RESULTS
Our sample was predominately Caucasian and represented a diversity of gender, specialty, and participant characteristics (Table 1).
TABLE 1
Participant characteristics (N=23)
| Characteristic | ||
|---|---|---|
| Age (years) | Mean and median=55, range=28–83 | |
| Years in practice | Mean=22.4, median=19, range=0–56 (1 resident, 1 fellow, 2 retired) | |
| Sex (n/N) | Male 13/23 | |
| Ethnicity (n) | 19 Caucasian, 3 Asian, 1 African American | |
| Specialty | Family practice/internal medicine: 5 | |
| Adult subspecialist: 4 | ||
| Pediatrics/child subspecialist: 6 | ||
| Surgical specialty: 3 | ||
| Neurology/anesthesia/emergency medicine/radiation oncology: 5 | ||
| Practice type | Clinician: 10 | Clinician/researcher: 5 |
| Clinician/educator: 5 | Clinician/administrator: 3 | |
| Practice location | University hospital: 11 | |
| Community hospital: 2 | ||
| Private practice: 9 | ||
| Research/nonpracticing: 1 | ||
| Tumor type | Breast: 5; renal: 4; prostate: 5; lymphoma: 3; colon: 2 (1 participant had 2 cancers) | |
| Bone/brain/larynx/head & neck/thyroid: 1 each | ||
| Illness stage | Disease-free >5 years: 9 | |
| Disease-free >6 months: 5 | ||
| Disease-free <6 months: 4 | ||
| In treatment: 2 | ||
| Metastatic/rapidly progressive disease: 3 | ||
The nature of self-doctoring What is self-doctoring and when does it occur?
The participants did not identify a discrete activity or group of activities that constituted self-doctoring (Table 2). Some activities were obvious because they required privileges restricted to medical personnel—for example, ordering one’s own abdominal computed tomography scan. Other activities were less obvious because they could be performed by any patient—such as treating oneself for a minor illness like low back pain.
Should you doctor yourself? Whereas only 1 participant recommended self-doctoring, the rest were more or less strongly opposed to the practice. Despite this stance, most participants were able to identify instances during which they did doctor themselves. Sometimes they doctored themselves without acknowledging this activity as doctoring.
EF: Do you ever feel like you do anything where you doctor yourself?
PARTICIPANT: No I don’t think so . . . I’ve never had a primary care physician, which is probably a mistake because I tell all my patients they should have one.
EF: How did you get your PSAs [prostate-specific antigen]?
PARTICIPANT: I would just go down and get my blood done myself.
EF: So would you say that is an example of being your own doctor?
PARTICIPANT: Yeah, I suppose it is to some degree!
Reframing the question: from self-doctoring to health care-seeking strategies. Although our questions were about self-doctoring, participants spoke less about self-doctoring and more about their strategy for obtaining health care. This concept of health care-seeking strategies accounted for all of the various methods that participants used to obtain health care, of which self-doctoring was one.
TABLE 2
Subtle ways in which participants doctored themselves
| Decide when to seek or not seek care |
| Did not get alarmed about neck mass because she knew what cancer felt like |
| Did not call physician with most things because they are “silly” |
| Did not go to physician until family member insisted |
| Establish a diagnosis |
| Broke own bad news by going into the hospital computer on a weekend |
| Diagnosed self as depressed but that it was subclinical |
| Went directly to a gastroenterologist to evaluate abdominal pain |
| Called physician with a diagnosis, not a problem |
| Learn about illness |
| Became an expert in own disease |
| Called an expert colleague at another institution to critique care |
| Influence care decisions |
| Rejected a recommendation that did not coincide with medical training |
| Decided on a specific surgical procedure, then found an oncologist |
| Chose a physician who she knew would go along with whatever she wanted |
| Assumed he didn’t need a second opinion because he was a physician |
| Get treatment |
| Managed only illnesses in her own specialty |
| Followed own Dilantin levels |
The continuum of health care-seeking strategies
The following examples illustrate 3 health care-seeking strategies. When viewed together, these strategies create a continuum ranging between the roles of physician and patient. The following categories are not intended to be mutually exclusive, but to indicate an individual participant’s emphasized role. We referred to strategies that emphasized the physician role as PHYSICIAN-patient, here exemplified by this internist who had more than 40 years of experience in clinical practice.
One evening I felt a mass in my right lower quadrant. I figured I had a little hematoma—I couldn’t see anything, but I was pretty asymptomatic and by chance felt [the mass]. I watched it for maybe a week or so and it didn’t seem to change. I did a couple of routine blood tests and my CBC and Chem-20 profile were okay. But then when [the mass] didn’t go down, I asked one of my partners to feel it. He said “yes, I can feel a mass—you’d better look into it.” I didn’t see a doctor—just a curbside-type thing. So then I set up a CT scan, I got a CE antigen, and I just did this on my own, and the CT scan showed a mass in the appendiceal area and the CE antigen was up a little bit. I guess I went right to my surgeon!
At the other end of the continuum, this middleaged pediatric subspecialist represents those physicians whose health care-seeking strategies were based on their roles as patients. We labeled this strategy physician-PATIENT, emphasizing the patient role.