‘‘Coming Out’’ as Patients 165
expressed, and how information was framed. Only since being a patient
himself did Lou realize the need to be positive with sick coworkers.
With other colleagues who are patients, I try to be upbeat, and
more cheerful. ‘‘What are you doing for fun?’’ I ask, ‘‘How are you
doing?’’ if they want to talk about the illness.
Lou’s comments raised dilemmas as to whether and when such attempts
at positive framing may verge on denial.
Either conflicts or mutual enforcement concerning disclosure may
ensue. At one extreme, both parties may be ambivalent about discussing
a coworker’s illness, leading to mutual silence. Deborah said colleagues
avoided her, and she then eschewed them as well.
They often ignore me, and I kind of ignore them, too, because I
don’t want to get into it. Or they just don’t know what to say.
I don’t ever call them on it—go up and say, ‘‘Hi.’’
Preferences for or against disclosure can thus collide. Doctors, colleagues,
and patients may benefit from being more aware of the implications of
these contrasting preferences and needs. No doubt, patients who work in
nonmedical fields encounter similar complex interactions and potential
tensions. Yet the experiences here reveal critical attitudes and insen-
sitivities of doctors that can shape their views of patients more broadly.
Telling Patients
Ill physicians struggled as well with dilemmas of whether and what to
disclose concerning their health and personal life to their patients. Should
patients ever know about a providers’ illness, and if so, when? Do pa-
tients have a right to such information? Who should decide? Divulged
information can shape a professional relationship. At core, these physi-
cians faced difficult quandaries of what is professional in these matters.
These issues arose prominently among doctors with HIV, but also
appeared among doctors with other disorders. HIV is infectious, carries
particular stigma, and constitutes an epidemic, affecting many others.
Though the infection could potentially harm a patient’s safety if an HIV-
infected surgeon worked in a closed, not visible, body cavity, the HIV-
positive doctors here all rigorously avoided such a possibility. Yet ill
doctors, particularly those with potentially life-threatening disorders
(e.g., cancer), confronted similar and related questions, even if at times to