"I told a woman I share a little office with," a woman at risk of Huntington's Disease recently told me. This woman's father had this disease, caused by a lethal mutation; and she feared she had it, too.
"Somehow, it just spilled out," she added. "Then I felt, 'Oh sh**!' I swore her to secrecy. But I then had to share what I was going through. I feel she's watching me, listening to my phone calls, wondering if I'm OK... I feel exposed, and wished I had kept it to myself."
Coworkers occupy peculiar in-between roles in our lives. Most days, we spend at least half of our waking hours with them. They can be close -- "work friends." And our social and work worlds often overlap. Friends may be, or may know, coworkers.
But while we can select our friends, we cannot generally choose our coworkers. Disclosing our personal problems to them can offer advantages, generating social support.
But at work, the norms of privacy, secrecy, and trust are often murky. We'll talk about what we did over the weekend, and at times about weekend benders, but rarely discuss diseases, or mutations we have.
With good or bad intentions, fellow employees can convey personal information about us to others, including bosses, prompting stigma and discrimination. Our colleagues can be unsupportive, even competitive, using our potential weaknesses to advance their own careers.
Hence, many patients, fearing prejudice, face dilemmas and hide diagnoses, disclosing medical information to these individuals only with extreme caution. Quandaries arise, especially with stigmatized types of medical information such as depression and other mental health problems, incurable cancer, or genetic mutations. Yet such secrecy can cause stress, exacerbating symptoms.
Universal health care can reduce the potential harms of leaks of personal health information. But until such laws are passed, we will all soon have to face difficult decisions.
Some people don't think about it beforehand, and readily disclose such conditions to coworkers.
But those who do so often later feel that they have been too trusting. The Americans with Disabilities Act (ADA) and the 2008 Genetic Information Non-Discrimination Act (GINA) were intended to prevent discrimination, but many patients remain leery. Discrimination can be subtle and hard to prove. GINA, for instance, covers health insurance, but not disability, life, or long-term care insurance. Moreover, employers may find it cheaper to fire patients and pay a fine than to cover increased insurance costs over decades. Indeed, despite years of legislation, discrimination based on race and gender continue.
Yet in an office, secrecy can be hard. The information can "slip," or get blurted out, or "leak." People cannot always conceal strong emotions about diseases they face.
"I spilled my guts to my coworker," a woman with a family history of breast cancer recently told me. "We were having a meeting, and I had just had a genetic counseling appointment. I couldn't help saying something because I knew I seemed negative." She had just learned that she had a mutation for this disease, despite having no symptoms.
But, once told, coworkers know forever. The information cannot be "untold," and chronic diseases and mutations do not go away. She feared that she would be subtly discriminated against.
To disclose is to enter the "sick role," and individuals thus encounter questions about when to take on and abandon this position. Coworkers can become jealous of an employee who goes on disability without seeming to be severely ill; yet colleagues can also offer support. Hence, patients face conflicts, and need to carefully assess coworkers' implicit attitudes, and indirect comments -- whom to trust.
Before disclosing a diagnosis to coworkers, some patients say, "I want to tell you something, but would like you not to tell others. Is that OK?" Such statements are not foolproof, but can at least establish expectations of confidentiality. In the end, it is up to each of us to respond to each other's wishes for privacy as much as we can.
Still, the eventual effects, whether good or bad, of a disclosure cannot always be predicted. Patients' fears of negative repercussions may prove unfounded. After all, as coworkers and friends, we can and should help each other, and fight prejudice in ourselves and others.
In fact, disclosures can generate support. In the end, even the woman at risk of Huntington's was glad that during this traumatic year, she had, "one person out there who knew." She was grateful for the succor her officemate gave.
Disclosures can also become mutual, fostering closeness. Often, one does not know about another person's illness until disclosing one's own. Ultimately, the woman above who confronted breast cancer found that her confession helped. "Everybody has something. You don't know until you talk," she told me. "My co-worker has been more open now. He has diabetes and gives himself shots five times a day. But he's so discreet... Maybe there's a reason he didn't talk about it before."
She looked at me and smiled slightly. "All he needed was someone to ask..."
For more by Robert Klitzman, M.D., click here.
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