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Personal Health Care of Residents: Preferences for Care Outside of the Training Institution

Received October 30, 2006; revised April 15, 2007; accepted June 13, 2007. Dr. Dunn is affiliated with the Department of Psychiatry and Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco; Dr. Moutier is affiliated with the Department of Psychiatry and the Office of Student Affairs and Undergraduate Medical Education at the University of California, San Diego; Dr. Green Hammond is a Consultant in Albuquerque, New Mexico; Drs. Lehrmann and Roberts are affiliated with the Department of Psychiatry and Behavioral Medicine at the Medical College of Wisconsin. Address correspondence to Laura Roberts, M.D., M.A., Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226; robertsl{at}mcw.edu (e-mail).

OBJECTIVE: The personal health care issues of residents are important but have received minimal study. Available evidence suggests that residents experience difficulties obtaining care, partly related to both the demands of medical training and concerns about confidentiality and privacy. METHODS: A self-report survey was distributed in 2000–2001 to advanced residents at the University of New Mexico Health Sciences Center. Questions related to personal health and health care attitudes, behaviors, preferences, and experiences, and vignettes related to personal illness and treatment. Here the authors report findings regarding preferences for obtaining health care "at" versus "outside" of one’s training institution. RESULTS: Data from 141 residents are presented. A substantial minority of residents had obtained care outside of their institution in the preceding year. Residents expressed concerns about their medical privacy and confidentiality related to obtaining care within their own institution, including concerns about being seen by other residents or by past or future attendings. Women expressed more concern than did men on numerous issues, as did residents in primary care versus specialty training. Residents expressed a preference for care outside the training institution when taking into account confidentiality and prevention of embarrassment; care at their own institution was preferred when considering expense and scheduling. Outside care was more strongly preferred for more stigmatizing illnesses (e.g., mental health-related). Most residents felt poorly informed regarding their personal health care confidentiality rights and did not know whether their institution had confidentiality policies regarding residents who develop physical or mental health problems. CONCLUSION: Residents worry about confidentiality and privacy when deciding where to obtain personal medical care. Trainees’ concerns are relevant to crafting policies on resident health care. Programs should strive to inform residents thoroughly about policies and rights pertaining to personal health care.

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