‘‘ Coming Out’’ as Patients 173
Providers may decide not to disclose, but should then be aware of how these decisions may impact patients. Alternatively, despite ethical justifications of reticence, doctors may volunteer information. But they may not be as aware as they should of the potential risks and benefits involved. These discussions need to take fully into account the nuanced and intricate social contexts of suffering and emotional difficulties faced by doctors( e. g., when patients ask) and by patients( e. g., whether to ask). As suggested here, a physician who decides that disclosure is not appropriate could respond to a patient’ s query not by ignoring or evading it, but by acknowledging it and alluding to the dilemma involved— for example,‘‘ We could discuss my health, but I think it makes more sense to focus on your health here today.’’ In any case, these concerns illustrate the delicate tensions involved in doctor-patient relationships.
Going Public
These doctors wondered, too, about disclosing even more broadly beyond the confines of the doctor-patient relationship— to the public-at-large. At times, larger groups, including the media, were interested in a physician’ s illness. To varying degrees, a few doctors opted to go public. Several announced their status widely for a range of reasons: because it might help others, or because the pressures of secrecy became too much. Yet, in retrospect, many who did so regretted it. In the fiercely competitive field of medicine, some wanted or planned to go public, but decided to wait, at least for the moment.
A few wanted to write about their illness. Deborah, the psychiatrist with breast cancer, considered doing so, but chose not to, because it could jeopardize her future.
I decided to write about all these things. But at the last moment, I decided not to, because of discrimination: I was going for job interviews. I couldn’ t be exposing myself early in my career. Once I got established, it would be different.
Sadly, nine months later, Deborah died, never having penned her experience.
These issues of public announcement arose prominently, though clearly not exclusively, with HIV. A few with HIV dared to go public officially, involving the media, in order to make a broad political statement.