Pediatric Neurology Part I: Chapter 9. Announcing the diagnosis: counselling the parents (Handbook of Clinical Neurology)

Diagnosis appears as a triumph, crucial for further therapeutic endeavors. Yet, what is said may be misunderstood. New, even helpful, diagnosis may be disturbing. All we have is information. It is necessary to know the person and to understand the context in which diagnosis is given, by a senior, in privacy. What may seem “good news” to the neurologist may be tempered by the scale of the ordeal that has to be faced by the child and family. To understand the frustration of the parents obliges us to look at some of the motives for having children. The stages of grief are shock, denial, depression, guilt, and coming to terms. “Psychological defences” consists of repression, denial, projection, displacement, rationalization, and sublimation. Diagnosis represents a potential major and irreversible life change. As for any other medical act, announcing to parents that their child has severe neurological sequelae consists of an irreversible decision in which the physician is often faced with situations for which written regulations are clearly insufficient. Indeed, moral duty dictates injunctions that pull the decision in opposite directions: loyalty in announcing a terrible truth but protection from dreadful moral sufferance.