‘‘ Coming Out’’ as Patients 161
Fears of disclosure led some to stay in jobs they would otherwise leave—‘‘ stuck,’’ wary of job or insurance discrimination if they moved. Others avoided particular jobs because disclosure would be necessary. Thus, the need for secrecy can limit one’ s type of practice. Pascal, the internist with HIV, felt trapped because if he were in private practice, he would have to try to purchase his own insurance. If not for his illness, he would have been‘‘ more aggressive’’ in his career.
I might consider doing private practice. I want to be my own boss. But I’ d have to buy insurance.... That’ s why I work for an institution. I don’ t like it, but can’ t move.
Blurring Boundaries: Colleagues’ Reactions to Disclosure Decisions
‘‘ Don’ t tell me too much,’’ Anne’ s boss told her. Within the tight subculture of the workplace, colleagues may not want to know about or discuss a coworker’ s illness. Colleagues may be aware of, but not speak of, a colleague’ s disorder in order to preserve and respect privacy and‘‘ professional’’ norms. About his colleagues, Peter said,‘‘ They want their privacy. We’ ve never even sat down and had a meal together!’’
Yet an ill doctor’ s right to privacy could potentially conflict with his or her patients’ rights to learn the physician’ s diagnosis. Coworkers— particularly superiors— may‘‘ not want to know,’’ since disclosure at work can raise liability concerns. Divulgence to a boss can complicate subsequent interactions. Roxanne, the gastroenterologist with cancer, said,‘‘ I told my boss. It adds an extra level of complication to the relationship. He doesn’ t want to think,‘ Here is a liability. She could die.’’’
Professional aspects of a relationship can hamper not only disclosure to colleague-friends, but also the ability of these individuals to offer support, especially if they occupy different levels in the medical hierarchy. Colleagues who have specific political influence over one’ s career may not want to know much about an illness, since it can precipitate a conflict of interest. Anne, the Swiss internist, was explicitly told by her boss:‘‘‘ It’ s not good to say too much.’ That was painful for me. I don’ t think I was asking for more than support.’’’ Clearly, definitions vary of what is‘‘ too much.’’ Evidently, Anne’ s boss felt he had to separate his personal and professional roles as much as possible in order to avoid a