General

Doctor Shopping

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12 Sep 2016 - General

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Doctor shopping is the act of visiting multiple physicians to seek medical opinion until a patient hears a preferred diagnosis/ treatment or to collect prescription drugs. I have encountered quite a few cases during my career as a resident and it is quite alarming. Moreover, it breaches the doctor-patient relationship. In the code of ethics, patients must inform his/her doctor that she will be seeking another physician's opinion. This allows the attending physician to plan endorsement of the patient to the new doctor if needed be. Junkies for pain relievers are also quite common and I have met a fe who request for a month's supply of NSAIDs. For physical medicine and rehabilitation, these are my primary concerns with doctor shopping: 1.) Patient safety. We always ask patients if they are taking NSAIDs as other specialties such as internists already prescribe pain medications. Double dosing of of NSAIDs can lead to GI bleeding, acute kidney injury, or myocardial infarction 2.) Procedure duplication. The interval of intra-articular steroid injection should be at least 4 months in between to prevent ligament/tendon rupture and possible infection. Some would go doctor shopping to obtain another procedure that could do more harm than good. For other specialties, what are your concerns with doctor shopping? For the allied healthcare professionals, do you have experiences to share with "shopping"?

物理治疗与康复医学科

Maria Cristina Inserto Dentist shoppers are quite common. Not to mention those that really shop to compare fees of dental procedures. Which among the three are the most common in your practice? I am guilty of switching to another dentist once after my wisdom tooth extraction. I told dentist A who performed the procedure that a sore developed near the surgical site after the extraction. It was so painful that it re...

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Periodontics

In Dentistry, doctor shopping is very common. But they come in different forms. (1) There are shoppers who are the most common, and they are the ones looking for a second, third (or so) opinion and in my years of practice I've gotten quite accustomed to sniffing these types. Some are obvious but some are quite honest and will tell you that they've been to someone else. (2) There are shoppers who have no loyalty and these are common with HMOs, so they just shop through their booklet and p...

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物理治疗与康复医学科

Marinelle Castro Oh yes. Being in denial prompts a patient to shop for doctors until they hear the response that they want. That is quite a story for a patient who really needs surgical intervention. Glad to hear that the surgery went well for her. It is common for patients, especially the elderly, to seek for other treatment options other than surgery. Maybe this is the reason why alternative medicine (i.e. cupp...

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物理治疗与康复医学科

Lianne Marie Victoria Laruan I don't know why the general practitioners are stereotyped as inadequate here in the Philippines and even in Pakistan. The main role of general practitioners is to give primary intervention and refer if a case needs the management of a specialist. Maybe, it is because of the out-of-pocket system in the country that encourages patients to bypass a step in order to save money. We can...

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Others

There are some patients who engage in "doctor shopping" because they want to hear a certain medical advise that sounds comforting to them. In neurosurgery, this is frequently encountered comng patients who have surgical diseases such as herniated discs, brain tumor, and unruptured aneurysm. More often than not, they want to hear that what they have does not require an operation and would resolve by medical management. I remember this patient who sought consult with my attending. It was...

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Pharmacist

It's true that general practitioners are not very highly regarded here in the Philippines, and maybe it is again due to patients' lack of being informed well, as well as wanting to skip a step in the ideal scheme of getting a disease treated. Another downside when going directly to specialists is that, the patient has separate doctors for different conditions, and he/ she ends up with a lot of medications that either doctor may not know he/ she was prescribed. This could again be another...

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物理治疗与康复医学科

Tahira Nawaz Thank you sharing your thoughts and experience concerning discrimination against general practitioners in Pakistan. Our countries share the same dilemma. The general population think that they can bypass a GP consultation since they can search for their illness but this is not entirely true. If you search only for one symptom in a search engine, chances are there will be misdiagnosis. For example, a ...

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物理治疗与康复医学科

Theekshana Abayawickrama Thank you for sharing the situation in your country. It is also one of the reasons why patients shop for doctors. They feel that inadequate prescription was given. Unfortunately, they will find a doctor who will give in to their desired prescription. Part of the reason why patients go "doctor shopping" is because other doctors give them reason to patronize this act. Encounter wit...

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Pharmacist

I am agreed to both of you Dr. Jennifer Winter and Dr. Mark Edmon Tan. You have raised a very good point related to patient’s choice for a Doctor. Here, in Pakistan, the patients show same discrimination because they are more attracted toward specialists then the GP. Although the right way to diagnose your problem starts through GP, patients must visit GP as the first consultation. Now GP will decide about the patient’s referral toward right specialist depending on patient’s condition. I think G...

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Surgery

Doctor shopping is quite frequently seen in my country too. There are several reasons why they do this. There are people who think treating a disease can be done in a day or two. They go to one doctor, and expect them to cure their illness with the first few doses of the drugs they prescribe and when they do not see any results they go to the next. Sometimes patients are not satisfied when the doctors do not order a few quite expensive investigations, or straightaway prescribe a high end antibio...

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物理治疗与康复医学科

That is a very good point. Patients have to be seen by general practitioners first to assess the possible condition and possible referral to a specialist. They serve as the triage and we should follow the model used by first world countries. Unfortunately, being a general practitioner is met with a raised eyebrow here in the Philippines and I don't understand why there is such discrimination by patients. General practitioners are really capable of addressing immediate medical concerns before...

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Surgery

Mark Edmon Tan: I completely agree with you there. This is where having a family medicine doctor or a GP would work out best. It is just too bad that here in the Philippines the general public thinks so little of these doctors and right away go to a specialist. It's like needing ground control before flying off. Then there is also seeing a private physician is expensive which is why most patients go to Out Pa...

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物理治疗与康复医学科

Jennifer Winter " I would explain to them that this one doctor would be familiar with their whole history, can properly monitor them properly and can give them the appropriate treatment." This is especially important for elderly patients who are taking multiple medications for various illnesses. Staying loyal with a doctor for a certain illness will ensure that there will be minimal drug-drug interactio...

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Surgery

I would encourage patients to find a doctor they like and stick with them. This is for their own benefit as I would explain to them that this one doctor would be familiar with their whole history, can properly monitor them properly and can give them the appropriate treatment. Definitely it points towards patient safety Mark Edmon Tan, as if they keep on changing doctors the treatment they receive may be doubled o...

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