‘‘ Coming Out’’ as Patients 159
than I do. It would take only one senior professor to say,‘‘ I’ m not going to work with him in my OR.’’ That would be the same as getting fired.
Larry felt that he had little choice but to conceal, and that, in retrospect, his decision was right. A senior professor later read Larry’ s chart.
One of my professors came to visit me and said,‘‘ Oh, I went through your chart and everything looks ok.’’ I still haven’ t told the clinical director that someone went through it.
Larry felt he had to remain silent even about this violation of privacy, illustrating again colleagues’ insensitivity to the lack or distortion of boundaries.
Still, as a result of his reticence, Larry underwent a‘‘ fancy,’’ costly diagnostic workup that yielded nothing, even though he knew that HIV caused his problem.
Fears of the consequences of disclosure led some to forgo all insurance coverage, despite the potential jeopardy to one’ s health. For a year, Paul had no insurance. At a previous job, he had had to divulge his HIV infection on an insurance form.
There was documentation of me being positive through my previous insurance, so I couldn’ t lie. There was a preexisting waiting period, so I had no health insurance for a year with T-cells of 200!
Regardless of their diagnosis, these doctors feared the increasing loss of privacy in society generally. Erosion of job stability in medicine exacerbated apprehensions of future denial of insurance. Jessica, the pediatrician with Hodgkin’ s, said:
There were subsequent jobs where I couldn’ t get insurance because of a waiting period, or having a‘‘ preexisting condition.’’ I’ m paranoid that some day if I change jobs I will be denied insurance. I just have a general angst— from the media and Big Brother. The less that people know about me, the better.
A nationalized health insurance system could potentially ameliorate these problems, though ill physicians remained skeptical about the likelihood of such a policy being adopted in the United States.
Silence also precluded support or help from colleagues. Several physicians arranged for colleagues to monitor them for subtle symptoms that