OHSU Researchers, Collaborators Make Recommendations to Self-Treating Physicians
04/12/04 Portland, Ore.Study examines health care benefits and disadvantages when physicians treat themselves
An analysis of self-doctoring among physicians shows that while the practice has benefits, it can also have serious pitfalls. The study, directed by an Oregon Health & Science University researcher/physician, was conducted to discover whether physicians with a serious illness doctored themselves, their reasons for doing so, and what the consequences were.
"I was struck by the fact that while the conventional wisdom about self-doctoring is that 'A doctor who treats himself has a fool for a patient,' previous surveys have found that only 50 percent of physicians even have a personal physician and that between 42 and 82 percent of physicians treat themselves in one fashion or another," said Erik Fromme, M.D., the study's lead author and a physician-researcher in the Division of General Internal Medicine and Geriatrics at OHSU.
To conduct the research, Fromme interviewed 23 physicians currently or previously treated for cancer. Fromme collaborated with researchers at the University of Pittsburgh and the Johns Hopkins University School of Medicine. Results are printed in the April edition of the Journal of Family Practice.
"It's never been determined whether self-doctoring should always be discouraged," said Fromme. "What we found was that even doctors who didn't approve of self-doctoring might do so, sometimes without thinking through the implications of what they were doing. They simply did for themselves what they would normally do for their patients--like ordering lab studies, checking biopsy results, or adjusting medication doses. This led to some problems--one physician delayed seeking care for her thyroid cancer because she rationalized that cancer should be a hard lump and hers was soft. Also, physicians who self-doctored missed out on the guidance and support that they might otherwise have gotten from their own doctor."
An example of this lack of support was demonstrated in the comments of one study participant. The physician decided to review the results of her CAT scan while working a shift in her hospital. When the report showed two lesions in the liver, the physician nearly went into hysterics.
Other physicians got into problems following their physicians' advice even when it went against their own medical instincts. One physician reflected that he didn't think the needle biopsy done on his enlarged lymph node was the correct procedure to rule out lymphoma, but that he didn't challenge his doctor's decision because he wanted to be a "good patient."
Furthermore, the study authors report notable advantages of self-doctoring, such as the ability to schedule tests and treatments when most convenient and the feeling of being in control of one's own health care.
"As physicians, we learn to keep our emotions in check in the face of life-threatening illness," said Fromme. "It seems only natural that we might take refuge in the power and familiarity of our physician-role when faced by our own life-threatening illness. So therefore, should physicians doctor themselves? I think this is the wrong question. What any patient, physician or not, should be concerned about is getting good care. The concerns that are most frequently expressed about objectivity are valid, and in most cases the best care occurs in the context of a doctor-patient relationship. In most cases, self-doctoring means cutting corners. On the other hand, it seems disingenuous to ignore all the knowledge and training we have as physicians and downright dangerous to ignore our instincts in order to fit into our notion of 'good patient behavior'. After all, all patients doctor themselves for minor illnesses like colds or low back pain."
The authors also describe self-doctoring as a two-way street where many physicians don't know how to approach physician-patients. One example is a physician who recently explained the difficulties she has had in getting her doctors to treat her like a patient--the treating physicians keep telling her to order her own tests and write her own prescription refills.Based on their findings the study authors developed a list of questions doctors should ask themselves when seeking health care. These questions assess the reasons for seeking care from another physician or self-doctoring. Question themes include:
- Do you have, at a minimum, physicians that you can trust?
- Are you too emotionally involved to be objective, and how do you know?
- Do you have the training and experience to handle your own care?
- Are you ignoring your medical instincts in order to 'be a good patient'?
- Are you using the time you save doctoring yourself to do more work?
- Are you getting the support and care you would want your own patients to receive?
Study authors believe these types of questions must be asked routinely by physicians to determine whether they would be better off responding to an illness more like a patient or a physician.
"In the end, whether a physician self-doctors or seeks another professional, the central goal must always remain the same, to get the best care possible," said Fromme.
Funding for this study was provided by the Kenneth B. Schwarz Center in Boston, Massachusetts.