Jane McCredie: Self-treating quandary

WHEN Dr Jerri Nielsen discovered a lump in her breast back in 1999, she didn’t have much option but to treat herself.

Dr Nielsen was spending winter as the team doctor at the US South Pole research station at the time. With no colleagues to rely on, and no possibility of evacuation before the spring thaw, she famously performed her own biopsy with the help of a welder who had practised by sticking a needle into a shriveled apple. The biopsy confirmed that she had breast cancer.

Supplies were air-dropped in, allowing Dr Nielsen to manage her own chemotherapy until she was eventually evacuated 5 months after the discovery of the original lump.

I found myself thinking about Dr Nielsen’s story last week, as I read a discussion on social media website Quora about doctors treating themselves.

Few doctors ever face a clinical challenge like the one that confronted Dr Nielsen, but all would at some point have faced the dilemma of whether to treat themselves or a family member.

The comments from doctors on Quora seemed surprisingly polarised, ranging from “When I fall ill, I usually treat myself because I understand my symptoms best” to “Most doctors I know (including me) never treat themselves”.

Other doctors said they would self-treat for anything that might be handled by a GP but seek specialist advice in other cases.

Research suggests that may be the most common approach.

One survey of US neurologists found 94% thought it was all right to treat their own acute minor illnesses and 87% thought it was acceptable to do this for family members. Substantial minorities thought it was okay to treat their own chronic conditions (37%) or those of family members (36%) or to order their own diagnostic blood tests (42%) or imaging (40%).

An earlier Australian survey reported similar findings, with 89% of GPs and 91% of specialists saying it was acceptable to treat themselves for an acute minor illness. For chronic conditions, 28% of GPs and 21% of specialists believed self-treatment was acceptable and a disturbing 9% overall believed it was all right to self-prescribe psychotropic medication.

As with most things in life, it’s probably better not to take too black and white a view of this.

Some degree of self-treatment is probably inevitable and it may even be the best available option at times, particularly in minor cases.

What is perhaps disturbing, though, is the hard-to-dispel notion that doctors don’t really need GPs because they can do that stuff themselves.

A neurologist isn’t going to take on his or her own orthopaedic surgery, but might well feel equipped to treat a chronic ear infection or a case of chlamydia.

This confidence often extends to treating family members. As the daughter of a medical specialist, I don’t remember ever seeing a GP as a child, though I was occasionally referred to other specialists.

Attitudes have probably changed in recent years, but maybe not enough.

Fundamentally, this approach seems to reflect an attitude that GPs are only there to hand out prescriptions and referrals, which are things any doctor can do.

But now that I’m a grown-up and have an (excellent) GP of my own, I know they do far more than that.

Generalists are the people who join the dots. The best of them treat the whole person, not just the disease. Perhaps most importantly, they pick up the things we’re in denial about, the conditions we’ll never seek specialist attention for because we’re too busy trying to pretend they’re not a problem.

And why would anybody — doctor or otherwise — deny themselves that?

Jane McCredie is a Sydney-based science and medicine writer.

Postscript: Dr Jerri Nielsen survived her initial battle with breast cancer and wrote a book about her Antarctic experience. Sadly, however, she died in 2009 after the cancer recurred.

Posted 4 March 2013