Every year at one of the largest meetings of physicians who specialize in the treatment of cancer, doctors can be seen puffing cigarettes during breaks.
While the sight may strike many as shocking, it is only a snapshot of a broader picture involving doctors and health issues. Doctors, as reluctant as they are to admit it, suffer from the same bad habits and serious health concerns as everyone else.
The difference between physicians and the populations they serve is that it may take them longer to acknowledge something is amiss.
Dr. Jeffrey Trilling, chief of family medicine at New York's Stony Brook University Medical Center, said physicians can readily recognize health problems in others but find the task tougher when it comes to themselves.
He knows from personal experience. Trilling put off a hip replacement and avoided the problem until the pain became so excruciating one summer while on vacation that after walking a mile, his children had to carry him.
Cancer, heart attack, stroke, alcoholism, smoking, obesity and drug abuse affect physicians just as they affect professionals in other lines of work.
"Physicians are more aware -- and afraid -- of the cascade effect of medicine," Trilling said. "That is, you order one test, it comes back equivocal and then you order another and it's more invasive, more painful than the previous, and that may be equivocal as well."
Much of what is known about the way physicians handle personal health issues is anecdotal, Trilling added. But he said there are often common threads that link one physician's health story to another's.
"There are a couple of interesting things," Trilling said. "The first one is denial. And the other one is that physicians know too much. They know the symptoms that they're having may be significant, and it's just human nature to procrastinate and deny."
The American Medical Association does not maintain statistics on the number of physicians who have chronic or life-threatening conditions.
Most physicians confronting a health issue, Trilling said, seek the opinion of a colleague.
Doctors may lose sight of their own health because they are so focused on their patients, said Dr. Diana Fite, immediate past president of the Harris County Medical Society in Houston. She is a vocal advocate for doctors paying attention to their health concerns.
Fite, an emergency physician, has high blood pressure and was aware that it had reached a potentially life-threatening level: 200/120.
Normal blood pressure is less than 120/80. Hypertension begins at 140/90.
After a brief period of taking medication for her blood pressure, Fite stopped because the drugs caused swelling in her throat and loss of her voice. "The medication just wasn't working for me," Fite said. "I felt that I was young. I have children who are still young -- I shouldn't have to worry about high blood pressure. I know now that was just plain stupid."
While leaving work in early June of last year, Fite, for a split second, felt weak on her right side. She was steering with her right hand and holding her cell phone in her left.
"I thought I must have worked too hard," she said of the weakness. "But within another second the car started weaving and I realized I had no strength at all. So I grabbed the steering wheel with my left hand. I had to get my foot off the gas pedal. It was just dead. I had to kick it off.
"I looked in the rearview mirror and tried to smile but the right side of my face didn't move at all. So I knew immediately that it was a full-blown stroke."
Fite managed to grab her phone, which she had tossed in her panic to steer. She punched 911. But words were difficult to form: "I was making these horrible noises in the phone. It was a cell phone and they couldn't find my location.
"It took a long time to get them to realize where I was. I just grunted the word out, stroke, in a very low voice."
When the ambulance arrived, Fite instructed emergency personnel to take her to a stroke center, which was significantly farther away than the nearest hospital. As a doctor she knew she stood her best chance of full recovery if she was treated with the clot-buster TPA. She arrived at the center within the narrow time window.
Today, she has no vestiges of the stroke. But she is serious about taking medication for hypertension.
"There is no way I would not take it," she said. "The medications can make you tired -- and there are several that I take.
But when I feel one of those side effects I say anything is better than that stroke."