Silence as a manner within the doctor's epistemic posture during the diagnostic process: A case study in a French hospital

The notion of silence often emerges between the lines in studies on diagnosis and the disclosure of bad news to patients. However, silence rarely takes center stage in such studies, risking an underestimation of its significance. This study, conducted through observations and semi-structured interviews in a hospital specializing in liver and pancreatic diseases, centers its analysis on the role of silence. It explores how institutional norms and constraints shape doctors' use of silence during consultations and diagnostic processes. The findings reveal that silence, understood as withholding information or concealing the name of a disease, serves distinct functions: in the pre-diagnostic phase, it helps prepare patients for the possibility of illness while respecting institutional expectations; at the moment of diagnosis, it reinforces doctors' adherence to a scientific framework. This research argues that silence is a central attitude of the doctor's epistemic posture, mediating the complex interplay between institutional demands and patient care.