"Seeing a doctor is just like having a date": a qualitative study on doctor shopping among overactive bladder patients in Hong Kong

Abstract

BackgroundAlthough having a regular primary care provider is noted to be beneficial to health, doctor shopping has been documented as a common treatment seeking behavior among chronically ill patients in different countries. However, little research has been conducted into the reasons behind doctor shopping behavior among patients with overactive bladder, and even less into how this behavior relates to these patients’ illness and social experiences, perceptions, and cultural practices. Therefore, this study examines overactive bladder patients to investigate the reasons behind doctor shopping behavior.MethodsMy study takes a qualitative approach, conducting 30 semi-structured individual interviews, with 30 overactive bladder patients in Hong Kong.ResultsMy study found six primary themes that influenced doctor shopping behavior: lack of perceived need, convenience, work-provided medical insurance, unpleasant experiences with doctors, searching for a match doctor, and switching between biomedicine and traditional Chinese medicine. Besides the perceptual factors, participants’ social environment, illness experiences, personal cultural preference, and cultural beliefs also intertwined to generate their doctor shopping behavior. Due to the low perceived need for a regular personal primary care physician, environmental factors such as time, locational convenience, and work-provided medical insurance became decisive in doctor shopping behavior. Patients’ unpleasant illness experiences, stemming from a lack of understanding among many primary care doctors about overactive bladder, contributed to participants’ sense of mismatch with these doctors, which induced them to shop for another doctor.ConclusionsOveractive bladder is a chronic bladder condition with very limited treatment outcome. Although patients with overactive bladder often require specialty urology treatment, it is usually beneficial for the patients to receive continuous, coordinated, comprehensive, and patient-centered support from their primary care providers. Primary care doctors’ understanding on patients with overactive bladder with empathetic attitudes is important to reduce the motivations of doctor shopping behavior among these patients.

A meta-ethnography to understand the experience of living with urinary incontinence: ‘is it just part and parcel of life?’

“…Some said that it was about finding the right doctor. A 'match doctor' [148] was described as more than someone who provides treatment: they hear and respect you; they create an understanding atmosphere by listening and seeing things from your perspective, they are knowledgeable and informative; they respond to individual needs; they are compassionate, empathetic and friendly. Some described how healthcare professionals could be unresponsive, rushed, disinterested, lack of empathy, or even blame you for your problem.…”

Characteristics of doctor-shoppers: a systematic literature review

“…In studies enrolling patients with chronic conditions such as diabetes [7], eye floaters [26], or nephrolithiasis [9], the definition of doctor-shopping specified a higher number of visits, whereas in cases of urgent conditions or infections, definitions specified a timeframe and were, for example, limited to one day [27] or to the same illness episode [6,10,12,[28][29][30][31][32][33][34]. Studies focusing on the evaluation of doctor-shopping in general medicine or primary doctor facilities had longer timeframes of 1 year [35,36], 2 years [37], or even 3 years [38].…”

“…Overall, 17 (39.5%) studies were conducted in the USA, out of which 9 were based solely on retrospective data from large databases [9,11,13 [6,8,10,29,33], and 4 (9.3%) in Japan [12,31,32,48]. There was a one study from Australia and one from India [7,35].…”

“…Patients with chronic diseases, multiple comorbidities, and persistent symptoms were more likely to visit a larger number of healthcare providers [10,14,37,41,46,47,48]. A good relationship with a doctor and positive experiences were factors that helped to prevent doctor-shopping [33,38]. Individuals who consumed opioids and drugs for the treatment of attention deficit hyperactivity disorder (ADHD) and engaged in doctor-shopping were more likely to pay cash and to travel great distances to doctor facilities or pharmacies [19,24].…”

<p>The Association Between Doctor and Pharmacy Shopping and Self-Reported Misuse and Abuse of Prescription Opioids: A Survey Study</p>

“…These reasons are not unlike those identified among patients with other chronic conditions who are doctor shopping. 22 There were very few patients who reported reasons suggestive of prescription opioid misuse or abuse, such as wanting "more opioid pain medications to get high on"; however, this may be an underestimate, although we tried to control for it. Because of the social stigma associated with opioid abuse and misuse, we obtained a Certificate of Confidentiality to assure participants of the protection of their confidential information and to alleviate other concerns they may have had.…”