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Paediatricians, powerful others, and loci of control
  1. ARCHIVIST

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    You are on £16 000. If you answer the next question correctly you will take home at least £32 000. The question is: “what is your health locus of control?” Is it (a) your GP's surgery, (b) a newly discovered brain stem centre which increases its neuronal firing rate when you are ill, (c) your beliefs about who or what is most important in keeping you well, or (d) the National Institute for Clinical Excellence (NICE). Not sure? Better phone your old friend Archie, who for a mere ten per cent cut will tell you the answer is (c). What is more, he will tell you that it can be measured using the MHLC (Multidimensional Health Locus of Control) scale. (Why is it “health locus of control” and not “locus of health control” or even “control locus of health”, I wonder?)  This 18 item scale measures your beliefs about who or what controls your health; yourself, doctors or other health professionals (“powerful others”), or chance. Since doctors (all of them except you and me, of course) tend towards egotism and cynicism, you might expect them to score highly in the first and third of these belief categories. The care that medics arrange for themselves has been related to MHLC score and medical speciality in an American study (Cary P Gross and colleagues. Archives of Internal Medicine2000;160:3209–14).  A cohort of 1948–64 graduates of Johns Hopkins Medical School were followed up, assessing their “regular source of care” (RSOC) in 1991 and use of routine services in 1997. Now, we all know that paediatricians (even you and I) are the good boys and girls of medicine, and so it proved. Forty six per cent of pathologists, 39% of physicians, and 34% of surgeons, but only 22% of paediatricians (and 21% of psychiatrists) had no RSOC. Not having an RSOC went along with high MHLC scores for self or chance as determinants of health. So presumably paediatricians (or at least those in America) have a strong belief in “powerful others”. Not having an RSOC was a predictor of not being screened for breast, colon, or prostate cancers and not having influenza vaccine.  Does a strong belief in “powerful others” for yourself imply, or exclude, a strong belief in yourself as a “powerful other” for others?

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