Doctors who need doctors

What do you call a highly educated, financially successful person with easy access to health care who nonetheless fails to see a physician regularly?

Often, you call him "Doctor."

Health-care professionals worry about the fact that 14 to 18 percent of Americans do not see a doctor routinely. Most of the seemingly obvious reasons for this failure -- low income, inadequate education, lack of insurance, etc. -- don't apply to physicians. Yet, according to a study in last week's Archives of Internal Medicine, they are twice as likely as other people to have no "regular source of care," or RSOC.

In a sample of 915 graduates of the Johns Hopkins University School of Medicine, with an average age of 61, 252 doctors reported having no RSOC, and another 60 said their primary physician was the person they saw every morning in the bathroom mirror.

"These are all people who should have regular physicians," says Cary Gross of the Yale University School of Medicine, the lead author of the study. He says that the 34 percent no-doc figure was "a little bit higher than we expected. . . . We were surprised at how common that was."

Especially delinquent were Gross' fellow internists -- "we who are supposedly great promulgators of prevention," he says. At 39 percent, only the pathologists (46 percent) scored worse. The doctors who were best at following their own advice were psychiatrists (only 21 percent lacked an RSOC) and pediatricians (22 percent).

Aside from the smirks that these findings may inspire, there are lessons. As Gross and a group of colleagues from Hopkins note in the study, "many patients look to their physician for advice about medical care," and earlier studies suggest that "physicians' own health habits influence the preventive health counseling they provide to their patients."

By that measure, the doctors without doctors don't set a good example. Consider these findings from the study:

-- 75 percent of doctors with an RSOC reported being screened recently for colon cancer, compared with 49 percent of those who didn't have a regular doctor.

-- Of the female doctors considered prime candidates for mammography, 84 percent of those with an RSOC had received this screening for breast cancer, compared with 47 percent of the others.

-- While 78 percent of the RSOC physicians had had flu shots, only 59 percent of those without a regular doctor had done so.

So is Gross condemning his fellow doctors as hypocrites? Hardly. "I do not practice what I preach" when it comes to having a regular doctor, he confesses. "I don't have one, I'm embarrassed to say."