“Haiyaah… I have been having this cough and sore throat for about three days now, I have seen a doctor already, the medicines given to me is useless lah”
“You should see my doctor in clinic ABC, his medicines are very good one, you take one or two tablets only, sure okay already”
“Really? …. I have been trying to find a doctor for my back pain also. I have seen many doctors already. Every time I go to a new doctor, I was given the same medicine, pain killer only!”
Source: handsintheworld.wordpress.com –
These are some of the conversations I often heard when I am incognito in public places. It never fails to put a smile on my face, for such free entertainment is not without its own genuine absurdity both from public perspective as well as from the health care practitioners.
Hopping from one doctor to another doctor in search for ‘better’ medicines is indeed very common practice in Malaysia. One study in University Science Malaysia done in 2005 estimates about 56% of interviewed patients fit the criteria for doctor hopping. We, general practitioners (GPs) often hear it from our own patients, often too proudly proclaiming that they have finally met a great doctor in us, after searching for years for their specific problems. Of course, those who somehow did not manage to find that similar ‘greatness’ in us, were never heard again.
Hopping from one doctor to another is a phenomenon called as ‘doctor-shopping’. It is defined as changing of doctors without professional referral in the same illness period. There are many factors which are contributing to this. The most important factor is patient dissatisfaction toward the current doctor, may it be in the form of communications, services or effectiveness of treatments. Let me emphasis here, the guilt is both on the patient and doctors. In fact, just like in any professions, some bad apples out there may have very well contributed to the worsening of this phenomenon.
However, this article is written with the public in mind. Therefore, the discussion will be aiming at educating the masses about negatives consequences of doctor-shopping.
Sometimes doctor-shopping is rooted from a genuine attempt to get a second opinion. However, proper second opinion should be coordinated by a primary care doctor with proper referral letter and record keeping. In contrast, in doctor-shopping, the ‘second opinion’ is often sought in secrecy and absolutely uncoordinated. More often than not, even after the tenth opinion later, the patient still seeks for the elusive ‘second opinion’ and thus fulfilling the definition of doctor-shopping.
Bear in mind, this article is not about the practice of doctor-shopping (or rather prescription-shopping) which commonly occurs among patient seeking drugs of addiction. Rather this is a behavior with relatively common illness such us cough and colds and pain and aches with unrealistic expectation of nature of cure.
Why is doctor-shopping considered unhealthy practice?
First and foremost, doctor-shopping will deny the patient a proper follow up from a genuine caring doctor. Often at first contact of every illness, when the definite diagnosis is not clearly established, a provisional or working diagnosis is given. Based on the provisional diagnosis, treatment is given with the expectation that patient will come back to provide some feedback several days or weeks later. In the subsequent visit, after letting both the disease and treatment take their courses, a clearer picture may have emerged and better treatment plan can be instituted. However, this bigger picture often not conveyed clear enough to the patient. If it did, the patient may have not grasp it or understand the significance of it. Consequently, when illness persists, dissatisfaction arises and thus doctor-shopping occurs.
This is what exactly happens to the person with the back pain above. Every time the complainant sees a new doctor, apparently similar medicine is given which are probably generic pain killers. The problem is, a new doctor would have to start form ‘step one’ for a new patient with a new case. However, if the patient is seeing the same previous doctor and cheekily said that the previous medication did not work, the doctor may be forced to think that there are other sinister causes to this back pain. More examinations and investigations can be therefore discussed or the case can even be referred to a definite specialty.
Source: www.swhealthcaresystem.com
Other negative factors associated with doctor-shopping are lack of proper medical recording of illness. This is due to the disjointed stories spread across many doctors. Doctor-shopping also exposes patient to many drugs which can be of similar types prescribed by different doctors. Taking these drugs at the same time will put the patient at risk of drug overdose or dangerous drug to drug interactions. Doctor-shopping also put the patient under unnecessary mental stress for believing that the health care system is being unfair or believing that their illness is incurable or even may be into believing that the illness is due to some form of mystical origin. It is not surprising that studies have shown that those patients who often do doctor-shopping are at higher risk of developing or being associated with some form of mental disorders.
In conclusion, avoid doctor-shopping and stick to your chosen doctor. Let him have the opportunity to gather your story over several visits. Let him know you inside and out, literally. In no time, your doctor will be the best person not only to treat your illness now and in the future, but also to advocate you when you have to see other doctors of different specialty.
This article was written by the Malaysian Medical Gazette’s permanent columnist Dr. Rizin H Kusop who is currently the proprietor and MO in charge of a group practice franchise in Sabah who has a special interest in Anti-aging, Regenerative and Aesthetics medicine. Find out more about him at The Team page.
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]
References:
- Hasan, N et al. Doctor-shopping behavior amongst adult patients attending family medicine clinic, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan. Int Med J. 2005; 12:251-257.
- Sansone, RA and Sansone, LA. Doctor Shopping: a phenomenon of many themes. Innov Clin Neurosci. 2012; 9(11-12):42-46.