Doctors’ health has been discussed vigorously for two decades. Most studies have focused on their mental health — sleep deprivation, drug dependence, depression and suicide. Yet, mortality data show that most doctors die from physical rather than mental illness. 1 There are, however, limited data on doctors’ physical health or their health maintenance behaviour. 2,3 Here, we outline what information is available and stress how important it is for all doctors to have an independent general practitioner.
We doctors enjoy a low standard mortality rate. 4 However, this is a crude measure of health. One study found that 44% of doctors have chronic health problems,5 and another reported that half of a group of 408 GPs in the United Kingdom had had a serious illness or an operation as an adult. 6 Illnesses experienced by doctors include all the expected categories for the population at large: cardiovascular disease (4%–15%), respiratory illness (10%–21%), musculoskeletal problems (9%–38%), cancer (2%–3%) and psychiatric illness (3%–10%). 7-10 The interrelatedness of doctors’ physical and mental health has been noted: 30% of doctors attending for psychiatric care were found to have a concomitant chronic physical illness,11 and doctors with physical illnesses have been reported to be at higher risk of suicide. 12
Yet, it is well known that doctors are often reluctant to seek medical advice. In one survey, 26% of doctors with a medical problem reported feeling inhibited consulting another doctor. 13 One doctor described how his self-diagnosis and lack of an independent GP led him to delay seeking medical care for lymphoma. 14
In a follow-up study of the sample of UK GPs mentioned above, 8.6% retired before 60 years of age because of illness. 15 Little is known about the burden of disease in the Australian medical community. Such information could be used to inform both occupational health issues and initiatives for alleviating the current medical workforce shortage.
We searched the medical literature for studies of the health maintenance behaviour of doctors, concentrating on interventions of proven efficacy: vaccination against tetanus and hepatitis, regular checks of blood pressure and serum cholesterol level, mammograms and Pap smears. We found few data on doctors undertaking preventive health activities for themselves, even for those procedures or tests with evidence of efficacy.
The studies we did find are summarised in the Box. All studies identified were self-report questionnaire surveys. In all but one, doctors on medical registers, or a random selection from these, were recruited. Response rates ranged from 48% to 100% and were considered acceptable, as they were consistent with those of other self-reported studies. The resultant data were heterogeneous and often nested in surveys focusing on mental rather than physical health issues.
From available data on vaccination rates for hepatitis B and tetanus (Box), few doctors are adequately vaccinated. Despite recommendations for vaccination against hepatitis B due to our occupational risk,22 vaccination rates ranged from 49% to 87%. A survey including other occupational risk groups, such as dentists and pathology laboratory supervisors, found that these groups achieved close to 100% hepatitis B vaccination coverage. 16
Studies show we are better at checking our cardiovascular health status — we can measure our own blood pressure and arrange a cholesterol test. One study showed that 93% of GPs had checked their blood pressure and 64% had checked their cholesterol level in the previous 3 years,19 consistent with preventive health guidelines. 23 Fifty-one per cent of doctors reported that it was acceptable to order a blood test for themselves for diagnostic purposes. 5 The high rate of cholesterol tests reflects this. Whether independent advice is then sought about the results is not known.
A variable proportion (ranging from 47% to 81%) of women doctors of appropriate age reported having had a mammogram in the past 2–5 years. By comparison, in the general Australian population, 74% of women have screening mammograms. 24 Reported Pap smear rates for women doctors ranged from 44.8% to 82%; 74% of Australian women doctors reported having had a Pap test,19 compared with 64% of women in the general Australian population. 24 A survey in Ireland found that over 30% of women doctors had never undergone a Pap test. 18 Australian data show that 11% of women in the general population have never had a Pap test. 24
Although preventive guidelines do not recommend prostate specific antigen (PSA) testing,23 studies have found that 26%–51% of male doctors over 40 years have been tested8,9 (the higher rate was from a survey of urologists attending a urological meeting). 8 If our personal screening habits influence the screening we recommend to patients,25 then these data have wider ramifications.
It is accepted wisdom that doctors should have their own GP, and one study found that 55% of doctors do. 5 But, the question remains, is the GP really operating independently of the doctor being treated? Another study found that, although 43% of doctors reported having a GP, fewer than 25% had an independent one: 5% treated themselves and 13% consulted their professional partner. 19
What are the advantages of having an independent GP? Firstly, it can ensure better documentation and delivery of evidence-based preventive care and opportunities for health promotion advice. Secondly, having a GP facilitates access to the healthcare system, which is often difficult for doctors. 26 We do not really know why doctors have these difficulties. Contributing factors may include embarrassment, delusions of invincibility, or, simply, inconvenience compounded by being so busy.
Finally, finding a GP for routine health issues means that, when a problem arises, especially if the need is urgent (or embarrassing), a relationship with a trusted GP has already been established.
There is a need to incorporate physical health into the debate on doctors’ health. Clearer recommendations for us all to have a GP, not just to coordinate preventive care, but to establish a pathway into the healthcare system when needed, should be supported by data. The paucity of such data is surprising (if not disgraceful).
Preventive care behaviour of doctors: percentage of doctors surveyed complying with preventive activity (period within which compliance occurred is given, where applicable)
Study |
Design and sample |
Vaccination |
Blood pressure check |
Cholesterol test |
Mammogram |
Pap smear |
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Hepatitis B |
Tetanus |
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Chambers6 |
Survey of 850 GPs (48% response rate) |
49% |
69% |
|
52% (ever checked) |
|
80% (5 years) |
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Coutts et al16 |
Survey of 30 GPs and 50 other professionals with an occupational risk of hepatitis B infection (100% response rate) |
83% |
|
|
|
|
|
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Wachtel et al9 |
Survey of 458 providers of care for specific health organisations (67% response rate) |
|
|
|
71% (3 years) |
81% (3 years) |
82% (3 years) |
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Frank et al17 |
Survey of 4501 US women physician respondents to Women Physicians’ Health Study (all included) |
|
|
|
90.8% (5 years) |
79.8% (2 years) |
|
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Wines et al8 |
Survey of 275 urologists attending the Annual Scientific Meeting of the Urological Society of Australasia (70% response rate) |
86% |
|
|
|
|
|
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O’Connor and Kelleher18 |
Survey of 300 members of the Irish Medical Organisation (64.7% response rate) |
|
|
86.5% (5 years) |
53.4% (5 years) |
|
44.8% (5 years) |
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McCall et al19 |
Survey of 544 general practitioners in Victoria (58.5% response rate) |
87% |
|
93% (3 years) |
64% (3 years) |
47% (2 years) |
74% (2 years) |
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Richards et al20 |
Survey of 500 doctors (102 women) registered with the New Zealand Medical Council (62.2% response rate) |
|
|
|
65.6% (5 years) |
|
72.5% (3 years) |
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Cornuz et al21 |
Survey of 686 general physicians in three cantons of Switzerland (72.3% response rate) |
|
|
97% (5 years) |
86% (5 years) |
|
|
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Abstract
Studies of doctors’ health have emphasised psychological health, and limited data have been collected on their physical health status.
Doctors often fail to follow current preventive health guidelines for their physical health.
About half of doctors do not have an established relationship with an independent general practitioner. This would enhance their health and provide a means of ready access to the healthcare system should a problem arise.