BMJ 2001;323:728-731 ( 29 September )

Primary care

Challenge of culture, conscience, and contract to general practitioners' care of their own health: qualitative study

William T Thompson, lecturer, ^a Margaret E Cupples, senior lecturer, ^b Caryl H Sibbett, researcher, ^a Delia I Skan, senior employment medical adviser, ^c Terry Bradley, assistant director. ^d

^a Graduate School of Education, Queen's University of Belfast, Belfast BT7 1HL, ^b Department of General Practice, School of Medicine, Queen's University of Belfast, Belfast BT9 7HR, ^c Employment Medical Advisory Service, Health and Safety Executive for Northern Ireland, Belfast BT6 9FR, ^d Northern Ireland Council for Postgraduate Medical and Dental Education, Belfast BT7 3JH

Correspondence to: M E Cupples m.cupples{at}qub.ac.uk

Objective: To explore general practitioners' perceptions of the effects of their profession and training on their attitudes to illness in themselves and colleagues.
Design: Qualitative study using focus groups and indepth interviews.
Setting: Primary care in Northern Ireland.
Participants: 27 general practitioners, including six recently appointed principals and six who also practised occupational medicine part time.
Main outcome measures: Participants' views about their own and colleagues' health.
Results: Participants were concerned about the current level of illness within the profession. They described their need to portray a healthy image to both patients and colleagues. This hindered acknowledgement of personal illness and engaging in health screening. Embarrassment in adopting the role of a patient and concerns about confidentiality also influenced their reactions to personal illness. Doctors' attitudes can impede their access to appropriate health care for themselves, their families, and their colleagues. A sense of conscience towards patients and colleagues and the working arrangements of the practice were cited as reasons for working through illness and expecting colleagues to do likewise.
Conclusions: General practitioners perceive that their professional position and training adversely influence their attitudes to illness in themselves and their colleagues. Organisational changes within general practice, including revalidation, must take account of barriers experienced by general practitioners in accessing health care. Medical education and culture should strive to promote appropriate self care among doctors.

What is already known on this topic High levels of stress, psychological distress, and suicide have been reported among doctors Doctors are reluctant to seek help in the normal way when they become stressed or ill What this study adds The perceived need to portray an unrealistically healthy image is stressful and a barrier to appropriate self care The emotional response to personal illness can produce an oscillation between panic and denial The working arrangements of general practitioners reinforce a culture in which their own and colleagues' distress is overlooked

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