Against Recommendations, Physicians Often Treat Themselves

MONTREAL, Quebec — The practice by physicians of prescribing medication or treating themselves or their family and friends appears to be almost universal, despite widespread guidelines that recommend against such practices, some researchers reported here at the 2012 AMA/CMA/BMA International Conference on Physician Health.

"We have a wide gap between what we do and what we say we ought to do," said Michael Kaufmann, MD, medical director of the Physician Health Program at the Ontario Medical Association, in Toronto, Canada.

Treatment of Self, Family, and Friends

Michael Gendel, MD, medical director emeritus of the Colorado Physician Health Program in Denver, and colleagues recently surveyed 600 Colorado physicians and found that more than 90% engaged in some form of self-prescribing (J Med Ethics. 2012;38:294-298).

"We broadened the definition of self-prescribing so that it was not just the prescribing of medicines for oneself, but included a variety of what we call personal medical care at home," Dr. Gendel explained.

More than 90% of doctors reported providing medical care that could be given by a nonphysician (such as using over-the-counter medications or treating minor wounds) or treating a minor illness or injury (such as using antibiotics for strep throat, sewing up a laceration, or providing immunization), 30% reported treating a serious illness or injury under emergency conditions (such as setting a limb, treating high-altitude pulmonary edema, or managing myocardial infarction), 60% reported treating a serious or chronic illness (such as diabetes, cancer, or depression), 35% reported prescribing or providing office samples of addictive drugs, and 15% reported managing acute life-threatening medical problems (such as delivering one's own child).

The survey also revealed that physicians prescribe at home in much the same way as they prescribe at work; those who prescribe antibiotics are work are likely to prescribe them at home (P < .001), those who prescribe antidepressants at work are more likely to prescribe them at home (P = .044), and those who prescribe opioids and other addictive substances at work are more likely to prescribe them at home (P < .001), Dr. Gendel explained.

In addition, physicians who informally prescribed addictive medications were more likely to engage in other self-prescribing behaviors.

Impaired Judgment?

Dr. Gendel wonders whether this has to do with impaired judgment, and asked: "What's going on with the prescription of addictive substances? Why is that predictive of other self-prescribing? Is it because people are involved in an emerging addictive illness? Is it because once you're under the influence of such drugs you're more likely to have reduced judgment, or is it that you have reduced judgment and so you're prescribing addictive substances at home?"

The patterns revealed in the survey mirror those in several European countries, according to other presenters at the session.

Studies of Norwegian physicians (BMC Med. 2005;3:16 and Soc Sci Med. 1998;46:581-590) suggest that 73% to 90% self-prescribe or receive informal treatment from colleagues, and that 99% are asked for such treatment by family and friends, said Karin Isaksson, MD, from the University of Oslo in Norway.

Of particular concern is the fact that about 12% of these physicians self-prescribe anxiolytics or hypnotics, she said.

Similarly, surveys in Spain suggest that about 80% of doctors self-prescribe, and that 15% of male doctors and 19% of female doctors self-prescribe addictive medications, according to Pilar Lusilla, MD, PhD, a psychiatrist from Vall d'Hebron University Hospital in Barcelona, Spain.

"Professional Boundary Issue"

Dr. Gendel called self-prescribing "a professional boundary issue" and recommends a profession-wide dialogue and education on the matter. "Is this the best way to go about treating ourselves and our families? I think most of us would say no, but apparently a great number of us do it," he said.

Dr. Kaufmann wonders whether guidelines are appropriate or too stringent. "With so many doctors engaged in these practices, do they need more education and direction, because our colleagues are telling us in huge numbers that they are indeed doing this," he said.

Asked by Medscape Medical News to comment on this issue, Andrew Clarke, MD, executive director of the British Columbia Physician Health Program in Vancouver, Canada, said that, in general, the answer to whether self-prescription is acceptable is "a very firm no."

"It's not illegal, but it's not considered good medical practice," he said. In some jurisdictions, it's easier to discuss this issue with physicians, connect them with someone who can prescribe what they need, and protect their licenses, he explained.

But it might be this invasion of privacy and confidentiality that many physicians want to avoid, noted Anna Reid, MD, president of the Canadian Medical Association, in an interview with Medscape Medical News.

"We are afraid to go see a psychiatrist or psychologist because we don't want to be seen coming out of their office.... Clinic staff may recognize us, or worse, have access to our records.... There's always that concern about confidentiality — even though it's supposed to be complete, in reality it never is," Dr. Reid explained.

In addition, there are issues related to licensing.

"Most colleges require that you tell them if you're being treated for a mental health or addiction problem; it's part of the form you complete for your reapplication each year. If you've treated yourself, you don't have to reveal that (although you should)," she explained.

Revealing this information would probably lead to "questions and possibly a monitoring program. Physicians are afraid of losing their license, but actually they're more likely to lose their license for problems related to not getting treatment," she noted.

Dr. Kaufmann, Dr. Gendel, Dr. Isaksson, Dr. Lusilla, Dr. Clarke, and Dr. Reid have disclosed no relevant financial relationships.

2012 AMA/CMA/BMA International Conference on Physician Health (ICPH). Presented October 26, 2012.