Doctors’ health-seeking behaviour: a questionnaire survey

Many studies show that, when doctors experience ill health, they disregard the advice they give their patients.1,2 The medical community has developed a culture in which working through illness and self-treating is the norm.3,4

Although doctors have lower overall rates of mortality than the general population, they are at higher risk of certain physical and psychological problems.5,6 The impact of these illnesses may be exacerbated by a culture that discourages admission of health vulnerabilities.7 Personal testimonies of doctors who have experienced major illness suggest that the “pull yourself together and just get on with it” mentality is a significant barrier to seeking appropriate treatment.8 A New South Wales study found that 26% of doctors experienced a condition warranting medical consultation, but felt inhibited about consulting a doctor.9 When doctors do seek external care, evidence suggests they receive a lesser quality of care than lay patients.7,8

Self-treatment for doctors includes diagnosing and treating one’s own illness and prescribing for oneself. It also includes undertaking informal, or “corridor”, consultations and self-referring to a specialist. Self-treatment is inappropriate because of its lack of objectivity.10

We aimed to describe doctors’ perceptions of the acceptable limits to self-treatment, and to determine whether selected attitudinal or demographic variables predict doctors’ decisions to self-treat in three hypothetical situations.

Four elements identified in a preceding qualitative study and a literature review as being potential barriers to seeking formal healthcare were embedded as independent variables in each vignette. The variables were concerns over confidentiality, heavy workload, embarrassment, and confidence in treating the condition. Each variable was included in the vignette either as a concern for the participant, or as not a concern (Box 1). To evaluate the effect of these variables on the decision to seek appropriate care, each variable was fully crossed with the other three variables at both levels, producing 48 possible combinations. A fractional factorial design11 was used to reduce this to 18 combinations: six each for anxiety, hypertension and asthma, in an even distribution. Six versions of the questionnaire were produced, each consisting of one version of the anxiety, hypertension and asthma vignettes.

Versions 1 and 2 of the questionnaire were each sent to 150 participants and versions 3 to 6 were each sent to 149 participants. Questionnaires were anonymous but coded so nonresponders could be followed up. Administrative staff recorded receipt of questionnaires and then gave them to the researchers. A second mail-out was conducted after three weeks. Two weeks later, a random sample of 200 nonresponders was contacted by phone and encouraged to complete and return the questionnaire.

The response rate for our study is rather low, so caution is needed in generalising the results. However, it is comparable to other Australian surveys investigating doctors’ own medical care.9,13 It has been suggested that the personal nature of the topic contributes to low response rates.9

Our study described doctors’ opinions and attitudes, rather than their actual behaviour in managing their medical conditions. Given that recommendations against self-treatment are well known in the profession, responses may have been influenced by social desirability factors, and it is possible that more respondents would actually support self-treatment, including the self-prescribing of psychotropic medicines, in real situations.

Previous studies have found differences between GPs and specialists in their patterns of health-seeking behaviour,1,9 but this is the first study to show that GPs are significantly less likely than specialists to seek appropriate treatment across several situations. The attitudinal data suggest that GPs’ preferences for self-treatment may be associated with their perception that doctors are embarrassed to attend a colleague and that it is difficult to find a good treating doctor.

Our results support previous assertions that the culture of medicine is a barrier to doctors seeking healthcare.1,3,7 The perception that doctors are more likely than other professionals to work through illness may be symptomatic of a culture in which an image of invincibility is encouraged and vulnerability is denied.3 The direct result of this phenomenon is likely to be delayed presentations even for serious conditions.

Fifty-five per cent of respondents had their own GP. This is higher than the 42% reported by Pullen,9 but is considerably less than the New South Wales Doctors Mental Health Policy recommendation that all doctors have their own GP.14 Having one’s own GP was a significant predictor of seeking appropriate care in the hypertension and asthma vignettes, but not in the anxiety vignette. The reason for this discrepancy is unclear, but the emergence of confidentiality as a significant predictor in the anxiety vignette suggests that issues of trust are involved in the more sensitive psychological conditions. This is consistent with a previous study,3 in which concerns about confidentiality were a barrier to seeking psychiatric services. Similarly, confidentiality breaches, combined with professional attitudes discouraging admission of vulnerabilities, have been reported to influence doctors’ reluctance to seek mental healthcare.7

One of the most disturbing findings was that, in spite of professional recommendations to the contrary,14,15 a quarter of respondents thought it was acceptable to self-treat chronic conditions and an even higher proportion thought it was acceptable to order blood tests on oneself to monitor a chronic condition. Other studies have examined self-treatment in relation to specific medications or symptoms, and have not grouped self-treatment into acute conditions, chronic conditions, diagnostic procedures and monitoring categories as we did. Therefore, although it is not possible to directly compare across studies, our results are consistent with a previous finding that doctors would self-treat for seven out of 10 sets of acute and chronic symptoms for which they would recommend other doctors seek care.1 The finding of little consensus regarding acceptability of self-treatment is also consistent with the earlier study.1 Although most respondents were satisfied with the care they had received from other doctors, many thought it was difficult to find a doctor with whom they were comfortable. Reasons for this may include embarrassment or concern about confidentiality for sensitive health issues. This highlights the need for doctors to be appropriately trained for consultations in which the patient is also a doctor.15

Our results indicate that there are significant barriers to doctors seeking formal medical care, and that this may be particularly true for GPs. It is important that this be addressed in medical school, as such attitudes are already in place among many junior doctors.13 Strategies aimed at doctors’ self-treatment should focus on challenging the culture of doctors’ self-reliance.