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Doctors Sometimes Skimp on Own Care, Study Shows

One in three physicians in the survey had no regular source of service, despite education, income and prime access.


Doctors are said to make lousy patients. Now comes a study indicating that many docs avoid being patients altogether.

Researchers at Johns Hopkins School of Medicine decided to examine how well doctors took care of their health after previous studies suggested that doctors' bad habits--among them smoking and drinking--influence what they tell patients.

Using annual health surveys completed by graduates, they found that a surprising number of physicians--about one in three--had no regular source of care, even though they had ready access, were better educated and could more easily afford it than the average American. Of the 312 (out of 915 Hopkins grads) who didn't see a doctor regularly, 28% had no medical care, and 7% treated themselves (the authors suspect that figure is probably higher).

And these are the folks who tell us that good eating, exercise and regular checkups are the keys to a longer life. What's going on here?

Several factors may underlie some doctors' reluctance to see another doctor, said Dr. Michael J. Klag, director of the Hopkins study. They may be anxious because they know what can go wrong, they may worry about confidentiality in seeing an associate or they may simply self-diagnose, writing their own prescriptions and ordering their own tests, although that's not considered the best practice.

In other cases, doctors may not perceive any need to be examined, even though conditions such as high blood pressure, glaucoma and high cholesterol are silent. Klag said he knows of doctors who learn of their high cholesterol only by undergoing free screenings at the annual American Heart Assn. meetings.

But it's at the routine checkups that a primary care doctor can help break down a patient's natural reluctance to be tested for illnesses they may not want to think about.

"Very few people volunteer to have a colonoscopy," said Klag, interim chairman of Hopkins' department of medicine.

"A lot of primary care is educating people and convincing them to make changes in lifestyle or to undergo some tests they don't want to undergo," he said. "If you don't have that nudge, you don't get it done."

And if a third of doctors aren't getting such primary care, they, too, need to be educated.

The Hopkins researchers analyzed survey responses in 1991 from 915 medical graduates, 91% of whom were men. Their average age was 61. The researchers also studied 1997 surveys for indications about use of preventive care services.

Doctors on the whole were pretty good about preventive care: 66% had undergone a colon cancer screening, and 71% had had a flu shot. Of the women, 74% reported having a mammogram, and of the men, 76% had had a PSA (prostate-specific antigen) test to detect prostate cancer. Those figures exceed the 60% goal for each screening established by federal health officials in Healthy People 2000, a blueprint for improving Americans' health.

However, among those physicians who reported no regular doctor in 1991, a follow-up survey showed that six years later, only 49% reported they'd had a colon cancer screening, only 47% had undergone mammograms, 62% had gotten a PSA test and 59% had received a flu shot.

The proportion of doctors with no regular provider--35%--far exceeds the 14% to 18% estimates for the general population. Two large studies in the past have suggested that the most common reason for not having a regular doctor is often a personal belief that it's not necessary, rather than lack of health insurance.

The Hopkins study seems to confirm that theory holds true among doctors. About 40% of the respondents said their own health matters are up to fate or chance, and another 40% said they had control over their health by modifying habits--beliefs that researchers pointed out are not mutually exclusive.

Surgeons, internists, and pathologists were least likely to have a regular health provider, with 34%, 39% and 46%, respectively, not having one. Psychiatrists and pediatricians were better about regular care, with 21% of psychiatrists and 22% of pediatricians reporting they had no regular doctor. Internists were the most likely to treat their own illnesses.

The challenge of the findings, said Klag, is, "how do we turn this into an educational intervention? It needs to be done through professional organizations." Already, the American Academy of Pediatrics has contacted Klag about encouraging more of its members to get routine care.

The study's authors cautioned that their sample comes from a single medical school with a strong academic orientation and that the survey respondents were a relatively healthy group.

The study, which appeared in the Nov. 27 issue of the medical journal Archives of Internal Medicine, was supported by the National Institutes of Health, a grant from the Robert Wood Johnson Clinical Scholars Program and the Johns Hopkins School of Medicine in Baltimore.

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