Saturday, October 23, 2004

Healing ourselves?

Some eye-opening data from this month's Psychiatric Annals, devoted to "Physician Health and Impairment." Dr. David B. Feller, MD and Dr. Robert L. Hatch, MD, MPH, ask, "Do Physicians Take Care of Their Health?" Not very well, it seems:

"Several surveys have measured the proportion of physicians who have their own health care provider. Results indicate only one-third to two-thirds of physicians have a health care provider of their own. Several factors suggest that the percentage is even lower than this. The response rates to these surveys were somewhat low (40% to 77%) which would tend to underestimate the presumed "bad response" of not having your own physician.

"Furthermore, even when physicians reported having their own physician, 30% of the time it was their partner, and 12% of the time it was themselves...It has been estimated that 82 to 86% of the general population has a regular health care provider."

And as for self-treatment: "According to Sir William Osler, 'A physician who treats himself has a fool for a patient.' Today's physicians appear to agree - only 7% of physicians agreed with the statement, 'Doctors make few mistakes when treating themselves.' Nevertheless, multiple studies have demonstrated that the majority of physicians do treat themselves. Resident physicians display similar behaviors: 52% reported self-prescribing, with 42% of self-prescribed medications obtained from the sample cabinet." Another common practice, in my experience, is for one MD to approach another with a blank prescription pad, saying, "I think I have bronchitis; would you be willing to write for some antibiotic?" The doctor receiving the entreaty is often flattered and accomodating, and the result is disguised self-prescribing.

I have colleagues who think nothing of walking into a drugstore, saying, "I'm a doctor, and I'm writing myself this prescription." But I have never been able to do that. Instead, I engage in the vastly more uncomfortable exercise of being a "Sick Psychiatrist Visiting Their Doctor..." no doubt, as uncomfortable for the treating provider as it is for me. The pressure to not have medical problems (or, if there is a problem, to have an agreeable and easily treatable one) is immense. As noted in this month's Annals, the problem is immeasurably greater when the issues are addiction or behavior problems...which sounds like a good topic for a second post. To be continued...
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