56 Becoming a Patient
infection to sexual partners when using condoms. But he now wanted to
set a moral example. He wondered whether doctors had different moral
obligations than did nondoctors, and if so, how, and what the implications
were if they did not follow their own standards.
I like to set an example. If an HIV-positive person fucked with a
condom and didn’t tell his or her partner, that would be ok. But
I don’t feel it’s ok for me: it’s a slippery slope. I want to hold myself
to a high ideal, so I don’t deviate from it.
However, Kurt felt guilty because he had gone further, and had even had
sex with a former patient.
I’ve been so ‘‘off’’ in the past. I ran into people who were patients.
A former patient—I had been fired—had sex with my boyfriend,
and I had sex with someone else in the same bathhouse room. This
patient had a problem with crystal meth, and was whacked out
of his mind. So was I. I felt really awful—because I was his doctor,
and was getting fucked by some other guy without a condom,
and he was fucking my boyfriend without a condom. I should be
setting an example!
Yet moral standards may not always be clear. If an MD should adhere
to the highest possible standard, what was it? Kurt wondered, for ex-
ample, whether he was obliged to disclose to partners if he engaged with
them in oral sex.
If I’m in a park or a bathhouse, I’m not sure: Do I have to tell them
I have HIV? Am I morally obligated? Ideally, especially since I’m a
physician, I should tell everyone. I like to hold myself to that
standard. So when I don’t do that, I start questioning it. If the
condom breaks, do I tell them then? What is ok, and what isn’t?
He remained unsure.
The fact that these doctors deviated from their preaching illustrated the
degree to which knowledge alone was insufficient to alter health behavior.
Perhaps with patients in general, incentives can help. For example, in-
surance companies can request that patients engage in preventive care, or
pay higher premiums. Such approaches may or may not work, but these
doctors’ experiences clearly raise the need at least to consider such pos-
sibilities, given the deep psychological obstacles that exist.