Why Physicians Neglect Their Own Health: the ‘Poorly Shod Shoemaker’ Effect
By Matthew Goldenberg, D.O.
Board Certified Psychiatry and Addiction Psychiatry
Associate Medical Director, Promises Professionals Treatment Program
Doctors devote their careers to the well-being of others, yet research shows that almost half admit to neglecting their own health.
It is reminiscent of the “poorly shod shoemaker,” who goes barefoot despite his knowledge, access and expertise. For physicians, a variety of factors play into why these experts of health and wellness, working in the heart of the healthcare system, so often miss out on the very services they provide for others.
The first reason is simply the difficulty of finding a colleague to fill in when they need a break. Resources and staffing are often stretched paper-thin. So asking a colleague may actually be an impossibility.
Another factor is the intense pressure physicians feel to maintain an image of invulnerability, control and competence. If they begin to struggle with physical or mental illness, that image can seem to falter.
In reaction, physicians often downplay or ignore their symptoms. And when they do recognize there is a problem that must be addressed, they tend to manage it themselves. Studies show, for example:
- 84% of medication taken by doctors is self-prescribed.
- A third of physicians’ medical workups are self-initiated.
- While 71% of physicians have their own doctor, only 10% of them go for routine checkups.
- Even if they do have a family doctor, doctors tend to prefer asking a colleague for their opinion — so-called “corridor consultations” — over formal doctor visits.
This type of self-treatment is widespread throughout the medical community and often justified as a necessity — a response to a lack of time and the pressure the physician feels to remain on the job.
But there are often other undercurrents at play. For example:
- A desire not to impose on a fellow doctor, especially for symptoms that may be considered trivial or vague.
- Worry that a treating physician may judge them as incompetent if, for example, their own suspicions about their illness are proven wrong.
- And in some cases, reluctance to visit medical professionals they consider less competent than themselves.
Mental Illness, Addiction and Stigma
A key, and often overlooked, reason that physicians self-treat is to avoid disclosing problems that might negatively impact their careers. This is especially true when a psychiatric illness or addiction is part of the picture.
Doctors often fear that an official diagnosis of such issues will lead to consequences from the regulatory boards that oversee them, their malpractice carriers and also the insurance companies that they bill. They may be ordered into treatment or instructed to take time off from their duties. They may become unable to qualify for insurance or even lose their license to practice medicine. There is significant fear that they may lose their career and livelihood.
For many doctors, it feels like too big of a risk, so they try to handle their issues themselves, confiding in friends and family rather than consulting a professional.
The problem, of course, is that delay doesn’t help with healing; it only allows the condition to progress and become more difficult to treat. Doctors dealing with depression or suicidal thoughts, for example, may self-prescribe antidepressants and try to keep their feelings hidden. Or doctors dealing with alcoholism may try to beat it themselves, without engaging in formal evaluation or treatment. In both cases, they are missing out on receiving therapies and treatment that would have allowed them to get to the root of their problem, learn ways to address it, and reclaim their health.
Doctors are at same overall risk of mental illness and addiction as the general population. However, because they operate in such high-stress environments and have access to medications as part of their occupations, they are at higher risk of specific substances of abuse and negative outcomes such as burnout and suicide.
As a 2015 analysis of physician health created through the Québec
Physicians’ Health Program noted: “Suicide is the only cause of death that is more prevalent among physicians than the general population.”
Taken as a whole, the current environment in which doctors practice causes them to neglect for themselves the care they provide for others, just like the shoemaker. The effect is that small problems over time can snowball into bigger ones.
So how do we turn the tide on this mindset?
- Rather than seeing regulatory boards as the enemy, physicians should instead reach out to their hospital well-being committee and/or state physician health programs for resources and to oversee and monitor the healing process. It is important to be proactive and act before their health deteriorates to the point the board must be notified. While the accountability these organizations require may seem intimidating, especially in cases of substance use disorder, their resources and monitoring have been proven to be a key reason that physicians tend to have better outcomes in recovery than the general population.
- The medical community should move away from its history of expecting its healthcare providers to work themselves to exhaustion and ignore their own well-being, and doctors should give up on the superhuman image they feel compelled to pursue.
- Medical organizations and communities should promote programs that focus on wellness and prevention (addressing problems before they start), rather than reacting primarily to aftermaths.
- Doctors should heed the advice they give to patients and start with obtaining (and regularly visiting) a primary care physician. Unfortunately, research shows that physicians are reluctant to comply with the practices or treatment they prescribe to their own patients.
- Doctors and the healthcare organizations under which they function should change their outlook and promote physicians taking the time needed to cultivate well-being, as it will pay dividends in the long run.
Perhaps most crucially, the entire medical community should work to change the negative filter through which mental health and addiction issues in particular are seen. This stigma was on full display in interviews compiled during the Québec Physicians’ Health Program study: “If a doctor has a heart attack, people say, ‘He collapsed on the job. He did himself in by working too hard.’ But if a doctor has to stop working because of burnout, people say, ‘He wasn’t strong enough. He couldn’t take the pressure.’”
Doctors also need to become comfortable allowing themselves to share their stories of recovery and the benefits of having accepted help. It is not only good for their own peace of mind, it makes it more acceptable for others to reach out for their own care when needed. Physicians have a high likelihood of achieving a strong and lasting recovery when they engage in treatment, and that is a healthy outcome for everyone.