‘‘Coming Out’’ as Patients 177
The consequences of secrecy with families can be very costly. When his
family visited, Charles, the underground researcher, had to ‘‘de-AIDS’’ his
home and ‘‘hide my medicine.’’ If they knew, he feared they would de-
value him: ‘‘I have to imply to them that I am gainfully employed. To tell
them would worry them. And I’d lose stature in their eyes.’’
In short, these doctors faced questions of whether, what, when, and to
whom to disclose their illness, as they sought to shape how others saw
them. Some readily disclosed, but others did so only indirectly, in code or
nonverbally. Workplace norms mitigated against personal revelations, and
many opted for silence. Broader loss of privacy in contemporary society,
and especially in hospitals, compounded these concerns. Yet noncom-
munication also carried costs: reduction in potential support, increase in
isolation, and impediments to care. Secrecy could require mendacity and
psychic energy; prevent these physician-patients from entering the sick
role with its attendant advantages; and lead to social awkwardness and
feelings of being ‘‘stuck’’ in jobs. Disclosures could be difficult, too, as
colleagues were fellow physicians, and could be friends—occupying three
roles that at times conflicted. Supervisor-friends may ‘‘just want to know’’
a diagnosis—as friends. Coworkers may know a diagnosis, but not whether
or how to talk about it.
These physicians struggled not only with whether to tell colleagues, but
whether and what to tell patients—some of whom noted evidence of their
physicians’ disease, and asked directly or indirectly in ways that these
physicians felt were appropriate (or not). These decisions—whether to
prevaricate or not—could shift doctor-patient relationships.
A few of these physicians went public, though in so doing, taboo
diagnoses such as mental illness and HIV posed particular hurdles. Going
public required a high degree of acceptance of one’s illness and an ability
to tolerate the potential career costs. Many longed to go public, but felt
they could not.
Disclosure often emerged here as a process less of strictly individual
decisions, and more of dynamic, two-way interactions. Yet past literature
on illness disclosure has generally not examined expectations of those
who are disclosed to, and their reactions (12).
Expectations and pressures from others concerning divulgence were
often powerful and unanticipated. These internal and external pressures
intensified stresses with which, as we shall see, physicians then struggled
to cope.