It has been largely assumed that healthcare workers (HCWs) take better care of themselves than the patients they treat because they have greater knowledge of appropriate healthcare choices than the general public and because of their position as role models for patients. “HCWs represent an important group in which to study individual health behaviors,” explains Kenneth J. Mukamal, MD, MPH. “Empiric evidence suggests that HCWs who appear to adhere to the advice they give to their patients may have their advice taken more seriously than from HCWs who are less healthy. Unfortunately, little data exist from long-term studies to confirm this association.”
In many respects, HCWs represent a best-case scenario for public health research, according to Dr. Mukamal, because of their access to the best health knowledge available. He adds that when physicians are successful in achieving certain health-related goals, it may indicate what accomplishments can be expected in the general public if efforts are made for greater education on that topic. However, he says the pendulum swings both ways, warning that if HCWs are not meeting a certain goal, it suggests that societal pressures may be difficult to overcome.
A Deeper Look into Healthcare Worker Lifestyle
Dr. Mukamal and Benjamin K. I. Helfand, MSc, had a research letter published in JAMA Internal Medicine that further investigated the healthcare and lifestyle practices of HCWs. The study team used the CDC’s Behavioral Risk Factor Surveillance System, an annual telephone survey of adults in the United States. HCWs were identified as respondents who replied “yes” when questioned if they provided direct patient care as part of their routine work. The authors then assessed and compared the prevalence of six preventive health behaviors and 14 lifestyle factors among HCWs and non-HCWs (Table). Although the survey did not separate physicians from other HCWs, Dr. Mukamal notes that results were separately stratified. “We further vetted respondents based on whether they at least graduated college, which we felt would mostly constitute physicians, nurses, therapists, and other more highly trained providers,” he says.
Key Findings on Accessing Care
As expected, HCWs generally reported more desirable behaviors than non-HCWs in areas related to accessing healthcare. “HCWs were more likely to report having had a checkup in the past 2 years, a Pap smear in the past 3 years, a dental visit in the last year, and—although not quite significant—a sigmoidoscopy or colonoscopy,” says Dr. Mukamal. HCWs were also more likely to report having a personal physician, deny partaking in recent heavy or binge drinking, and having exercised within the past 30 days.
Dr. Mukamal says it is reassuring to know that HCWs performed better in several healthy behaviors, but that may be due to having more immediate access to healthcare. “Access to care alone was not the only explanation for our findings since similar healthcare behaviors—such as with mammography—were not always more common among HCWs. We can only speculate that this discrepancy may reflect that HCWs are perhaps more familiar with the discomfort related to mammograms.”
For many behaviors, no significant differences were seen between HCWs and non-HCWs. HCWs were also more likely to deny partaking in recent heavy or binge drinking and report having a personal physician and having exercised within the past 30 days. “It’s not clear why no significant differences were seen in some areas, except perhaps that these behaviors may simply be hard to change for anyone,” Dr. Mukamal says. “Illustrating these points is the fact that obesity rates continue to climb across the country, and smoking rates are still high. It’s difficult to get all people to eat right, exercise regularly, and quit unhealthy habits like smoking.” He adds that the positive healthy behavior findings for both HCWs and non-HCWs may also be the result of most people in the U.S. already doing those behaviors.
Implications on Practice and Patients
Dr. Mukamal says that, in some cases, this information can be helpful during patient consultations. “For example, when HCWs recommend to patients that they should get a Pap smear test, they can be confident when they tell them that HCWs are doing it. On the other hand, in the areas needing improvement—such as smoking or obesity—it’s important to change the focal point of the conversation and think about what the system-wide challenges are to meeting our goals. In that framework, patients and clinicians can work together to identify hurdles and develop potential strategies to overcome them.”
Readings & Resources (click to view)
Helfand B, Mukamal K. Healthcare and lifestyle practices of healthcare workers: do healthcare workers practice what they preach? JAMA Intern Med. 2012;173:242-244. Available at: http://archinte.jamanetwork.com/article.aspx?articleid=1483956.
Frank E, Breyan J, Elon L. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000;9:287-290.
Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. Am J Epidemiol. 2005;162:199-200.
Centers for Disease Control and Prevention. Behavioral risk factor surveillance system: questionnaires. Available at www.cdc.gov/brfss/questionnaires/questionnaires.htm.
Shahar D, Henkin, Rozen G, et al. A controlled intervention study of changing health providers’ attitudes toward personal lifestyle habits and health-promotion skills. Nutrition. 2009;25:532-539.