Addiction among Professionals

When Self-Care Is Bad Medicine

Editors Note: This article, written to physicians, first appeared in the newsletter of the Georgia Board of Medicine in the United States. Its purpose was to urge physicians to avoid being their own doctors.

Throughout my career as a father, friend and a physician, I have found myself saying: "Take care of yourself." This is usually good advice, especially when it applies to those of us that are better at managing the lives of others than our own. In case you are wondering who I am talking about, I mean you. Physicians are notorious for sublimating their own needs into care of their patients. In doing so, they become excellent diagnosticians. They develop maternal or paternal relationships with their patients. A strong word from a good physician still holds a lot of weight with patients; it motivates them to take care of themselves.

But what happens to this paternal, sublimating, advice giver? All too often, we wind up feeling a bit alone. Our careful counsel to our patients becomes refined over the years, and we become trapped in the ivory tower of our own wisdom. Our considered counsel of others traps us into thinking that we know best. We have no time in a busy practice to seek medical care when we have minor medical problems. Why should we take the time anyway, because we already know the diagnosis and treatment?

So we treat our own medical conditions. Sometimes out of a lack of time, sometimes because we think we know best, and sometimes because we have redirected our own needs for so long that we no longer know how to ask for help from others. It always starts off in a benign manner: antibiotics for an upper respiratory illness, self-prescription for self-diagnosed GERD. But when we enter this territory we put ourselves on a slippery slope. When we treat the URI, it becomes easier to take a sample narcotic from the office closet to treat the inevitable cough. When we have chronic degeneration in the knee, we drain it ourselves after we have had it done six times by our orthopedic (friend) physician.

I do not want to get on my high horse here, and say that physicians should never self-treat, even to the extent of our non-physician friends (who, by the way do the same thing, often deciding the best course of treatment for their back pain is to buy a back care book and see a chiropractor). The position I want to make clear is that physicians are in a complex and potentially dangerous place every time they treat themselves, and this place is more dangerous than that of the general public. The public has a limit on how far they can go with self-prescription. Physicians do not, and this lack of limits can be fatal.

The crux of the problem in physicians is the combination of knowledge, isolation, a sense of grandiosity, and a prescription pad in hand often leads to disaster. In my practice as a physician of physicians, I have watched countless lives destroyed by a series of bad judgments made over years around something as simple as intermittent back pain or headache. No physician can be objective about their own health. How the medical board addresses this problem is to discourage self-prescription of any medication and to investigate self-prescription of controlled substances. What I would like you to consider is that each time you treat yourself, you enter dark and uncertain waters, be wary! Consider your own limits. Regard your lack of objectivity about yourself as a fact. Remember that the very thing that makes you a good physician cripples your self-insight. Learn to ask for help. Find an internist you trust and follow their advice.

Self-care is something most of us need. Self-care does not mean self treatment, however. It means balancing your life, taking time for yourself. It means listening to the advice of your physician, something we all wish our patients would take to heart.

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