Swiss Primary Care Physicians Research Articles

Risk of COVID-19 and Psychological Impact of the Pandemic in Swiss Primary Care Physicians.

There is limited data on primary care physicians (PCPs) who suffered from COVID-19. We aimed to assess the proportion of PCPs with COVID-19, the proportion hospitalized with COVID-19, and the number of days off work. We also explored their psychological suffering due to the pandemic. We selected a random sample of 1,000 PCPs practicing in the seven cantons of Western Switzerland (November/December 2020). PCPs were invited by mail to complete a questionnaire. The participation rate was 51% (N=506). The burden of disease was high among PCPs: 13% suffered from COVID-19, 0.4% needed hospitalization, and 10 days off work were required on average. In addition, many PCPs reported experiencing heightened psychological symptoms, mainly fatigue (53%) and stress/anxiety (48%). These findings highlight the urgent need to implement preventive measures to reduce the risk of COVID-19 and psychological illness in PCPs.

A cross-sectional study of the health status of Swiss primary care physicians

There is limited data on the general health of primary care physicians (PCPs). We aimed to assess the physical and psychological health of Swiss PCPs. We selected a random sample of 1000 PCPs in Western Switzerland. They were asked about their self-rated health status, all medical conditions experienced in the past five years, and the number of days they were hospitalized and off work in 2019. They were also asked whether they had their own general practitioner (GP) and seen a psychiatrist/psychologist in the past 12 months. A total of 503 PCPs were included in the study (women = 51%, GPs = 67%, pediatricians = 19%, gynecologists = 14%). Ninety-four percent considered themselves in good or very good health. In the past five years, PCPs suffered mostly from depression/anxiety (21%), burnout (21%), dyslipidemia (19%) and hypertension (17%). Male and older PCPs had more often cardiovascular disorders, younger PCPs and GPs had more often psychiatric disorders. They were 9% to have been hospitalized (15% for PCPs over 60) and 20% to have been off work (32% for PCPs under 45). Only 47% had their own GP (37% for GPs). They were 16% (mostly female and younger PCPs) to have consulted a psychiatrist/psychologist. In conclusion, although PCPs considered themselves to be in good health, a substantial proportion suffered from a medical condition, mainly psychiatric (depression or burnout) and/or cardiovascular disorders, or were recently hospitalized or off work. Only half had a GP for themselves. These results may be useful for implementing specific health strategies targeting PCPs.

Prevalence and management of chronic insomnia in Swiss primary care: Cross-sectional data from the "Sentinella" practice-based research network.

We investigated the prevalence and treatment of patients with chronic insomnia presenting to Swiss primary care physicians (PCPs) part of "Sentinella", a nationwide practice-based research network. Each PCP consecutively asked 40 patients if they had sleep complaints, documented frequency, duration, comorbidities, and reported ongoing treatment. We analysed data of 63% (83/132) of the PCPs invited. The PCPs asked 76% (2,432/3,216) of included patients about their sleep (51% female); 31% (761/2,432) of these had had insomnia symptoms; 36% (875/2,432) had current insomnia symptoms; 11% (269/2,432) met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for chronic insomnia (61% female). In all, 75% (201/269) of patients with chronic insomnia had comorbidities, with 49% (99/201) reporting depression. Chronic insomnia was treated in 78% (209/269); 70% (188/268) took medication, 38% (102/268) benzodiazepines or benzodiazepine receptor agonists, 32% (86/268) took antidepressants. Only 1% (three of 268) had been treated with cognitive behavioural therapy for insomnia (CBT-I). A third of patients presenting for a non-urgent visit in Swiss primary care reported insomnia symptoms and 11% met the DSM-5 criteria for chronic insomnia. Hypnotics were the most common treatment, but almost no patients received first-line CBT-I. Reducing the burden of insomnia depends on disseminating knowledge about and access to CBT-I, and encouraging PCPs to discuss it with and offer it as a first-line treatment to patients with chronic insomnia.

Gout management in Swiss primary care - a retrospective observational study.

