Issue 7 / 4 March 2013

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

9 thoughts on “Jane McCredie: Self-treating quandary

  1. Bill McCubbery says:

    “Hard cases make bad law”. If we are capable of using professional judgement to decide whether we should treat a patient or seek consultant advice, we are capable of treating straightforward conditions in ourselves or others. For those who find this difficult or distasteful for whatever reason there is the option, for them, to refer everything on. However, that decision for them does not endowed of them with the right or authority to impose it on all their colleagues. Fascism is not dead and turns up in the most unexpected places.

  2. Richard says:

    Completely agree that repeat scripts for regular meds do not need a visit to a GP friend. However, a visit is always an opportunity for a second mind to consider the situation and perhaps a yearly check is a discretionary event to consider?

    I see the present “recommendations” from PBS and those who must be obeyed as yet more intolerable excuses to interfere in the lives and affairs of grown up professionals.

    To Rose… Surely you are able to help out with simple non schedule treatments, if there is an urgent need?

  3. Rose says:

    We should all have a GP for ourselves and our families, not to mention our in-laws , potentially our out-laws, and friends. We need to set boundaries to avoid becoming a prescription or referral pad , which incur professional liability, to save relatives and friends the bother of making a GP appointment. My response to relatives and friends who “just need a prescription, referral etc ” is to advise them to make an appointment to see their own GP .

  4. Nai says:

    I try to make appointments for myself and my family but we are dreadfully short of appointments at work and when I have seen other doctors they just question why I am seeing them and haven’t just printed out my own script or investigative forms. They always make me feel I have been wasting their time when it is something I could do myself.

  5. Gary Smethurst says:

    It adds to the quandary that it is a contravention of state (Victoria at least) drugs and prisons laws for doctors to self-prescribe any schedule 4 or 8 poison.

  6. Frank Johnson says:

    The Australian Senior Active Doctors association (ASADA) of which I am national president, has always held the view that doctors and their families should have their own GP. The registration category “Limited Registration, Public Interest – Occasional Practice (LRPIOP)” allows registrants to “a.refer a person to another registrant; or b, prescribe a scheduled medicine for a person that has been previously prescribed for the person, within the last 12 months, by another registrant who is not a limited registrant”.
    Statements have been made that senior active doctors want to treat themselves and their families. This is not true and never has been.

  7. Tony Krins says:

    Suggesting that doctors should not be “allowed” to write repeat scripts for their own or their family members for chronic or minor ills (e.g. antihypertensives), is patronising, bureaucratic, bigoted and unnecessary. Let’s go to the “evidence”. How much harm has occurred in Australia as a result of doctors providing minor medical services for themselves or their close relatives? My guess is that the ability and “right” to do this has caused so little in the way of problems, that we should leave well enough alone. Doctors are usually wise and our fraternity does not need this meddling in our private affairs, neither from the bureaucracy nor from our colleagues.

  8. Tom Ruut says:

    When we were kids dad,a GP,used to treat all of us unless we needed specialist attention.My own children had their own GP maybe because my wife had little confidence in my reassurances.I am a radiologist.

  9. Anonymous says:

    We’re all adults and smart enough to know when to seek help and when to treat ourselves or our family (on the whole). I think this should be left to our discretion.
    Of course there will be errors at times, just as there are errors with treating any patient.
    We’re grown up. Leave it to us to decide.

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