‘‘Coming Out’’ as Patients 167
unprepared, when they inquired. ‘‘A patient asked me if I’d been tested,
and I went blank. I don’t remember what I said. A technician was there.
I suppose I said something that was inappropriate.’’
The profession itself may impede disclosure, as colleagues may not
want a physician’s patients to know. For example, after returning from
her hospitalization, Deborah wanted to see her first long-term patient, who
‘‘was taken away from me. I really wanted to tell her what happened—I
never had the chance.’’ Institutions can erect structural barriers to decrease
physicians’ revealing their disease.
Patients might be told only if they asked. Pascal, the Lebanese inter-
nist, informed patients only if they inquired.
Yet patients may also ask inappropriately. For example, a patient once
rudely interrogated Mark, the internist with HIV whom I interviewed in
a diner over lunch.
A straight woman in her late thirties with the flu walked in off the
street with her boyfriend—white-trash type. But regardless, I
wasn’t just going to give her antibiotics and send her out; that’s not
the way I practice medicine. She was having some difficulty
breathing, and I was thinking about the possibility of pneumocys-
tis. So I asked her if she had ever been tested for HIV. She got
indignant, and said, ‘‘Yeah, about three years ago.’’ Her boyfriend
was there, and maybe she was bothered about discussing it. I said,
‘‘And it was negative?’’ She said, ‘‘Yeah,’’ and . . . she turned around
to me and said, ‘‘And you?’’. . . I said, ‘‘Yeah.’’. . . ‘‘And?’’ I said,
‘‘. . . I’m positive.’’ Her mouth dropped. . . . I thought: this could
come back to haunt me. . . . But I’d already decided I’m not going to
live like that. . . . I’m sure she’ll never come back, but that’s fine.
Patients may wonder about a physician’s health, but be afraid to inquire
or feel that to do so would be inappropriate. They may feel awkward and
uncomfortable asking, and hence wait to be informed. Stuart, the internist
with HIV now teaching at the university, said another physician’s patients
would not inquire, but hoped to be told. They refrained from asking due
to both their sense that such personal inquiry was ‘‘taboo,’’ and their own
fear and denial of their physician being ill or dying. About one colleague,
Stuart said:
This doctor had K.S. [Kaposi’s sarcoma, an AIDS-defining diag-
nosis, consisting of large purple splotches] on his face, and patients