BMJ 1999;319:605-608 ( 4 September )

Papers

Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines

Malcolm Forsythe, professorial fellow in public health,  Michael Calnan, director,  Barbara Wall, research officer. 

Centre for Health Services Studies, George Allen Wing, University of Kent, Canterbury, Kent CT2 7NF

Correspondence to: M Forsythe J.M.Forsythe-2{at}ukc.ac.uk

Objectives: To examine the adherence by senior NHS medical staff to the BMA guidelines on the ethical responsibilities of doctors towards themselves and their families.
Design: Postal semistructured questionnaire.
Setting: Four randomly selected NHS trusts and three local medical committees in South Thames region.
Subjects: Consultants and principals in general practice.
Main outcome measures: Personal use of health services.
Results: The response rate was 64% (724) for general practitioners and 72% (427) for consultants after three mailings. Most (1106, 96%) respondents were registered with a general practitioner, although little use was made of their services. 159 (26%) general practitioners were registered with a general practitioner in their own practice and 80 (11%) admitted to looking after members of their family. 73 (24%) consultants would never see their general practitioner before obtaining consultant advice. Most consultants and general practitioners admitted to prescribing for themselves and their family. Responses to vignettes for different health problems indicated a general reluctance to take time off, but there were differences between consultants and general practitioners and by sex. Views on improvements needed included the possibility of a "doctor's doctor," access to out of area secondary care, an occupational health service for general practitioners, and regular health check ups.
Conclusion: The guidelines are largely not being followed, perhaps because of the difficulties of obtaining access to general practitioners outside working hours. The occupational health service should be expanded and a general practitioner service for NHS staff piloted.

Key messages Senior doctors are not following the BMA guidelines on looking after their own and their families' health They seem very reluctant to consult their general practitioner They prefer to self treat, carry on working, and consult informally Potential barriers to access should be removed in order to improve their health

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