146 Becoming a Patient
treatment( e. g.,‘‘ I wish I could sleep standing up’’)( 2). Physician divulgences of health behaviors( e. g., diet and exercise) can also motivate patients concerning these behaviors( 3). Psychotherapists’ disclosures to patients of personal characteristics( e. g., religion and marital status) have been probed as well, and remain controversial. A psychotherapist’ s pregnancy, for instance, can evoke a wide range of psychological responses( 4). In psychotherapy, doctor-patient relationships, transference and countertransference, can be critical. Impaired physicians( e. g., due to substance abuse) have received attention, as such impairments may potentially interfere with patients’ receiving optimal quality of care( 5). But physicians’ disclosures of their own serious or potentially fatal illnesses or explicit medical problems— more sensitive areas that may threaten the stability of the doctor-patient relationships— remain relatively unexplored. How does medical information about an individual affect how he or she and others view that individual? As Erving Goffman described in The Presentations of Self in Everyday Life, each day, we all shape how others see us, as if we were actors performing on a stage( 6).
Disclosures at Work: Weighing Pros and Cons
Ill physicians and their colleagues disagreed not only over whether the physician-patient should still work, but also over whether and to what degree he or she should even discuss the illness. Four scenarios emerged that can be conceptualized as a 2 2 grid, in which the sick doctor did or did not want to talk about the disease, and colleagues did or did not wish to do so. These four situations were those in which( 1) both parties wanted to discuss the disease;( 2) the ill physician did not want to talk about it, but colleagues or staff did;( 3) the ill physician wanted to discuss it, but colleagues did not; and( 4) neither party sought to discuss it. These four basic patterns were further shaped by whether the sick doctor knew that colleagues knew of the diagnosis( i. e., that it was a rumor); and whether colleagues knew whether the sick physician knew that they knew( i. e., whether the sick physician was aware he or she was being talked about). At times, colleagues knew, but were unsure whether and how to discuss it.
Several doctors were surprised that‘‘ others don’ t know you’ re sick unless you tell them’’— that their own private trauma, so disruptive to themselves, could be utterly invisible to others.