Gout is the most common form of inflammatory arthritis worldwide and its prevalence is rising. In Switzerland, there are no data available on the characteristics and treatment of gout patients. In this study, we aimed to describe numbers of patients affected by gout and hyperuricaemia and unveil approaches Swiss primary care physicians (PCPs) use for the management. This was a retrospective observational study using electronic medical routine  data provided from 242 Swiss PCPs. Included were all their patients receiving urate-lowering therapy (ULT), with a diagnostic code for gout or who had a serum uric acid (SUA) measurement. According to their disease status, patients were classified into four subgroups (normal urate, hyperuricaemia, untreated gout, treated gout). For treatment analysis, patients with SUA measurements before and after ULT initiation were included. Comorbidities and risk factors for secondary causes relevant in the context of gout were collected. Outcomes were prevalence of gout and hyperuricaemia, characteristics of patients according to subgroup, number of SUA measurements, levels of SUA and patients who reached the treatment goal of a SUA level <360 µmol/l. We assessed 15,808 patients and classified them into the subgroups. This yielded a prevalence of 1.0% for gout and 1.2% for hyperuricaemia. 2642 patients were diagnosed with gout of whom 2420 (91.6%) received a ULT. Overall; 41.3% of patients with a gout treatment had at least one SUA measurement; 15.0% of patients with treated gout had a record of SUA measurements before and after ULT initiation; and 57.5% reached the treatment goal of <360 µmol/l after allopurinol treatment. Swiss gout patients received comprehensive treatment, which is reflected in a high number of patients treated with ULT, laboratory tests per person and a high treatment success rate, although there is no systematic approach to the treatment of gout.

Screening Refusal Associated with Choice of Colorectal Cancer Screening Methods. A Cross-sectional Study Among Swiss Primary Care Physicians.

Screening Refusal Associated with Choice of Colorectal Cancer Screening Methods. A Cross-sectional Study Among Swiss Primary Care Physicians.

Quality of antibiotic prescribing of Swiss primary care physicians with high prescription rates: a nationwide survey.

To assess the quality of antibiotic prescribing of Swiss primary care physicians with high prescription rates. In January 2015, we mailed a structured questionnaire to 2900 primary care physicians in Switzerland. They were included in a nationwide pragmatic randomized controlled trial on routine antibiotic prescription monitoring and feedback based on health insurance claims data. We asked them to record the diagnosis and antibiotic treatment for 44 consecutive patients with the most common conditions associated with antibiotic prescribing in primary care. We evaluated if the disease-specific antibiotic prescribing and the proportion of non-recommended antibiotics used, in particular quinolones, were within 'acceptable ranges' using adapted European Surveillance of Antimicrobial Consumption (ESAC) quality indicators. Two hundred and fifty physicians (8.6%) responded, providing 9961 patient records. Responders were similar to the entire physician population. Overall, antibiotics were prescribed to 32.1% of patients. For tonsillitis/pharyngitis, acute otitis media, acute rhinosinusitis and acute bronchitis the acceptable maximum of antibiotic prescriptions was exceeded by 24.4%, 49.6%, 27.4% and 11.5%, respectively. The proportion of non-recommended antibiotics was for all diagnoses above the recommended maximum of 20% (31.5%-88.7% across all conditions). Quinolones were prescribed to 37.2% of women with urinary tract infections, substantially exceeding the recommended maximum of 5%. Antibiotic prescribing quality of Swiss primary care physicians with high prescription rates is low according to the indicators used, with substantial overtreatment of tonsillitis/pharyngitis, acute rhinosinusitis, acute otitis media and acute bronchitis. Routine nationwide and continuous monitoring of antibiotic use and specific interventions are warranted to improve prescribing in primary care.

A two year study of verified spider bites in Switzerland and a review of the European spider bite literature

During a two-year study, all spider bites recorded by Swiss primary care physicians were reported to the Swiss Toxicological Information Centre and all collected spiders were identified. A total of 14 verified spider bites were recorded, involving five species from four families: Zoropsis spinimana (five cases), Cheiracanthium punctorium (four cases), Tegenaria atrica (three cases) and one case of Malthonica ferruginea (= Tegenaria ferruginea) (both Agelenidae), and one case of Amaurobius ferox (Amaurobiidae). The bites of all spider species produced relatively mild symptoms. Local symptoms such as moderate to severe pain, circumscribed swelling and redness were the only effects in most cases. Systemic symptoms were rare. There was complete recovery in all cases and all lesions healed completely without further damage or secondary disorders. Following a review of the European spider bite literature, the number of spider species capable of biting humans in Europe is considered to be much larger than could be concluded from this study. Most spider bites are restricted to species living synanthropically, thus promoted by climate and habitat change. The annual frequency of spider bites in Switzerland is estimated at 10–100 bites per million inhabitants, but this is predicted to increase due to the continuous arrival of new alien species, many of which have a high potential to establish in urban areas.

