Telling patients the truth about their medical histories and conditions promotes a trusting doctor-patient relationship, signals openness (the opposite of shame), reduces the sense of stigma, and enables patients to understand the health and quality-of-life benefits of adherence to medical care. Patient-centered care by definition cannot occur in the absence of truth-telling. Truth-telling needs to be geared to the child’s maturity and is most likely to succeed when it is accomplished in the context of a trusting patient-doctor relationship, one in which an atmosphere of trust has been fostered. In such circumstances, children feel comfortable asking questions and answering questions.

When clinicians are telling the truth to patients, the parents should be present so that there is no misunderstanding. The explanations should be geared to the developmental level of the child and the questions being asked. Full disclosure of the medical facts should typically occur at the latest by age 16 in cooperation with the parents and mental health members of the team. When a patient goes to obtain his or her records at age 18, he or she should find no surprises.