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When Residents Need Health Care: Stigma of the Patient Role

Received August 15, 2008; revised November 22, 2008, and April 27, 2009; accepted April 27, 2009. Dr. Moutier is affiliated with Psychiatry and the School of Medicine at the University of California, San Diego; Dr. Cornette is affiliated with Psychiatry and Behavioral Medicine and the Injury Research Center, Department of Emergency Medicine, at the Medical College of Wisconsin in Milwaukee, and with the Mental Health Division at Zablocki VA Medical Center in Milwaukee; Dr. Lehrmann is affiliated with Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee and with the Mental Health Division at Zablocki VA Medical Center; Dr. Geppert is affiliated with Psychiatry at the University of New Mexico in Albuquerque and with Behavioral Health Care at New Mexico Veterans Affairs Health Care System in Albuquerque; Drs. Tsao and Roberts are affiliated with Psychiatry and Behavioral Medicine at the Medical College of Wisconsin in Milwaukee; Ms. DeBoard is affiliated with Psychology at Marquette University in Milwaukee; Dr. Green Hammond is a consultant at Ecosystem Modeling in Albuquerque. Address correspondence to Christine Moutier, M.D., Associate Clinical Professor of Psychiatry, Assistant Dean for Student Affairs, UCSD School of Medicine, 9500 Gilman Dr., San Diego, CA 92093; cmoutier{at}ucsd.edu (e-mail).

OBJECTIVE: Whether and under what circumstances medical residents seek personal health care is a growing concern that has important implications for medical education and patient welfare, but has not been thoroughly investigated. Barriers to obtaining care have been previously documented, but very little empirical work has focused on trainees who seek health care at their home institution. METHODS: A self-report survey on special issues in personal health care of residents was created and distributed at the University of New Mexico School of Medicine in 2001. The authors report findings regarding stigma, fear of jeopardy to training status, and attitudes toward seeking self-care for residents in dual roles as patients and trainees. RESULTS: Residents (N=155) rated their concerns regarding stigma and jeopardy to training status and the likelihood of seeking care at their training institution for six vignettes. The vignettes were paired to make comparisons between attending or supervisor as treating physician and between clinical scenarios. Alcohol abuse, nausea and diarrhea, panic attacks, and pregnancy were the most highly stigmatizing to residents; diabetes and hypertension were the least. Differences were also found for gender and specialty. CONCLUSION: Residents’ perceived stigma for clinical situations was an influential factor, strongly affecting concern about jeopardizing training status and likelihood of avoiding care at their home institution.

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