162 Becoming a Patient
conflict of interest. He had to ensure first the best interests of the clinic,
not of individual employees within it. Hence, he tried to separate his
knowledge of Anne personally from his professional decisions.
Awkward situations emerged, too, if colleagues asked each other about
their health status ‘‘just as friends,’’ since over years at a workplace, per-
sonal and professional boundaries soften. Steven, the suburban endocri-
nologist with HIV, worried about colleagues inquiring if he’d ever been
HIV tested. He decided he would answer, ‘‘ ‘Everything is going ok’—
which is not a lie.’’ Here, he distinguished between full and partial truths
and lies. Steven felt he would be comfortable giving truthful, but only
partial and incomplete, information.
Yet failure to disclose can cause tensions, as some colleagues may know,
and disapprove of the dissembling. Given the consequences, Tom did not
list alcoholism on a form, but was confronted about this prevarication by a
fellow Alcoholics Anonymous member and colleague.
A hospital application asked about substance abuse. I knew one of
the guys on the credentials committee from AA. He’s an asshole,
and had his secretary call and say, ‘‘Are you sure you don’t want to
answer ‘Yes’?’’ I said, ‘‘I’m quite sure. Have him call me if there’s a
question.’’ He called: ‘‘I’m confused.’’ I said, ‘‘It’s none of their
business. I’ve never been in treatment, and frankly, you’re violating
my confidentiality by bringing it up! He was overstepping his
bounds. I would prefer to be 100 percent truthful. I like it when
they ask, ‘‘Do you currently have a problem with substance abuse?’’
That’s easy: No.
Tom illustrated the intricacies of different moral and psychological cal-
culations.
Perceived intentions underlying others’ questions about one’s health
shaped perceived responsibilities to tell the truth. Some of these ill doc-
tors felt lying was permissible, depending on who was asking, and why,
and whether the questioner really needed to know. They felt that the
potential harm from truth-telling could outweigh the benefits and possi-
ble moral censure incurred through lying.
Colleagues may suspect, even if they do not definitively know, a phy-
sician’s diagnosis, but be unsure how to discuss it or offer support. Nancy,
the endocrinologist with metastatic breast cancer, reported: