How many doctors self-diagnose?

As Dr. William Osler famously said, “A physician who treats himself has a fool for a patient.” So, it’s surprising that about two in five physicians (38.1%) report that they choose to diagnose their own health concerns rather than see a primary care physician (PCP), according to a recent MDLinx survey. Also surprising: More than one in five physicians (22.2%) don’t even have a PCP.

This survey received responses from 126 physicians, including PCPs and a range of different specialists.

Your primary patient

Barbers don’t cut their own hair, do they? So, is it smart for physicians to diagnose and treat themselves?

“I have a PCP,” one busy physician said. “Just don't have time to see him!”

“I think no one will care about me as much as I do,” said another respondent. “Physicians over-order studies to CYA [cover their ‘assets’]. And I don’t have a PCP because it’s inconvenient.”

One doctor stated, “I really believe I’m a better physician than the present crop of ‘cookbook doctors.’ I diagnose a problem with logic, not Google.”

Self-dx for self-limiting problems

Not all physicians surveyed take such a hard line. Many choose to make their own diagnoses for common or short-term problems, but then seek out a PCP or specialist for more serious situations. For example, about 30% of physicians prefer to self-diagnose except for emergencies.

“I self-diagnose simple diseases, but always see my PCP annually,” said one physician. Another explained, “I don't exclusively self-diagnose. I work with my PCP. Sometimes, however, I do not always agree with the PCP and modify their suggestions for treatment, etc.”

One doctor wrote, “There are many conditions that can be self-dx. The key is to know when to seek more expertise.”

Interestingly, physicians seek the expertise of certain specialists more than others. Here’s the number of respondents (by percentage) who said they’d see a specialist for these types of illnesses:

• Pain management – 14.3%
• Psychiatry – 21.8%
• Rheumatology – 26.9%
• Endocrinology – 29.4%
• Neurology – 35.3%
• Oncology – 37.0%
• Urology – 37.8%
• Dermatology – 39.5%
• Gastroenterology – 42.9%
• Surgery – 44.5%
• Orthopedics – 47.1%
• Ophthalmology – 54.6%
• Cardiology – 63.0%

Patients make lousy doctors

“I realize I should find a primary care doctor but to be honest with you, even with health insurance, medical costs are a concern,” voiced one physician. “I have seen a foot doctor for Jones fracture and a urologist to confirm Peyronie’s disease in myself but haven't seen a primary care doctor: He or she is likely to tell me lose weight, exercise, eat better. I kind of already know this.”

You kind of know a lot, but does that make you the best physician to treat you as a patient? More than one respondent said: “I have a PCP but usually self-diagnose since no one knows me better than myself.” However, this may lead to misdiagnosis, which, if not caught through a second opinion, may do more harm than good.

In an article in Medical Economics, Karen B. Weinstein, MD, FACP, Medical Director, Rush Primary Care, Oak Park, IL, countered that argument. She described how overwhelming fatigue led her to self-diagnose what she thought was hepatitis, as indicated by elevated liver enzymes.

“While I worried, I called a friend who diagnosed mononucleosis over the phone. It was confirmed, and I recovered quickly,” Dr. Weinstein wrote. “No harm was done, but I would have been diagnosed more quickly and efficiently if I had acted like a patient and not a doctor.”

She added, “We preach to our patients the importance of seeking medical care for their health issues. We as doctors are no different. We are not immortal, and when sick, we may not exercise the best judgment.”

As one respondent wrote, echoing Dr. Osler’s admonition, “I do not have a fool (myself) for either a physician or a patient.”