Measuring accuracy of sphygmomanometers in the medical practices of Swiss primary care physicians

Objective: Arterial hypertension has a high prevalence in most countries. Blood pressure measurements are performed frequently by primary care physicians. Recommendations from different societies emphasise the importance of measuring blood pressure with well maintained and calibrated instruments only. Since appropriate quality control measures are lacking the following survey was conducted in the medical practices of Swiss primary care physicians.Methods: This is a cross-sectional survey with Swiss primary care physicians. Nine hundred and seventy-five sphygmomanometers used in the daily practice of medicine were compared and calibrated against a certified calibrator. The magnitude of the measuring error before and after calibration was determined.Results: The proportion of the instruments that measured within the required tolerance of ± 3 mmHg over all measuring ranges was 81.4%. The average maintenance time was 5.6 years (± 3.8), and 97% (n = 353) of these instruments had not been maintained for two years (i.e. the recommended maintenance interval) or more. Two years after maintenance the number of devices with measurement errors of more than ± 3 mmHg increased significantly.Conclusion: In Swiss primary care practices, the majority of upper arm and wrist sphygmomanometers measured blood pressure within a tolerance of ± 3 mmHg despite low adherence to the recommended maintenance interval. Two years after maintenance the number of sphygmomanometers with measurement errors increased significantly.

Target blood pressure attainment with antihypertensive therapy in Swiss primary care

Introduction: The control of high blood pressure (BP) remains insufficient in developed as well as in developing countries. We conducted a cross-sectional survey to investigate the management of hypertension and the achievement of target BPs in a large population of hypertensive patients treated by Swiss primary care physicians. Methods. Data from 4594 hypertensive patients were collected and assessed for demographic data, mode of treatment and BP achievements for the overall population and for high-risk patients such as diabetics and patients with impaired renal function (CKD patients). Furthermore, we analysed the achieved BP in patients receiving single pill combinations or dual free combinations for the three most commonly prescribed substances. Results. In this large patient population, 84% of patients were receiving an antihypertensive treatment of which 54% showed BP control (< 140/90 mmHg or < 130/80 mmHg for diabetics and patients with CKD). Considering the higher BP target in the elderly, 60.6% of treated patients were on target. In contrast, 28.8% of treated diabetics and 29.7% of patients with impaired renal function met BP goals. Diuretics and blockers of the renin–angiotensin system were the most commonly prescribed substances. High-risk patients and patients at advanced age (≥ 80 years) received dual free combination more frequently than younger patients. The use of diuretics was particularly high because of the prescription of single pill formulations. Differences in the pattern of drug prescription were found according to the linguistic areas. Conclusion. The control of hypertension in the Swiss hypertensive population is relatively high but still insufficient particularly among high cardiovascular risk patients such as diabetics and patients with impaired renal function. A further improvement of BP control could perhaps be achieved with a greater use of single pill combinations particularly in patients with complicated hypertension.

Chronic Hepatitis C virus infection in Swiss primary care practices: Low case loads—high barriers to treatment?

Background: The primary care physician (PCP) diagnoses chronic Hepatitis C virus (HCV) infection in most patients. He serves as gatekeeper and plays a key role in counselling and treatment guidance. Objectives: To calculate the approximate HCV caseload per practice and characterize PCPs management of the disease; in particular, to determine antiviral treatment rates and reasons for PCPs for withholding treatment. The ultimate objective was to identify potentially modifiable barriers to treatment. Methods: A confidential self-administered questionnaire centred on the above-mentioned questions was distributed to 2371 Swiss primary care physicians. All respondents of the main questionnaire received an additional small questionnaire focussed on the initial disease workup. Descriptive statistics were used to describe questionnaire responses and PCP demographics. Results: The response rate was 53.1%. Of all participating PCPs (n = 1084), 86.2% reported having patients with chronic HCV, with an average number of 4 patients per practice; 18.6% (n = 142) of PCPs did not monitor their chronic HCV patients. Two-thirds (66.8%) of the sample chronic HCV patient population (n = 4626) never received antiviral therapy. The main reasons given by PCPs for withholding treatment were HCV-specialist advice, patient preference, normal liver enzymes and patient related factors like substance abuse or psychiatric co morbidity.Conclusions: Most PCPs follow patients with chronic hepatitis C, but practice caseloads are low, which may account for insecurity in managing this complex disease.

Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians

Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians

Relationships between work satisfaction, emotional exhaustion and mental health among Swiss primary care physicians

Work-related satisfaction is an important determinant of quality of care. However, its relationship with doctors' mental health is poorly understood. It could have an independent beneficial effect on mental health (direct association) or simply reduce the impact of work stress on mental health (moderating or 'buffering' role). One thousand seven hundred and thirty-two Swiss primary care physicians (824 board-certified generalists, 436 general internists, 162 paediatricians, 147 internal medicine specialists and 163 physicians without specialty qualification) completed a mailed questionnaire. Previously, validated instruments were used to measure mental health (SF-12), emotional exhaustion [Maslach Burnout Inventory (MBI)] and work-related satisfaction. Linear regression models with mental health as dependant variable were used to study the relationships between these variables. Differences in mental health scores were standardized to represent a one standard deviation (SD) difference in the other scales [standardized beta coefficients (SBC)]. In multivariate analyses, higher levels of mental health were found in respondents with higher work-related satisfaction with current income and social prestige (SBC 1.04) and professional relations (SBC 0.57), and in respondents with lower emotional exhaustion (SBC -4.98) and higher personal accomplishment scores (SBC 1.72). Interaction terms between these dimensions of work-related satisfaction and emotional exhaustion were significant, supporting a 'buffering' role of these dimensions. Work-satisfaction with current income, social prestige and professional relations are important correlates of mental health among primary care physicians, as well as emotional exhaustion. Higher levels of these dimensions of work-related satisfaction seems to mitigate the relationship between emotional exhaustion and physicians' mental health.

Self-reported smoking cessation activities among Swiss primary care physicians

BackgroundIndividual counselling, pharmacotherapy, and group therapy are evidence-based interventions that help patients stop smoking. Acupuncture, hypnosis, and relaxation have no demonstrated efficacy on smoking cessation, whereas self-help material may only have a small benefit. The purpose of this study is to assess physicians' current clinical practice regarding smokers motivated to stop smoking.MethodsThe survey included 3385 Swiss primary care physicians. Self-reported use of nine smoking cessation interventions was scored. One point was given for each positive answer about practicing interventions with demonstrated efficacy, i.e. nicotine replacement therapy, bupropion, counselling, group therapy, and smoking cessation specialist. No points were given for the recommendation of acupuncture, hypnosis, relaxation, and self-help material. Multivariable logistic analysis was performed to identify factors associated with a good practice score, defined as ≥ 2.ResultsThe response rate was 55%. Respondents were predominately over the age of 40 years (88%), male (79%), and resided in urban areas (74%). Seventeen percent reported being smokers. Most of the physicians prescribed nicotine replacement therapy (84%), bupropion (65%), or provided counselling (70%). A minority of physicians recommended acupuncture (26%), hypnosis (8%), relaxation (7%), or self-help material (24%). A good practice score was obtained by 85% of respondents. Having attended a smoking cessation-training program was the only significant predictor of a good practice score (odds ratio: 6.24, 95% CI 1.95–20.04).ConclusionThe majority of respondents practice recommended smoking cessation interventions. However, there is room for improvement and implementing an evidence-based smoking cessation-training program could provide additional benefit.

Das Burnout-Syndrom: eine medizinische Perspektive

The burnout syndrome is a heterogeneous concept mostly understood as a complex of symptoms, primarily exhaustion, in response to prolonged emotional and interpersonal stress at work. The prevalence of burnout is considerably high in Swiss primary care physicians. In spite of its vague definition, burnout is a serious stress disease with many associated medical problems and high economic costs. Previous recommendations for the psychosomatic management of patients with functional somatic syndromes also apply to burnout treatment. These are complemented by more specific interventions targeting job stress related factors. Relapse prevention focuses on early recognition of warning signs and is an ongoing process.

