Original Article

Physicians Caring for Physicians: The Perspective of the Primary Care Physician

Authors: Kathryn A. Teng, MD, Robert S. Butler, MS, Sarah Schramm, MA, J. Harry Isaacson, MD, Craig Nielsen, MD, Carmen Paradis, MD

Abstract

Objectives: How physicians provide longitudinal primary care to physician-patients (ie, physicians as patients) has not been well studied. The potential challenges of providing care to physician-patients include maintaining professional boundaries and adhering to practice guidelines. The objective was to explore the differences in identifying how physicians perceive caring for physicians-patients in the longitudinal setting versus caring for other patients in the general population.

Methods: The study consisted of focus groups, followed by quantitative survey. Participants were primary care physicians (internal medicine and family medicine) at an academic multispecialty group practice. Thematic analysis of focus groups informed the development of the survey.

Results: In focus groups, participants identified several benefits, challenges, and differences in caring for physician-patients versus the general population. When these findings were explored further by quantitative survey, participants noted differences in care regarding chart documentation protocols, communication of results, and accommodation of schedules. They agreed that there were benefits to providing care to physician-patients, such as believing their work was valued and discussing complex issues with greater ease. There also were challenges, including anxiety or self-doubt. Participants also agreed on the following strategies when caring for this population: make recommendations based on evidence-based medicine, follow routine assessment and examination protocols, follow routine scheduling and communication protocols, recommend the same follow-up visit schedule, and define boundaries of the relationship.

Conclusions: Physicians perceive caring for physician-patients as different and rewarding, although some find that it provokes anxiety. Many are willing to make concessions regarding scheduling and testing. With increasing experience, the anxiety decreased as did the need to follow protocols and maintain boundaries. Further investigation is needed to determine the impact of physician experience and training on the quality of care for physician-patients.

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References

1. Klitzman R. ‘‘Post-residency disease’’ and the medical self: identity, work, and health care among doctors who become patients. Perspect Biol Med 2006;49:542-552.
 
2. Fox F, Harris M, Taylor G, et al. What happens when doctors are patients? Qualitative study of GPs. Br J Gen Pract 2009;59:811-818.
 
3. Fox FE, Taylor GJ, Harris MF, et al. ‘‘It’s crucial they’re treated as patients’’: ethical guidance and empirical evidence regarding treating doctor-patients. J Med Ethics 2010;36:7-11.
 
4. Fromme E, Billings JA. Care of the dying doctor: on the other end of the stethoscope. JAMA 2003;290:2048-2055.
 
5. Noble SI, Nelson A, Finlay IG. Challenges faced by palliative care physicians when caring for doctors with advanced cancer. Palliat Med 2008;22:71-76.
 
6. Guzman JA, Sasidhar M, Stoller JK. Caring for VIPs: nine principles. Cleve Clin J Med 2011;78:90-94.
 
7. Koppe H. Barriers to good health care. Aust Fam Physician 2010;39:71-73.
 
8. Kay M, Mitchell G, Clavarino A. What doctors want? A consultation method when the patient is a doctor. Aust J Prim Health 2010;16:52-59.
 
9. Krall EJ. Doctors who doctor self, family, and colleagues. WMJ 2008;107:279-284.
 
10. Gross CP, Mead LA, Ford DE, et al. Physician, heal thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med 2000;160:3209-3214.