Not all doctor shopping driven by suspect motivations

Doctor Shopping: A Phenomenon of Many Themes | Nov-Dec 2012 | free full-text PMC article Doctor Shopping

Doctor shopping is defined as seeing multiple treatment providers, either during a single illness episode or to procure prescription medications illicitly. According to the available literature, prevalence rates of doctor shopping vary widely, from 6.3 to 56 percent.

The reasons for doctor shopping are varied.

Some patient explanations for this phenomenon relate to clinician factors, such as

  • inconvenient office hours or locations,
  • long waiting times,
  • personal characteristics or qualities of the provider, and/or
  • insufficient communication time between the patient and clinician.  

Importantly, not all doctor shopping is driven by suspect motivations.

WHAT IS DOCTOR SHOPPING?

Doctor shopping entails the scheduling by patients of office visits with multiple clinicians for the same agenda, either for a continuing illness or to procure prescription drugs illicitly.

EXPLANATIONS FOR DOCTOR SHOPPING

According to the existing literature, there are a number of reasons why patients engage in doctor shopping.

We will divide these patient justifications into two general categories: physician-related factors and patient-related factors.

Physician-related factors

extended waiting times contributed to doctor shopping among patients in a Hong Kong community medicine clinic.

physician attitude, particularly being stringent, stern, or strict, was a factor in doctor shopping among French patients in buprenorphine maintenance programs.

In a community sample from the United States, Kasteler et al. uncovered a number of physician factors related to patient doctor shopping. These factors included inconvenient office hours or locations, undesirable personal qualities of the physician, and insufficient time for communication between the clinician and patient.

Patient-related factors, illness variables

doctor shopping may be due to

  • symptom persistence,
  • a lack of understanding of either the proffered diagnosis or the treatment, and/or
  • no improvement in the illness.

In addition, patients may seek other providers because of the chronicity of the illness or disbelief in either the diagnosis or treatment.

According to Macpherson et al, there appear to be several specific medical diagnoses that are associated with consultations with multiple providers: upper respiratory tract infection, urinary tract infection, and gastroenteritis.

On a side note, Leung et al determined that doctor shopping was associated with failed appointments.

Patient-related factors, psychological dysfunction

A number of investigators have attributed doctor shopping to psychological dysfunction.

The patent majority of commentaries and empirical studies examining patient factors related to doctor shopping reside in the area of substance misuse/abuse.

This is becoming a problem in research: In the past years, all studies involving opioids are looking for substance misuse/abuse.

Importantly, not all studies have found relationships between doctor shopping and prescription misuse.

For example, in a different study by Wilsey et al, using data from the California Prescription Monitoring Program, investigators did not find a relationship between doctor shopping and the abuse of opioids

CONCLUSIONS

Doctor shopping is a relatively complex phenomenon.

While all forms of doctor shopping entail multiple visits with a clinician, the patient rationales for these excessive utilization patterns may vary from physician-related factors to patient-related factors.

On the one hand, doctor shopping may simply be related to

  • office factors,
  • clinician characteristics,
  • communication concerns, and/or
  • patient illness characteristics.

On a more ominous note, doctor shopping may be in the service of obtaining unnecessary prescription medications for illicit use.

The salient point here is that doctor shopping represents a broad range of patient behaviors that extend beyond merely procuring illicit prescription medications.  

Studies are finding that doctor shopping isn’t always the evil it is assumed to be.

Americans have always been free to choose and switch their doctors and do so for many reasons, but now a sinister motive is being attached to a common situation.

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One thought on “Not all doctor shopping driven by suspect motivations

  1. Laura P. Schulman, MD, MA

    Many people with chronic illness end up “doctor shopping” because of poor doctor-patient fit. I have always encouraged my patients to explore their options if they need to or want to. Unlike many providers who get caught up in ego issues and point the finger at their patients for looking elsewhere, I understand that just like any relationship, and even more so, the doctor-patient relationship is not necessarily made in heaven. Personalities may clash. I have had to ask two patients during my career to please look elsewhere, because we had such differing points of view that our therapeutic relationship wasn’t going anywhere. One parent of a pediatric patient did not want to see a doctor who has a disability. I congratulated her on knowing her own comfort zone, and gave her a list of other pediatricians she could interview.

    Pediatricians are routinely interviewed by prospective parents. I think this is tremendously healthy, as it gives everyone a chance to meet, share information and philosophies, ask questions, and check out personalities.

    Liked by 2 people

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