012; (Jul 3. [Epub ahead of print])
        • Heesen C.
        • Kolbeck J.
        • Gold S.M.
        • Schulz H.
        • Schulz K.H.
        Delivering the diagnosis of MS - results of a survey among patients and neurologists.
        Acta Neurologica Scandinavica. 2003; 107: 363-368
      5. Higgs R. On telling patients the truth. Moral dilemmas in modern medicine Oxford: OUP. 1985.

        • Kuhse H.
        • Singer P.A.
        Companion to bioethics.
        2nd ed. Blackwell, Oxford2006
        • Levine C.
        Delaying the diagnosis: truth-telling and multiple sclerosis.
        The Hastings Center Report. 1983; 13: 2-3
      6. Lo B. Avoiding deception and nondisclosure. In Lo B. Resolving ethical dilemmas: a guide for clinicians, 4th ed. Baltimore: Lippincott Williams & Wilkinsons, 2009.

      7. Maguire P, Fairbairn S, Fletcher C. Consultation skills of young doctors: II—Most young doctors are bad at giving information. British Medical Journal (Clinical research ed). 1996; 292(6535):1576.

        • Maynard D.W.
        On “realization” in everyday life: the forecasting of bad news as a social relation.
        American Sociological Review. 1996; : 109-131
        • McDonald W.I.
        • Compston A.
        • Edan G.
        • et al.
        Recommended diagnostic criteria for multiple sclerosis: guidelines from the International Panel on the diagnosis of multiple sclerosis.
        Annals of Neurology. 2001; 50: 121-127
        • McFarlane J.
        • Riggins J.
        • Smith T.J.
        SPIKE$: a six-step protocol for delivering bad news about the cost of medical care.
        Journal of Clinical Oncology. 2008; 26: 4200-4204
        • Meredith C.
        • Symonds P.
        • Webster L.
        • Lamont D.
        • Pyper E.
        • Gillis C.R.
        • et al.
        Information needs of cancer patients in West Scotland: cross sectional survey of patients' views.
        Bmj. 1996; 313: 724-726
        • Miyaji N.T.
        The power of compassion: truth-telling among American doctors in the care of dying patients.
        Social Science & Medicine. 1993; 36: 249-264
        • Mushlin A.I.
        • Mooney C.
        • Grow V.
        • Phelps C.E.
        The value of diagnostic information to patients with suspected multiple sclerosis.
        Archives of Neurology. 1994; 51: 67
        • Oken D.
        What to tell cancer patients.
        JAMA: The Journal of the American Medical Association. 1961; 175: 1120
        • O'Neill O.
        Autonomy and trust in bioethics.
        Cambridge University Press, 2002
        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • Clanet M.
        • Cohen J.A.
        • Filippi M.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria.
        Annals of Neurology. 2011; 69: 292-302
        • Ptacek J.
        • Eberhardt T.L.
        Breaking bad news.
        JAMA: The Journal of the American Medical Association. 1996; 276: 496
        • Rabow M.W.
        • Mcphee S.J.
        Beyond breaking bad news: how to help patients who suffer.
        Western Journal of Medicine. 1999; 171: 260
        • Salander P.
        Bad news from the patient’s perspective: an analysis of the written narratives of newly diagnosed cancer patients.
        Social Science & Medicine. 2002; 55: 721-732
        • Solari A.
        • Acquarone N.
        • Pucci E.
        • Martinelli V.
        • Marrosu M.G.
        • Trojano M.
        • et al.
        communicating the diagnosis of multiple sclerosis – a qualitative study.
        Multiple Sclerosis. 2007; 13: 763-769
        • Storstein A.
        Communication and neurology – bad news and how to break them.
        Acta Neurologica Scandinavica. 2011; 124: 5-11
        • Sullivan R.J.
        • Menapace L.W.
        • White R.M.
        Truth-telling and patient diagnoses.
        Journal of Medical Ethics. 2001; 27: 192
        • Swanton J.K.
        • Fernando K.
        • Dalton C.M.
        Modifi cation of MRI criteria for multiple sclerosis in patients with clinically isolated syndromes.
        Journal of Neurology, Neurosurgery, and Psychiatry. 2006; 77: 43
        • Swanton J.K.
        • Rovira A.
        • Tintore M.
        MRI criteria for multiple sclerosis in patients presenting with clinically isolated syndromes: a multicentre retrospective study.
        Lancet Neurology. 2007; 6: 677-686
        • Vandekieft G.K.
        Breaking bad news.
        American Family Physician. 2001; 64: 1975