Why Are Doctors Such Bad Patients (Physician, Book Thyself)

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Hello and welcome back to Chart Less, Live More, the show for physicians and APPs who want to practice excellent medicine, think clearly about hard stuff, and still have an actual life outside their EHR. I’m your host, Dr. Junaid Niazi.

Why are doctors such bad patients?

“Physician, heal thyself.”

You’ve heard it. Maybe from a relative, right after you told them to watch their salt while you ate cold pizza over the sink at eleven at night.

It’s one of the oldest sayings about doctors there is. People have been teasing doctors about not taking their own advice for at least a couple thousand years.

That’s a long time for a joke to stay funny. When a joke lasts that long, there’s usually something true in it.

So today’s question: why are doctors such bad patients?

The easy answer is personality. We’re stubborn. We know too much. We assume we’re the exception. And there’s some of that. I won’t pretend there isn’t.

But most of it is how the job is set up. There’s often no coverage when you’re sick. There’s no time in the schedule for your own appointments. And the whole system is built around you wearing the white coat. Wearing the gown is something nobody ever taught you how to do.

That makes sense, in a way. Being the doctor is your job. Of course you don’t spend much time thinking about being the patient.

It’s a little like an electrician. He spends all day fixing other people’s wiring. And his own house is the one with the kitchen light that’s been flickering for months. It’s not that he doesn’t know what’s wrong. Fixing things is his job, and his own house never makes it onto the schedule.

But the light still needs fixing.

So here’s the thesis. It’s only partly a personality quirk. Mostly, it’s design. And some of it you can fix this week.

How many physicians don’t have their own doctor?

Let’s start with a simple question. Who’s your doctor?

Not the friend down the hall who’d take a quick look. Not the group chat from residency. Not the old mentor you still call when something feels off. The person whose name is on your chart as your primary care.

If a name came to you right away, great. If you paused, you’re in good company.

In 2000, a team at Johns Hopkins published a study with a title that fits this episode perfectly. “Physician, Heal Thyself?” With a question mark.

They followed Hopkins medical school graduates from the classes of 1948 through 1964. In 1991, nine hundred and fifteen of them answered a simple question: did they have a regular source of care? A doctor, or a place, they went to when they needed care.

About thirty-five percent said no. More than one in three.

And it varied a lot by specialty. Psychiatrists were the most likely to have a doctor of their own.

About twenty-one percent went without. Pathologists were the least likely. Forty-six percent had no regular source of care.

Pathology. The specialty that sees, in more detail than anyone, what happens when things get missed. And nearly half of them didn’t have a doctor.

I’m not picking on pathologists. I’m pointing out that knowing exactly how things go wrong does not, apparently, make anybody book an appointment.

Does it matter if physicians don’t have a regular doctor?

Ok, Junaid, why does it matter? Six years later, the researchers checked back on preventive care. The physicians without a regular doctor were less likely to have been screened. For colorectal cancer screening, it was forty-nine percent of physicians without a regular doctor, compared with seventy-five percent of those who had one. For the flu vaccine, fifty-nine percent compared with seventy-eight.

Two honest caveats. First, this is correlation, not causation, and the authors say so. Physicians who skip having a doctor may differ in other ways too. Second, this is older data, from physicians who trained in the forties, fifties, and sixties.

But as you’ll hear, the newer research doesn’t tell a very different story.

Why do physicians work when they’re sick?

Second question. When was the last time you called out sick?

Not the time you planned to call out and then came in anyway. The time you actually stayed home.

In 2014, researchers surveyed more than nine hundred attending physicians and advanced practice clinicians at a large children’s hospital. Julia Szymczak and colleagues published the results in JAMA Pediatrics in 2015.

Eighty-three percent had worked sick at least once in the past year.

Fifty-five point six percent said they would come to work with significant respiratory symptoms.

These are pediatricians, specialists, and APPs at a children’s hospital. Nobody understands infection control better. They know exactly what a cough on a pediatric floor can do.

So the researchers asked why they came in anyway. The top reason was not wanting to let colleagues down. Ninety-eight point seven percent. Right behind it was staffing concerns, at ninety-four point nine.

Nobody’s coming in out of stubbornness. They’re coming in out of loyalty and a sense of responsibility. That’s the uncomfortable part. The best things about these people are what keep them working sick.

What those answers describe is a staffing design with no backup built in. In a lot of practices, if you call out, your patients don’t disappear. They get added to a colleague’s day, or pushed into your own schedule next week, which is sometimes worse. When staying home means your colleague doubles their panel, people come in. Of course they do.

So I’m not going to tell you to take better care of yourself. You know how. The problem isn’t knowledge. The system is built on the assumption that you will never be sick. So you aren’t allowed to be.

Why do doctors treat themselves?

Which brings us to what we do instead.

Last year, Family Practice Management, the AAFP’s journal, ran a review called “Physicians as Patients,” by Drs. Urmi Patel, Becky Lowry, and Megan Hiles. It pulls together the research on what happens when doctors need doctors.

A few findings stood out.

In a survey of Australian doctors, nearly half didn’t have a regular GP of their own. And ninety percent said it was acceptable to treat their own acute conditions.

Ninety.

And if you’ve ever treated a colleague, you know how that visit goes. They walk in with their own differential, their own plan, and some notes on your plan. You’re not really their doctor. You’re more of a consultant they can overrule.

What is post-residency disease?

There’s a name for the pattern underneath all of this. A physician and researcher named Robert Klitzman interviewed doctors who had been through a serious illness themselves. Looking back, a lot of them recognized the same thing: how long they’d waited, and how much they’d explained away. He had a name for it. “Post-residency disease.” The habits training builds, like ignoring your own symptoms, pushing through, and never being the one who needs help, keep running long after residency is over.