Change in pain severity with open label venlafaxine use in patients with a depressive symptomatology: An observational study in primary care

Purpose Venlafaxine has shown benefit in the treatment of depression and pain. Worldwide data are extensively lacking investigating the outcome of chronic pain patients with depressive symptoms treated by venlafaxine in the primary care setting. This observational study aimed to elucidate the efficacy of venlafaxine and its prescription by Swiss primary care physicians and psychiatrists in patients with chronic pain and depressive symptomatology. Subjects and methods We studied 505 patients with depressive symptoms suffering from chronic pain in a prospective naturalistic Swiss community based observational trial with venlafaxine in primary care. These patients have been treated with venlafaxine by 122 physicians, namely psychiatrists, general practitioners, and internists. Results On average, patients were treated with 143 ± 75 mg (0–450 mg) venlafaxine daily for a follow-up of three months. Venlafaxine proved to be beneficial in the treatment of both depressive symptoms and chronic pain. Discussion Although side effects were absent in most patients, physicians might have frequently omitted satisfactory response rate of depression by underdosing venlafaxine. Our results reflect the complexity in the treatment of chronic pain in patients with depressive symptoms in primary care. Conclusion Further randomized dose-finding studies are needed to learn more about the appropriate dosage in treating depression and comorbid pain with venlafaxine.

Primary care physician supply and other key determinants of health care utilisation: the case of Switzerland

BackgroundThe Swiss government decided to freeze new accreditations for physicians in private practice in Switzerland based on the assumption that demand-induced health care spending may be cut by limiting care offers. This legislation initiated an ongoing controversial public debate in Switzerland. The aim of this study is therefore the determination of socio-demographic and health system-related factors of per capita consultation rates with primary care physicians in the multicultural population of Switzerland.MethodsThe data were derived from the complete claims data of Swiss health insurers for 2004 and included 21.4 million consultations provided by 6564 Swiss primary care physicians on a fee-for-service basis. Socio-demographic data were obtained from the Swiss Federal Statistical Office. Utilisation-based health service areas were created and were used as observational units for statistical procedures. Multivariate and hierarchical models were applied to analyze the data.ResultsModels within the study allowed the definition of 1018 primary care service areas with a median population of 3754 and an average per capita consultation rate of 2.95 per year. Statistical models yielded significant effects for various geographical, socio-demographic and cultural factors. The regional density of physicians in independent practice was also significantly associated with annual consultation rates and indicated an associated increase 0.10 for each additional primary care physician in a population of 10,000 inhabitants. Considerable differences across Swiss language regions were observed with reference to the supply of ambulatory health resources provided either by primary care physicians, specialists, or hospital-based ambulatory care.ConclusionThe study documents a large small-area variation in utilisation and provision of health care resources in Switzerland. Effects of physician density appeared to be strongly related to Swiss language regions and may be rooted in the different cultural backgrounds of the served populations.

Sickness certification in primary care - the physician's role.

Sickness certification is a routine task of primary care (PC) physicians which has an impact on patients' health, the health care system and the economy. As sickness certification is poorly studied, we quantified sickness certification and explored qualitatively the sickness certification process by Swiss PC physicians. PC physicians participating in the Swiss Sentinel Surveillance Network (SSSN) recorded the frequency and duration of absence from work of each related consultation and certificate during 2005. Patients' age and gender, reason for sick leave, psychosocial cofactors, problems at the workplace, type of employment, type of occupation, duration of absence (weeks) and type of certificate were registered. Physicians' views on the procedure and their suggestions for change were gathered before and after the study by means of a questionnaire containing four open-ended questions. Of the 223 SSSN physicians 73% participated. A total of 24,676 forms issued by 150 physicians were analysed. An average of four certificates was issued per 100 consultations; somewhat fewer by internists than by general practitioners and less in rural areas than urban areas. Psychosocial or work-related factors were mentioned in 20% of the certificates and were more often associated with longer absences from work. These factors were seen as inseparable from the somatic factors. Recommendations for change included the prolongation of self declaration time, a uniform declaration form, availability of an authority to which complex cases can be referred and the use of case management models. Sickness certificates were issued in 4% of GP consultations. This task has been assessed by physicians as part of their function. The certification process should be improved through better coordination and communication between all parties involved: patients, employers, insurers, physicians and politicians.

Adherence to recommended standards of diabetes care by Swiss primary care physicians.

