The prevalence of medical nomadism of the followed patients in rheumatology

Abstract

The nomads are defined as patients related to multiple practicians of the same speciality or different specialities for the same symptomatology during a certain period. The objectives of this investigation were to evaluate the prevalence of medical nomadism of the followed patients in rheumatology and compare their profile with those patients followed in neurology and gastroenterology. A multicentric transverse study (September 2009-March 2010) was conducted in three departments of CHU Ibn Sina Rabat-Salé, Morocco; rheumatology, gastroenterology and neurology. Only patients seen in external consultations were included. Patients' socio-economic and demographic background (familial status, instruction level, monthly revenue, social assistance) were recorded, as well as the clinical parameters related to the pathology (pathology, duration of the illness, diagnosis final time). A questionnaire containing variables on the patients' state concerning diagnosis, satisfaction degree of the patients and other variables evaluated the notion of taking medication and the practice of alternative medicine. Medical nomadism has been defined by the consultation for the same symptomatology of three different practicians, either of the same speciality or of different specialities during the study period of 6 months. There were 250 patients included in this study (150 patients in rheumatology, 50 in gastroenterology and 50 in neurology), the mean age was 46 ± 13 years and females dominated (65.6%). The average duration of the evolution was 7 ± 5 years, 35% of the patients were illiterate, 30% had a primary school education, 22% had a secondary school education and 13% had a university-level education. Sixty-two percent of the patients were jobless, 27% were workers, 9% were the functionary and 2% were the based liberal. Fifty-six percent had no social assistance. Rheumatoid arthritis and degenerative pathology were the most frequent diagnoses in rheumatology, being 20% and 40%, respectively. In gastroenterology, the most frequent pathologies were functional colopathy (25%) and proctology (20%), and migraine (42%) in neurology. The global prevalence of nomadism was 51%; 36% in rheumatology, 58% in neurology and 86% in gastroenterology. The associated factors of nomadism phenomena in rheumatology were: the satisfaction degree of the patient (P = 0.001), the wrong beliefs (P = 0.007), the practice of alternative medicine (P = 0.009), the pathology (P = 0.01) and the psychic profile (P = 0.001). Our study suggests that medical nomadism is frequent. It seems to be more frequent in the gastroenterology area, was linked with the degree of the patients' satisfaction, the alternative medicine practice and the type of the pathologies. Other studies of a high level would be necessary.

Patient-Initiated Second Opinions: Systematic Review of Characteristics and Impact on Diagnosis, Treatment, and Satisfaction

“…A large proportion of patients seeking a second opinion were women (66%-82%) with an average age of 54 years, typically in the setting of breast cancer. 38,40,42,43 The education level of second opinion seekers included those with less than a high school education, patients with tertiary education, and those with a university degree. Boudali et al 42 studied a group of 250 "nomadic" patients (50 with gastroenterologic symptoms, 50 with neurologic problems, and 150 with rheumatologic disorders) who had seen 3 physicians, either of the same or different specialty, for the same symptoms during a 6-month period.…”

“…Patients with cancer seeking a second opinion were typically recently diagnosed women with breast cancer. 38,43 In contrast, patients with general medical conditions typically had persistent symptoms and extended disease durations (rheumatologic, 6 years; neurologic, 5 years; gastroenterologic, 16.7 years) 42 and had undergone treatment for months (rheumatologic, 4 months; neurologic, 10.6 months; gastroenterologic, 3.7 months). 39,41,42,44 Motivating Factors.…”

“…38,43 In contrast, patients with general medical conditions typically had persistent symptoms and extended disease durations (rheumatologic, 6 years; neurologic, 5 years; gastroenterologic, 16.7 years) 42 and had undergone treatment for months (rheumatologic, 4 months; neurologic, 10.6 months; gastroenterologic, 3.7 months). 39,41,42,44 Motivating Factors. The articles reported factors motivating patients to seek a second opinion, including confirmation of a diagnosis or treatment, dissatisfaction with an initial consultation (generally over communication issues), unfulfilled needs, a desire for additional information, hope for a change of a diagnosis, high risk for major morbidity or mortality, or treatment complications or adverse effects.…”

“…Nomadic patients were most likely to seek a second opinion because of dissatisfaction with prior consultations, wrong beliefs about their disease, the practice of alternative medicine, disease pathology, and personality profile. 42 Patients with cancer often wanted additional information about their disease (33% 38 -89% 43 ), its treatment (70% 38 -97% 43 ), or their prognosis (93% 43 ). A large proportion of patients (17%, 45 61%, 38 68% 43 ) needed reassurance that their diagnosis or treatment was appropriate, and 68% hoped for a change in their diagnosis.…”

The Evolving Role of Ophthalmology Clinics in Screening for Early Alzheimer’s Disease: A Review

“…For healthcare professionals, improved diagnostic pathways may help to avoid “medical nomadism” which can be experienced during the diagnostic process, wherein patients present to various doctors with the same complaint over a short period of time [ 18 ]. For services, better workload planning and resource allocation were highlighted in a study that asked primary care practitioners (nurses and GPs), and there may be an increased ability to anticipate future demand [ 19 ].…”