When Medical Knowledge Is Not Enough: Medication Adherence and Self- Treatment Among Physicians With Chronic Illness in Upper Egypt

Background Medication adherence in chronic illness is influenced by behavioral, psychological, and contextual factors. Whether physicians—despite high medical literacy—demonstrate superior adherence compared with non-physician patients remains unclear. This study compared medication adherence between physicians with chronic illness and matched non-physician controls and examined psychological and behavioral correlates, including self-treatment practices. Methods A cross-sectional comparative study was conducted among 250 physicians and 250 age-, sex-, and disease-category–matched non-physician adults receiving long-term pharmacotherapy at university outpatient clinics in Upper Egypt. Self-reported adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8) as the primary adherence measure. Self-treatment behavior, depressive symptoms, anxiety, and burnout were evaluated using validated instruments. In a consenting subset, objective adherence was estimated using pharmacy refill data (proportion of days covered [PDC]) and documented pill-count records. Multivariable logistic regression models were used to examine factors associated with adequate adherence. Results The prevalence of adequate self-reported adherence did not differ significantly between physicians and controls (28.4% vs. 31.2%, p = 0.557). Among participants who consented to pharmacy linkage (36% physicians; 43% controls), median PDC and the proportion achieving PDC ≥ 0.80 were comparable between groups. Agreement between self-reported and objective adherence was poor in both cohorts. In adjusted analyses, physician status was not independently associated with adequate adherence. A higher number of prescribed medications and greater engagement in self-treatment behaviors were independently associated with higher odds of adequate self-reported adherence. Conclusions Physicians with chronic illness demonstrated adherence patterns comparable to matched non-physician patients. Professional training and medical knowledge were not independently associated with better adherence. Behavioral engagement and treatment-related factors appeared more strongly associated with adherence than occupational status. The limited concordance between self-reported and objective adherence highlights the importance of multimethod assessment in adherence research.