172 Becoming a Patient
reveal. If a doctor divulged a positive HIV status, should he or she re-
veal the mode of viral exposure (e.g., sexual activity)? Physician nondis-
closure or misrepresentation may also skew and dampen the doctor-
patient relationship.
Currently, physicians make these decisions by themselves, since at least
initially, they alone possess this information, while their patients do not.
Patients may want, or feel they have a right to, this knowledge, and may
indeed have such a right, if it is pertinent to their health (10). But these
determinations can pose complications (e.g., whether such patient concern
should ever trump the physician’s right to privacy). Patients’ claims in-
volve their physical or psychological health, while physicians’ rights may
involve protection against potential stigma and discrimination. Here, the
degree of threat to a patient’s health may be key. Patient death or serious
physical harm clearly could trump a physician’s right to privacy, yet pa-
tients may claim, without merit, that they suffer psychological distress
from knowing that their physician is ill. Even if they remain uninfected,
patients have attempted to sue—though unsuccessfully, given the low
degree of actual harm—HIV-infected physicians who had not disclosed
that information (11). Moreover, discrimination and stigma of physicians
could impair their psychological well-being.
Questions also arise of whether and when a doctor should tell patients
that he or she knows that he or she may not or will not be able to provide
long-term care to patients (due to retirement or change of job). Especially
in psychiatry, the loss of a physician can distress fragile or vulnerable
patients, exacerbating symptoms, and possibly decreasing patient adher-
ence, and hence health outcomes. Patients who feel abandoned or be-
trayed may then decide to access future health care less. Hence, patients
may argue that they have the right to this knowledge as well. But do they?
How long before leaving their job should physicians disclose such infor-
mation? These types of knowledge about a physician vary from job change
to serious illness and short life expectancy. Arguably, physicians’ symptoms
of fatigue or decreased concentration could affect quality of care, too,
necessitating disclosure, though the effects on care may be small. None-
theless, dilemmas remain of who should make these determinations,
and how these decisions should be made. Physicians and patients may
hold conflicting implicit definitions of ‘‘appropriate’’ communication.
Physicians should not divulge all ailments to all patients, but should
realize that patients may be anxious about these issues, and view pros and
cons of physicians’ decisions differently than do these doctors themselves.