‘‘Coming Out’’ as Patients 169
was going on. Suddenly, it solved my problem. I dreaded the next
three months, of people saying: ‘‘What are you going to do?’’ In-
stead, everyone understood.
Occasionally, doctors disclosed to patients in order to motivate the
latter to improve the therapeutic alliance, and start or adhere to treat-
ments. Physicians then had to gauge when the information would be use-
ful (e.g., ‘‘if it seems to serve a purpose’’).
Others told when they became frustrated at patients’ complaints about
relatively minor matters. To a patient who complained all the time, Nancy,
with metastatic breast cancer, disclosed in utter frustration. Again, quan-
daries arose as to the appropriate boundaries between doctor and patient—
specifically, when, if ever, the doctor may be shifting these too far by
divulging too much. Nancy explained:
I became exasperated with this man, because all he did was com-
plain: He had a horrible wife, was overweight, had diabetes, was
depressed, his wife was having more children, and he was $300,000
in debt. He felt that everything we suggested was not going to
work. . . . I lost my patience and said, ‘‘Look, you want to know a
real problem? I have a real problem.’’ He was shaken, and I admit it
was not very professional for me to do. But it did take him aback a
little. I said, ‘‘You have the ability to make yourself better, and I don’t!
You should do that. I wish I could.’’
Nancy saw her display of emotion as unprofessional, but felt that in the
end, it benefited her patient. Physician anger and frustration may not be
appropriate to express, but are all such displays of emotion or personal
issues taboo? Should physicians always remain cool and detached? Doc-
tors may in fact hide behind façades. Questions arose as to the degrees to
which physicians did hide, and the costs involved. Perhaps a physician’s
display of emotion can at times motivate or otherwise benefit a patient,
though when and why need further clarification. As the field becomes
technologically more effective in treating disease, perhaps the norms of
professional demeanor among physicians should change to permit more
human interactions and emotion than some doctors now allow.
Some physicians disclosed their illness to impel patients to continue to
work and not retire on disability. Mark, the internist with HIV inter-
viewed in the diner, disclosed to discourage a patient who desired to leave
work prematurely.