You suspect a patient may be showing denial about a serious diagnosis. Before revealing the answer, decide how you would assess for this.

Ask the patient directly about the situation and note whether there is a refusal, or an apparent inability, to acknowledge its emotional significance, or sometimes even its basic facts. Observe whether an outward, matter-of-fact acceptance of practical details coexists with the emotional weight of the situation going entirely unacknowledged. Note whether behaviour continues as though the difficult situation does not exist or does not apply to the person, such as making long-term plans inconsistent with a serious diagnosis. Distinguish this carefully from dissociation of affect by assessing whether the acknowledgement of the facts themselves, not merely the matching feeling, is what is missing or incomplete.