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Doctor Shopping

There is a rising trend amongst patients in the recent past, that has them going to multiple doctors for consultations about the same health issues. The term aptly coined to describe this behavior is “doctor shopping”, which has potential adverse effects on both the healthcare provider as well as the patients.

The reasons why patients indulge and give in to doctor shopping are varied. They could include:
1. Ready availability of medical tourism facilities and companies that can facilitate expert, specialized physician consultations at multiple travel destinations.
2. Looking for the best price for a consultation or a procedure
3. Searching for a new doctor, as they had a bad experience with the previous medical team, either at the clinic, hospital or practice
4. Cross checking the expertise of the previous doctor
5. Looking for a treatment alternative that suits the patient, hoping to find a doctor that validates his preferred option
6. An inherent mistrust of doctors and medical professionals in general
7. A tendency to believe unverified medical information on the internet, the famed “Dr Google”, which makes them skeptical of the advice being provided by healthcare professionals.
8. Hypochondriac behavior, where patients believe that they are continuously suffering from multiple health issues or diseases and are in search for solutions for the same.
While patients are of course entitled to good quality healthcare from their preferred specialist , as well as to obtain a second opinion about their conditions, it has often been observed that “doctor shopping” is done with the intention of searching out multiple opinions for the same medical condition , which in the long run may be counterproductive to the patient, his health and the doctor-patient relationship.

The outcomes of doctor shopping could be:
1. Inconsistent, patchy and unreliable medical history, which may be intentionally or inadvertently hidden from the doctors, leading to misdiagnosis, and further perpetuating the cycle of mistrust.
2. Duplication of investigations prescribed by the different physicians which leads to wastage of resources and mounting medical bills.
3. Incomplete management of health conditions, or leaving a treatment plan midway, which leads to further complications or deterioration of the disease.
4. Polypharmacy: which is the simultaneous use of multiple medications, usually five or more, including prescription based, over the counter and alternative medications or supplements. Not only does this overload the body, putting strain on the organs assimilating the drugs, it also has the potential to stimulate adverse drug interactions and reactions, which can have a detrimental effect on the patient’s health.
5. Indiscriminate and incomplete use of antibiotic courses, which could lead to the development of antibiotic resistant strains of bacteria, causing dangerous and unresponsive infections.
6. While dealing with chronic health conditions, especially involving children, patients and caregivers are often determined to find a quick and permanent solution to the problem, which makes them unwilling to stick with a treatment regimen given by one physician for very long. They tend to move on impatiently to another physician, believing that this change of hands could maybe make a difference. While there maybe slight variations in drugs or treatment regimes, the overall principle of treatment is generally consistent, and may progress as slowly. This causes them to move on from one doctor to another, in search of a miracle cure, which results in incomplete treatments and often worsening of the condition.
While this behavior is seen globally, several studies in western countries have shown an alarming tendency for drug misuse and abuse, especially for prescription medications like pain killers. Doctor shopping gives patients taking drugs like painkillers, an opportunity to get multiple prescriptions for the same condition driving up incidents of drug dependence and addiction. There are factitious disorders, where individuals deliberately act as if they or a dependent family member, have a mental or physical illness, when they are not actually sick. Feigning disease symptoms and doctor shopping are both indications of this disorder, which becomes very hard to identify and diagnose.
In addition to driving a wedge in the doctor-patient relationship and further deepening the mistrust with medical professionals, doctor shopping does have long term effects on the patient’s health as well, causing conditions to worsen due to incomplete treatment regimens.
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Dr C P Ravikumar

Aster CMI Hospital, Bangalore

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