166 Becoming a Patient
lesser degrees. Bill, the Southern radiologist with HIV, said he’ d prefer to know if his surgeon was intoxicated more than if he had HIV.‘‘ I’ d much rather know if my doctor’ s had three drinks that morning before he takes me to the OR, than if he’ s got HIV. And surgeons who drink: that happens all the time.’’
Yet in day-to-day interactions, principles can conflict with practice. Often, the social contexts of relationships with patients created expectations and pressures for candor. At times, patients observed outright evidence of disease in physicians, and then had to decide whether to inquire. When Lou, the internist with cancer who had an award on his wall, became bald, patients asked about his health, which led to more of a human-to-human, as opposed to doctor-to-patient, relationship:
Since my hair was gone, patients were aware of it. I couldn’ t hide it. They’ d ask how I was, and it deepened the relationship. I didn’ t tell everyone. I didn’ t want them to worry. But if they seemed to notice, I would tell them:‘‘ I’ m on chemo.’’
Given the complex interpersonal dynamics of these relationships, though ethically not obligated to disclose, Lou did so, responding to patients’ queries.
To help patients put their own symptoms into perspective, other doctors divulged, if asked. Brian, who had hepatitis, sometimes felt sicker than his patients, and said so to them.
At times, I’ ve felt sick, and said very jokingly,‘‘ Now don’ t think you have an overwhelming illness. In fact, right now, I’ ve got fever and am probably sicker than you.’’ A few weeks ago, I had a really bad cold and headache, and had to work a night shift. A patient actually said,‘‘ You look like you don’ t feel well.’’ I said,‘‘ You’ re right. I don’ t,’’ and in a joking sense:‘‘ You’ re better than I am right now.’’
For others, questions lingered of what to tell patients who probed. Deborah, the psychiatrist with breast cancer, said,‘‘ Patients were asking,‘ What happened? Where is she?’ Nobody would say anything. That was a dilemma: what to tell patients.’’
The complexities of the pros and cons involved left some doctors utterly unsure and confused about what to say. Simon, a radiologist with HIV who refused audiotaping, terrified that others might somehow learn of his infection, did not want to disclose to patients, and was taken aback,