‘‘Coming Out’’ as Patients 147
As we shall see, each of these roles—doctor, colleague, friend, and
patient—involved varying norms, desires, and expectations of truth-
telling that could clash.
Tell Why?
Despite the potential dangers, for several reasons these doctors decided to
disclose their illness to colleagues. Some of these ill physicians simply
could not hide their disease; the severity and symptoms were too obvious.
Jim, the drug company researcher, disclosed his lymphoma to everyone
because he felt he had no alternative. ‘‘I was so sick, and knew I was going
to be dealing with this for a long time, and be out of work. To try to conceal
this just never would have worked.’’
Long-standing relationships with colleagues could instill expectations of
disclosure, particularly about less stigmatized disorders. Bradley disclosed
his MI to his boss, since they had known each other for over four decades.
‘‘I’d been in the same place for forty-five years. The flow back and forth is
pretty high about personal as well as professional things.’’ Hence, over
time, professional and personal boundaries can blur.
Others chose to sacrifice some privacy in return for certain benefits,
making risk/benefit calculations about disclosure. David, the psychiatrist
with HIV, worked for a government clinic, and knew he could not be fired
because of his illness. Initially, he disclosed to avoid being on call. (‘‘My
boss said, ‘‘If there’s anything that we can do. . . .’’ I said: ‘‘Yeah, get me off
call!’’)
But those who disclosed had to decide, too, how much and what in-
formation to provide concerning prognoses over time, and when and
whether to reveal test results that marked worsening disease. A physician
may divulge the ‘‘basic problem,’’ but not later test findings that show a
worsening prognosis. Between the two extremes, gradations of infor-
mation existed. For example, Lou, who had an award on his wall, didn’t
tell coworkers when he had follow-up studies. ‘‘I had CTs every six
months. They were negative. But I didn’t say anything because people
might say, ‘Well, they could be positive!’ ’’ He feared that colleagues
would see even his need for follow-up as evidence of his continued high
risk for disease.
Illness might be discussed only indirectly, in code or euphemistically.
These ciphers might or might not be correctly interpreted. Albert, who