Looking few decades back the situations for doctors and patients were different. The trust, confidence and transparency were the key to drive the health care system. The doctor-patient relationship was a novel bond for healing and patient never restrained from sharing his details. Few leading questions from the doctor use to give reasonable understanding of the diagnosis. The investigations were required only to exclude certain conditions with similar presenting features. With advanced technologies and social awareness, patients often come to the doctor with request for various clinical investigations, though not needed. Such patients have little trust on the doctor’s clinical skills and feel inadequate without such investigations. On several occasions when the doctors deny the value of investigation, patients themselves visit the laboratory to get it done to bring report to the doctor. Such behavior of the patients is more observed in urban settings that also makes them to consult several doctors in the area to get different opinion of the same problem. With each interaction, patient feels more informed about his disease and often decide to go for a particular modality of treatment.
The behavioral characteristic of patient also depends on type of disease i.e. acute or chronic, mildly symptomatic or with severe symptomatology. The multiple interactions that patient might have with his doctor in the past also affect his attitude and behavior towards the health care professionals. The extremes of respect and arrogance shown by the patient at different times is well accepted by the doctor as he understands the changing mindset of the patient during his illness. Unfortunately, there is no formal training given to the doctor for handling different sets of patient’s behaviors. Every doctor learns this skill slowly during his clinical practice in his clinic, hospital or any other healthcare settings.
It has been observed that patient prone for “doctor shopping” keeps moving to multiple physicians in search of right advise that they want to hear or treatment that they think could be suitable. Though there could be several reasons for consulting multiple doctors for the same illness such behavior is typically associated with a negative connotation among healthcare providers. There are various reasons of doctor shopping that can be divided into two categories i.e. physician related and patients related factors. Usual physician related factors are long waiting hours in clinic, stern & stringent attitude, inconvenient office hours or locations, insufficient time for patient communication, and lack of personal integrity of the doctor.
The patient related factors are obvious lack of response to treatment, lack of understanding of the disease due to improper communication by the doctor. Interestingly patient may take multiple opinions due to lack of belief in doctor’s diagnosis and treatment modality. Medically unexplained symptoms can be another reason for consulting multiples healthcare providers. Further, patient with high emotional instability and somatic symptoms go for multiple consultations. It is also known that frequent consulting with multiple doctors is a traditional method for getting prescriptions of controlled drugs. It is quite common in patients seeking drugs like tranquillizers, narcotic analgesics, stimulants and weight loss medicines.
Whatsoever the reason patient gives for multiple consultation to different doctors, each consultation makes him more knowledgeable (or confused) about his illness. Not uncommonly these patients communicate the diagnosis and treatment to his next physician based on previous consultations thus leaving no scope for of any further work up. The worst part of such behavior is presenting confusing medical picture in each visit, undergoing unnecessary diagnostic testing. The fear of such behavior may lead to labelling patients as somatization, medically unexplained symptoms (MUS) and hypochondriasis etc.
The flipside of such problem is overprescribing medications with nonspecific indications and patient is unnecessary exposed to drugs that could affect his otherwise normal health. It is practically difficult to judge by the doctor if the symptoms narrated by the patients are real or due to his accumulated knowledge gained after multiple visits to different doctors. Also, at times patient is more worried about his trivial symptoms ignoring the serious underlying disease. In this situation doctor’s counseling plays a significant role to address the real issue and adhere to treatment recommendations. Though there are no defined methodology to convince and retain such patients but integrity, trust and maintaining personal relationship with patient may help. In other words, it is more art than science that heals the patients.
There are several articles and books written on the patient behavior and doctor-patient relationship to raise and address such issues. Interestingly all these articles are read by the doctors and none by the patient leaving him ignorant about his side of the story. The subject of patient access to such information may be debatable but knowing at least few of the basics would definitely help them changing their attitude towards health care providers. In the era of digitalization and ease of access to such information patient can be well informed about the reasonable and expected behavior when visiting the doctor. It will not only help to develop a robust bond between patient and doctor but also get more attention about his medical problem. Next question is if anything will work to influence the patient behavior that can favorably affects his health. A patient focused approach with behaviorally based orientation will be better than disease-based approach to influence the patient behavior. No individual is fully rationale and so the patient. The human decision making is affected by cognitive biases, habits and sociocultural environment. There is a need to create a supportive system that engages patients and their care givers.