Being a physician has challenges and benefits. I had this explicit discussion with my new intern and resident this morning (special holiday schedule team). When we walk into a patient’s room and introduce ourselves, the patient and family generally like and respect us. We start out receiving the benefit of doubt and only lose repect when we do something wrong. The public rates us highly. Our profession remains admired, even in these times. Patients will tell us anything. We learn more about human nature than most people ever want to know. This can cause some stress – A Young Doctor’s Hardest Lesson: Keep Your Mouth Shut

An unspoken but ever-present issue in the life of any doctor is an immodest, completely nonmedical concern: are doctors boring people? Sober and serious, surely. Respectable and educated, one hopes. A bit stuffy at times, perhaps. But dreary? As a profession, I think we do tend to run on the dry side, though till recently the reason had eluded me. Then, last month, my wife and I bumped into an acquaintance of hers while walking along the street. The person, unbeknownst to my wife, is a patient of mine, someone whom I treat for a chronic infection. After the patient and I shared a moment of mutual panic, we three chatted amicably and moved on. Except, that evening, my wife kept asking me why I was being so quiet and, well, boring. And I suddenly saw the problem: doctors are waterlogged with secrets, hundreds of them, thousands of them. Each day brings a new batch: patients’ admissions about drug use or sexual indiscretion, a hidden family, a long-held dream, an ancient heartache, undisclosed H.I.V. infection. Over the years, this begins to add up, the bulge expands, the joints get stiff. Yet the secret – the consequences of our ever-expanding repository of others’ secrets – remains, well, secretive. The situation simply is not addressed, not at the start, middle, or the end of a career.

While I am not certain that I agree with the author, he has certainly made me think. The culture of medical training leads to us having a very different view of people and illness. We do understand the consequences of indiscretion. We understand human frailty.

Other professions that traffic in secrets typically maintain silence for a fixed period: lawyers and spies, accountants and politicians, mobsters and four-star generals. Power or leverage is at stake, but once things settle, the gabfest can resume. But for us, the silence is forever. The consequence of this tight-lipped life is readily evident anywhere young doctors have congregated. Exploiting the single loophole in the code of silence – chatting up one another – they busily swap stories about patients. Near-maniacal peals of laughter are heard as the latest "I once saw this woman in the E.R. who" tale is recounted. The hilarity, the need to yelp, surely derives from something other than the quality of the story at hand. I know this because, um, I have transgressed a few times, to try out a story on someone not medical. And rather than hearing the appreciative party guy hoot of laughter, I receive only a confused squint. So we learn to keep quiet about the whole thing, trusted advisers in the persistent palace intrigue. But conducting business this way is confusing. What is off limits, and what remains in play? Can I say this or that? Pretty quickly, it becomes clear that the easiest and safest – though the quietest and dullest – approach is simply to shut up concerning just about everything.

To this day – almost 30 years since graduating from medical school – I have stories, really funny stories, that I can only tell to other physicians. Non-physicians do not see the humor and even find the stories gross or insensitive. As a 3rd year medical student, I wondered why we always talked about medical incidents when we got together. After a long work week, here we were swapping war stories. Several weeks ago I visited my medical school – where I also did my residency. I ran into one of my fellow interns (now the chief of pulmonary medicine). We quickly degenerated into remembering war stories about patients. I guess we live in a "secret society". We must hold these stories confidential – except as stories to share with colleagues (omitting names and identifiers of course). But, it really is not a lonely life. It is a life full of the privilege of caring for others. But we often cannot talk about it or explain it. And maybe that is as it should be.

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