‘‘Coming Out’’ as Patients 153
Tom said: ‘‘Do you lie, and say to the dentist, ‘No, I’m not positive,’
because you figure it’s ridiculous, and you’re not putting anyone at risk’’?
These dilemmas proved difficult.
Pharmacies can also infringe on privacy. Tom, whose lover died of AIDS,
felt pharmacies provided no confidentiality. ‘‘They shout out, ‘Zoberex for
Jones!’ Everybody around, including my patients, then knows.’’ Though the
1996 Health Insurance Portability and Accountability Act (HIPAA) has
increased awareness of the need for privacy, significant concerns remain.
Another risk of disclosure is that one can never ‘‘untell.’’ Once it is
out, information can never be reconcealed; rather, it takes on a life of its
own. Information soon becomes an independent entity, separate from the
initial owner and intended recipient. Once divulged, the information can
no longer be truly owned, controlled, or contained. Steven, the suburban
endocrinologist, needed to tell someone, but now regretted having done
so. He informed two coworkers from whom he was now estranged. He
had considered sharing it with others, but was glad he had not.
My natural inclination was to share it with somebody. I needed to do
that. In retrospect, I wish I hadn’t. It hasn’t resulted in any bad
consequences yet, but that’s always lurking in the back of my mind—
that people I told ten years ago will not use that information in my
best interests. I told two friends. We’ve since parted ways.
Interpersonal relationships can wax or wane unpredictably with time,
complicating these disclosure decisions. Yet most of these doctors hadn’t
considered possible changes in relationships over time as potentially
threatening privacy.
In addition to discrimination concerns, ill physicians decided not to
disclose diagnoses because of fear that others would see them as ‘‘pa-
tients’’ and ‘‘ill,’’ rather than as ‘‘doctors,’’ or ‘‘whole’’. Lay patients, too,
often feel that their physicians treat them merely as ‘‘diseases.’’ Yet an ill
lawyer or accountant may still be seen as a lawyer or accountant, while
these ill physicians feared no longer being seen as doctors.
Physicians also may hide symptoms because of embarrassment at in-
capacity, loss of control over their body. Eleanor reported about her ill
husband:
People called me: ‘‘I stopped by, and he refused to see me.’’ He’d
say, ‘‘I was too tired; I wasn’t feeling well.’’ But his debility