Pactice recommendation
- Physician “self-doctoring” may have benefits, but it may also cause unanticipated psychological and medical problems. When faced with a serious medical problem, carefully assess both the potential positive and negative aspects of such behavior.
ABSTRACT
Background: Self-doctoring is providing oneself care normally delivered by a professional caregiver. Expert authors warn physicians not to self-doctor, yet cross-sectional studies document that physicians frequently do. Explanations for this disparity remain speculative.
Objective: To better understand the circumstances when physicians did and did not doctor themselves and the reasoning behind their actions.
Design: Qualitative semistructured interview study of 23 physician-patients currently or previously treated for cancer.
Results: Participants had multiple opportunities to doctor themselves (or not) at each stage of illness. Only 1 physician recommended self-doctoring, although most reported having done so, sometimes without realizing it. Participants’ approaches to their own health care created a continuum ranging between typical physician and patient roles. Participants emphasizing their physician role approached their health care as they would approach the care of their own patients, preferring convenience and control of their care to support from professional caregivers. Participants emphasizing their role as patient approached their health care as they thought a patient should, preferring to rely less on their own abilities and more on their providers, whose support they valued. Most participants balanced both roles depending on their experiences and basic issues of trust and control. Importantly, subjects at both ends of the continuum reported unanticipated pitfalls of their approach.
Conclusion: Our findings showed that participants’ health care-seeking strategies fell on a continuum that ranged from a purely patient role to one that centered on physician activities. Participants identified problems associated with overdependence on either role, suggesting that a balanced approach, one that uses the advantages of both physician and patient roles, has merit.
The physician who doctors himself has a fool for a patient.
—Sir William Osler
The consistent message in the medical literature, beginning with Osler, has been that physicians should not doctor themselves.1-9 Despite this belief, a number of cross-sectional studies suggest that at best only 50% of physicians even have a personal physician1,8-13 and that between 42% and 82% of physicians doctor themselves in some fashion.1,6,8,12
Becoming a competent physician does not automatically make one a competent patient.14,15 In fact, physicians are allegedly the “very worst patients.”15 Physicians are expected to understand and empathize with the patient’s perspective, yet most authors have maintained that physicians tend to avoid, deny, or reject patient-hood,2,3,5,11,13,14,16-22 and even the susceptibility to illness.23
Given the high prevalence of self-doctoring behavior among physician-patients, we sought to further explore seriously ill physicians’ experiences with self-doctoring. Specifically, we wanted to know if they doctored themselves and, if so, when, why, and with what outcome.
Methods
Design
For this qualitative study, approved by the Johns Hopkins Institutional Review Board, we used semistructured in-depth interviews.
Study population and sampling
A convenience sample of physicians who had been treated for cancer during or after their medical training was identified by clinicians in the divisions of oncology and radiation oncology at our institution. Of 38 physicians contacted, 25 agreed to participate; however, 2 subjects died before their interview could be arranged. Enrollment continued until no new concepts were identified, also called the point of theoretical saturation.24
Data collection
We based the interview questions on themes extracted from a literature search that identified 5 books, 26 articles, and 3 videotapes. (These references are available online as Table W1.) Interviews lasted approximately 1.5 hours. The interviewer (E.F.) started by asking subjects to tell the story of how they learned of their cancer and progressed to more focused questions about whether they acted as their own doctor and why. All interviews were taped and transcribed, and their accuracy was verified by listening to the audiotape.
Analysis. Two coders (E.F. and R.H.) independently coded all 23 transcripts. In case of disagreement, the coders achieved consensus through discussion and used this information to refine the boundaries of each theme.
Working together, we created a comprehensive coding scheme by arranging data into logical categories of themes using the strategies of textual analysis and codebook development described by Crabtree and Miller.25 The work by Crabtree and Miller addressed the theme “health care-seeking behaviors and strategies” and its associated codes developed using an “editing-style analysis” consistent with the constant comparative method in the Grounded Theory tradition.26
Trustworthiness. To ensure trustworthiness, we mailed an 11-item summary of the main points to the 21 surviving participants as the analysis neared completion. We asked them to review the main points of our study, indicate whether they agreed or disagreed (with no response indicating agreement), and add any clarifying comments they felt appropriate. This information was used to clarify and further develop themes.