To assess adherence to recommended standards of diabetes care by Swiss primary care physicians. Medical files of community-based primary care physician were reviewed to assess adherence to recommended standards of diabetes care. These standards of care were based on a uniform set of definitions addressing medical care processes involved in the detection and follow-up of pre-diabetic and diabetic patients. 186 physicians agreed to participate and 3,682 medical files were assessed. The prevalence of diabetes was 11% and 5% had impaired glucose tolerance (pre-diabetic). Screening of diabetes based on family or personal history was reported for 83% of the patients and on cardiovascular risk factors for 69%. Counselling for dietary changes was reported for 91% of diabetic patients and for 79% for physical activity, but only for 66% and respectively 60% of pre-diabetic patients. Among diabetic patients, regular HbA1c control was reported for 65%, yearly fundoscopy for 62%, yearly feet examination for 65%, yearly microalbuminuria control for 49%, regular blood pressure control for 96%, and yearly lipid profile for 89%. Regular screening of microangiopathic complications was reported for only 33% of diabetic patients. Adherence to recommended standards of diabetes care displayed important variations among this convenience sample of Swiss primary care patients. Screening and counselling of diabetic patients were frequent, whereas counselling for lifestyle changes of pre-diabetic patients and regular follow-up of microangiopathic complications among diabetic patients were suboptimal. These results could help to target areas of diabetes care that need to be addressed to improve adherence to recommended standards.

Adherence to recommended standards of diabetes care by Swiss primary care physicians.

To assess adherence to recommended standards of diabetes care by Swiss primary care physicians. Medical files of community-based primary care physician were reviewed to assess adherence to recommended standards of diabetes care. These standards of care were based on a uniform set of definitions addressing medical care processes involved in the detection and follow-up of pre-diabetic and diabetic patients. 186 physicians agreed to participate and 3,682 medical files were assessed. The prevalence of diabetes was 11% and 5% had impaired glucose tolerance (pre-diabetic). Screening of diabetes based on family or personal history was reported for 83% of the patients and on cardiovascular risk factors for 69%. Counselling for dietary changes was reported for 91% of diabetic patients and for 79% for physical activity, but only for 66% and respectively 60% of pre-diabetic patients. Among diabetic patients, regular HbA1c control was reported for 65%, yearly fundoscopy for 62%, yearly feet examination for 65%, yearly microalbuminuria control for 49%, regular blood pressure control for 96%, and yearly lipid profile for 89%. Regular screening of microangiopathic complications was reported for only 33% of diabetic patients. Adherence to recommended standards of diabetes care displayed important variations among this convenience sample of Swiss primary care patients. Screening and counselling of diabetic patients were frequent, whereas counselling for lifestyle changes of pre-diabetic patients and regular follow-up of microangiopathic complications among diabetic patients were suboptimal. These results could help to target areas of diabetes care that need to be addressed to improve adherence to recommended standards.

Personal use of medical care and drugs among Swiss primary care physicians.

To measure medical care and pharmaceutical drug use among Swiss primary care physicians and its determinants. Cross-sectional mailed survey. 1784 randomly selected Swiss primary care physicians, including general practitioners, internists and paediatricians. Twenty one percent (95% CI: 19 to 23) indicated having a regular doctor and 53% (95% CI: 50 to 55) reported at least one visit to a health professional in the preceding year. Sixty five percent (95% CI: 62 to 67) of the respondents had used pharmaceutical drugs during the preceding week, 34% (95% CI: 31 to 36) analgesics, 14% (95% CI: 12 to 15) tranquillizers, 6% (95% CI: 5 to 8) antidepressant and 13% (95% CI: 12 to 15) antihypertensive drugs. Among respondents reporting drug use in the past week, self-medication was reported in 90% (95% CI: 88 to 92) of the cases. In multivariate analyses, female sex, older age, higher work-related satisfaction and higher perceived stress were associated with more frequent visits to any health professionals; paediatricians reported more visits to primary care physicians, whereas women and physicians living alone reported more visits to mental health specialists. Reported use of analgesics was more frequent for younger physicians and general internists. Older physicians reported a higher use of tranquillizers, whereas physicians living alone reported higher use of antidepressants. Finally use of antihypertensive drugs was more frequent among men, older physicians, general internists and physicians with higher levels of work-related stress. Swiss primary care physicians rarely have their own general practitioner and self medication is common with frequent use of analgesics and tranquillizers. Psychological distress due to increasing constraints on primary care doctors probably contributes to these behaviours.