Dialectics of disclosure: Communication Privacy Management in provider–patient conversations about sexual health

BACKGROUND: Conversations between physicians and patients about sexual health are influenced by interpersonal dynamics and social expectations, which shape how patients disclose sensitive information. The theory of Communication Privacy Management reveals inherent tensions and motivations for revealing and concealing private information, particularly in the context of broader cultural discourses. METHODS: In-depth interviews with 20 female patients revealed how privacy management is shaped by broader discourses about clinical communication. RESULTS: Themes involve traditional dialectics of openness/closedness, conventionality/uniqueness, and emotional subjectivity/logical objectivity informed by cultural discourses around being a 'good' doctor or 'good' patient. Two novel dialectics are introduced. The first addresses 'their time/my time', which discusses the tension between valuing the patient's time and valuing the doctor's time. The second explores 'high power/low power' where patients discuss dilemmas around patients claiming their power. CONCLUSION: Theoretical advancements in Communication Privacy Management and practical implications for physician training are discussed.