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When I saw the tweet of whether a gay physician in a small community should disclose his or sexual orientation come through one of my Tweetdeck streams, my immediate response was, “No.”

After reading this clinical case, I think the same thing.

Here’s the scenario:
Dr. James is a young primary care physician starting out in the rural community of Cedar, where he shares a practice with one other physician; the next nearest outpatient care center is 35 miles away. Dr. James was sorely needed in Cedar. His colleague is minimally trained in obstetrics and gynecology, and Dr. James has a special interest and training in women’s health. He likes the size of the community and believes he makes a difference in the health of his patients. He has become Cedar High School’s sports medicine physician and volunteers at other civic events within the community. Dr. James is gay, and although he was out during medical school and residency, he has not been open about his sexual orientation within the Cedar community for fear of the reception he might receive.

Dr. James sees Mrs. Raymond often. She is a friendly woman having a complication-riddled pregnancy. One day after her exam, Mrs. Raymond and Dr. James were chatting about Cedar High, where Mrs. Raymond’s oldest child was due to start in a couple of months. Mrs. Raymond alluded to a recent controversy in a nearby town over a student’s desire to bring a same-sex date to his senior prom and said, “I’m just worried…how can we be sure kids here aren’t…that way? Dr. James, is there anything you can do to make sure there’s nothing like that going on at Cedar High? You try to keep your kids safe, to protect them, but you never know what bad influences are out there.” Dr. James did not speak, so Mrs. Raymond continued, “I mean, if I ever found out that there was one of them here—especially a teacher or a coach—I don’t know what I’d do.”

I understand that the case raises ethical questions about patient-physician relationship. Are patients really entitled to know private details about their physicians? I would again say, “no.” Do physicians have a duty to disclose such information to their patients? No.

In this particular case, Dr. Jones’s decision to disclose his sexual orientation is a personal and complicated one with risk and benefits that he can only weigh.

What are your thoughts?

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