Discussion
This study shows that few GPs seek help from the primary health service when they are ill. However, they are overrepresented in terms of consultations with contract specialists.
Older GPs apparently enjoyed better health than their peers with the same level of education, but this might be bias due to the so-called healthy worker effect (10). Both the ICPC morbidity index (the primary health service) and the Charlson score (the specialist health service) surveys chronic and serious illness (8, 9), but it is possible that illness among GPs is underestimated as they tend not to consult their own GP.
We had no access to more recent data than from 2018, and the health survey was performed with data from 2015–17. The results are consistent with many previous studies (5, 6, 11), but we do not know the degree to which they are still valid.
Doctors often tend to ignore their own symptoms, and to go to work even when they are ill (5, 11). Many studies have shown that self-treatment is widespread (1, 5). Primary care providers and GPs have wide-ranging competence and can therefore administer self-treatment for many different conditions. Although this can be a sensible, resource-saving approach when it comes to uncomplicated conditions, it increases the risk of incomplete investigation and delayed diagnosis of serious illness. It may also entail breaches of the Norwegian Medical Association's code of ethics for doctors (12): 'A doctor should take care of his own health and seek help if it fails.'
GPs identify strongly with the role of helper, and it can therefore be difficult to switch roles and ask for help. In most Norwegian municipalities, your GP will be a colleague whom you also know socially, and there may be concerns about confidentiality (6). Some may find it embarrassing to talk about their own problems with a colleague. On a busy workday, doctors may not take the time to make an appointment with their GP but may in passing ask a colleague at their place of work, usually an informal contact that is not entered in the medical records, nor is it recorded in any other way. There may also be some underreporting of genuine consultations if no patient user fee is required. This applies for example to the collegial support scheme for doctors (13).
This study indicates a higher use of contract specialists by GPs than by other groups. This may be due to the fact that GPs can refer themselves to a specialist, but it is also possible that doctors have a lower threshold for referring a colleague to a specialist.
It is well known that doctors more often struggle with work stress and mental problems (1–4), and it is therefore to be expected that they have a greater need for help from specialists in psychiatry than other people. That is also confirmed in this study, which shows that GPs consult contract psychiatrists almost three times as much as others. It can be particularly difficult to consult a GP colleague in order to be referred to a psychiatrist, so the opportunity to refer oneself may act as a safety valve.