Why don’t doctors go to the doctor?

Now, at the top I said this is only partly personality. So let’s be honest about that part.

Some of it is identity. For years, your job has been to be the one who knows. Sitting in the gown, answering intake questions, waiting for someone else to tell you what’s going on, can feel like a demotion.

Some of it is knowing too much. A patient with a headache thinks “tension.” A doctor with a headache has a differential. The bottom of that list is scary enough that it’s easier not to ask.

And some of it is fatalism. In that Hopkins study, physicians who believed their health came down mostly to chance were more likely to have no regular doctor at all. If it’s all luck anyway, why book the appointment?

None of that makes you a bad person. It’s what years of training and responsibility do to people. But it’s worth naming, since it’s hard to work around something you won’t admit is there.

Why is the hallway curbside a problem?

And then there’s the most common form of physician health care in America. The hallway curbside.

You know this one. A colleague catches you between rooms. “Hey, quick question. It’s probably nothing.”

Then they roll up a sleeve. Or they describe a headache that’s been going on for “a little while.”

Which turns out to mean since August.

Or maybe you’re the one rolling up the sleeve.

Either way, it is never a quick question.

Here’s what you lose when you treat yourself, or get your care in a hallway. The reason anyone has a doctor isn’t that the doctor knows things the patient doesn’t. You know plenty.

It’s an outside set of eyes. Someone who isn’t scared on your behalf. Someone who isn’t motivated to explain it away. Someone who isn’t hoping it’s nothing because they have a full clinic tomorrow.

You can’t be your own outside set of eyes. Nobody can.

Where can physicians get confidential mental health support?

And when the issue is mental health, the barriers get even higher, like licensing questions and worries about who will see your chart. So here’s a number worth having. The Physician Support Line, 1-888-409-0141. It’s free, confidential, and staffed by volunteer psychiatrists, and their site says it reports to no one. If you or someone you know is in crisis right now, call or text 988.

How can health systems make it easier for physicians to get care?

So what actually helps? The fixes in that FPM review are mostly structural, which is the right instinct.

Protected time. Appointment time built into the schedule for clinicians’ own care, including telehealth visits.

Coverage. Real backup, so a physician can actually leave for an appointment, or stay home sick, without a colleague absorbing the whole day.

Confidentiality. A lot of EHRs have something called a “break-the-glass” prompt. If your chart is flagged, anyone who tries to open it gets a warning screen first. They have to give a reason, and their access is logged. It doesn’t make your chart untouchable, but it means nobody opens it out of curiosity without leaving a trail. And for some people, the better answer is getting care at a different institution entirely, where nobody in the building knows your name.

If you’re in leadership, that’s your to-do list.

What should physicians check during open enrollment?

If you’re not, some of this is still in your control. And the timing is good. November is open enrollment season for a lot of employers, so you’re probably going to be in the benefits portal anyway.

It’s a natural time to check whether you have a doctor listed at all. A lot of plans let you name one, and a lot of physicians have never filled it in. If the last doctor you saw was ten years ago and you liked them, look them up. Find out if they’re in network and still taking new patients. You may be able to go back to someone who already knows you. And while you’re there, check what preventive care your plan covers.

And while you’re in there: last week, I asked you to go find two words. Own occupation. If you didn’t get to it, you’re already logged in.

This week: name your doctor

Here’s your prescription. Three things.

One: name your doctor. Say the name out loud. If you can’t, that’s your first appointment.

Two: book one overdue screening or visit before the end of the year. Especially if you’ve already met your deductible. That appointment may never be cheaper than it is in December.

Three: next time you’re sick, ask what the coverage plan is. If there isn’t one, that’s what you bring to leadership. Not “I need to be tougher.” Something more like, “We need a plan for when one of us gets sick, since one of us will.”

And this week’s action item is almost embarrassingly small.

Put your own doctor’s name and number in your phone contacts.

You have the number for your favorite takeout place saved. Your doctor deserves at least that.

Where does the time for your own care come from?

One more thing before I let you go.

When physicians tell me why they haven’t seen their own doctor, the answer is almost always time. And when we look at where the time goes, a lot of it is charting. At night, on weekends, at the kitchen table.

The hours for that appointment exist. They’re just getting spent on notes.

That’s what Charting Conquered Blueprint is for. It’s a self-paced digital course that covers the whole clinical day: before the visit, during it, and after it. So the charting gets done while you’re with the patient, and your evenings are yours again.

It also gets at the part that has nothing to do with workflow. The perfectionism. The guilt. The idea that hard means caring. A lot of us are wired that way, and no template can out-muscle it. It’s the same wiring that tells you your own appointment can wait.

It can’t. And once your evenings are back, some of that time can go to your own health.

Charting can be learned. So can making time for yourself.

It’s at chartingconquered.com/blueprint if you want to take a look.

Physician, book thyself

Here’s where I want to leave you.

“Physician, heal thyself” was never meant literally. Nobody expects you to take out your own appendix.

It has been done. A Soviet physician named Leonid Rogozov did it in Antarctica in 1961, as the only doctor at his station. He survived. It is not a model of care.

For the rest of us, the modern version is simpler.

Physician, book thyself.

If this episode made you think of a colleague who’s been saying “it’s probably nothing” since August, send it to them.

This has been Chart Less, Live More. Go chart less. Go book the appointment. Go live more. I’ll see you next time.

Content for this episode includes proprietary information from Prosperous Life MD and Charting Conquered, along with published research from the Archives of Internal Medicine, JAMA Pediatrics, Family Practice Management, the Medical Journal of Australia, and Perspectives in Biology and Medicine. It also includes the personal opinions and experiences of Dr. Junaid Niazi, and nothing in it is medical advice. For questions or comments, please email support@prosperouslifemd.com and include “podcast” in your subject line.