Self-doctoring: A qualitative study of physicians with cancer

You know, I think that a physician diagnosed with cancer is like any person diagnosed with cancer. Their first concern has nothing to do with their careers. I think the hardest thing about being a physician-patient is that you hate to bother your doctors. Or you want to sort of “call your doctor with the answer” instead of just asking questions. I think you sort of feel like sometimes that you should be able to somehow know whether [your] symptom is related to metastatic disease without having to ask, “Should I be worried about this or not?” Physicians have the same fears and difficulties as anyone else does and need to give themselves permission to act like a normal patient.

This next physician, a medical subspecialist who had recently undergone bilateral mastectomy for stage I breast cancer, falls somewhere in the middle of this continuum. We labeled this approach Physician-Patient, signifying the incorporation of both roles into her health care-seeking strategy.

This breast mass was discovered by my gynecologist but he told me, don’t worry—it’s a fibroadenoma. It was small, not really moveable, so I didn’t listen to him. I went to a surgeon. I wouldn’t say I doctored myself just because I didn’t necessarily listen to my physician. It didn’t make sense from my medical training, so I did what made sense—I can listen to those doctors’ advice, but I use my own judgment.

Advantages of being a physician-patient: convenience and control. Physicians recognized definite advantages afforded by their status, mostly related to added convenience in navigating through the system and scheduling appointments, and being able to control many aspects of their care. This specialist in infectious disease with metastatic cancer illustrates the importance of convenience and control in explaining why she often relied on self-doctoring.

I think idealistically you should never be your own doctor, but realistically I think I can accomplish more faster without interrupting the doctor’s schedule. A couple of weeks ago I started spiking fevers but I had no symptoms of any kind…. After the third day I thought, “I bet this is tumor fever!” So I went out and bought Naprosyn and I was afebrile the next morning…. Now I guess there is a small chance I have an abscess somewhere, but I think I can obviate a lot of workup that my physician is more obligated to do than I am, medico-legally … I am sure there are control issues because we all like control and I am sure I like the control and the convenience.

Disadvantages of being a physician-patient: denying yourself the opportunity to receive support; lack of objectivity; delaying care. In talking about the disadvantages of their strategies, physicians invariably referred to a previous negative experience. This young pediatrician with a large retroperitoneal mass described how she learned of her computed tomography scan results.

More insidious is the potential loss of objectivity that can occur when one’s own health is at stake. For example, a pediatric subspecialist with lymphoma described how she rationalized not bringing the enlarged lymph nodes in her neck to medical attention by telling herself that she “knew what cancer felt like.”

Advantages of being a physician-patient: trusting one’s care to others; relinquishing control; benefiting from the expertise and support of other physicians. Physicians who relied more on their physicians and less on self-doctoring approached control from the perspective of “letting go.” This emergency medicine specialist explains why he would rather trust his physician’s expertise than his own.

Find doctors you trust and listen to them because they’re the experts. The same way you’re the expert to your patients, the patients you care for. In some real sense, relinquish control. Give control to somebody else and even for nonphysician patients it’s very difficult but for physician-patients I think it’s one of the most difficult things but you have to do this. You have to trust yourself to someone else.

Disadvantages of being a physician-patient: being too trusting. This physician-patient describes adopting a more passive stance toward his health care in order to “be a good patient.” The result was that his Hodgkin’s disease was not diagnosed until 18 months after his initial biopsy.

By adopting that stance, I might have done myself a disservice. Our lives would have been very different had I questioned more aggressively the use of a needle biopsy because the pathologist here said, “You know, that’s an absolutely foolish inept way to look for lymphoma.” So in some ways the strategy backfired a bit.… But I really trusted their judgment.