Lets Go Shopping
Bad news is good news, good news is no news, no news is bad news.
Walking in the mall, and you see your elderly aunt, coming in the opposite direction, instinctively you walk across to say hello to her, and then you notice, a limp, and a grimace on her face.
“Hello Mrs.A, how have you been doing, hope all is well with you.”
“I am fine, how about you.”
“Doing well aunty, I noticed that, you are walking with a limp, what happened?.”
“Oh, that! I had a knee replacement done by Dr.S. It didn't go so well, they say I have an infection, I had to get it operated again and since then this limp has been there.”
Don't you think this is a typical conversation, which happens on a day-to-day basis when you see someone walking with a limp and in pain? This gets repeated every time she meets someone, who has not met her in the recent past. Imagine how many times this story gets retold.
Let us relook, if you had come across her and she wasn't limping, you would not ask her “have you had any surgeries in the recent past?” and she would not volunteer that she had a surgery done. No one advertises that they had surgery done, even if it is successful unless specifically asked, such information is volunteered only when you meet a person who is considering getting a similar procedure. Failures or bad news travels fast and it's easily imprinted on our minds. It is not to say that there are no failures, and the reasons can be discussed at length. Remember that Knee replacement is one of the most successful reconstructive procedures in the history of medicine. It works well more than 95% of the time.
These kinds of “horror” stories travel fast, far, and wide, and are one of the reasons for patients to develop fear or become surgery averse. Then they start shopping, going around trying to elicit from the doctor what they would like to hear.
“Ok, we can treat this non-operatively, with medication.”
Then their journey ends because they had already made up their minds not to get surgery done and were looking for someone to reinforce their beliefs. Sometimes doctors do realize what the patient wants and give it to them, thinking that anyway, this patient will continue to shop. Measure anything in the world in terms of risk-benefit ratio, even walking on the street has an inherent risk involved. It is up to the patient to elicit and the duty of the doctor to give the full information so that patients can make an informed decision. They can always ask, for the complications, and any other information they want before making decisions, and they should be taken on sound reasoning rather than beliefs. Now, we also have abundant information on the web to verify facts, even though not all information is peer-reviewed. It is not that all afflictions need surgery, but in some instances, it’s mandatory, e.g.; an abscess (collection of pus), needs to be drained to allow for the body to fight the infection and for the antibiotics to help. An intraarticular fracture needs a perfect restoration of the joint surface.
The other common error is the application of a principle at the wrong time and place. I had a forearm fracture when I was a kid and was treated in plaster, you cannot apply the same in an adult as we have lost the capacity for huge amounts of remodeling when we achieve skeletal maturity.
The second commonest reason in our country for doctor shopping is, non-resolution of symptoms, either the diagnosis is not made or the treatment is not giving the requisite relief. Not all stories end well, this is the story of an 11-year-old girl. She had been diagnosed as having tuberculosis of the hip joint, her signs, and symptoms along with the investigations, pointed in that direction, it is also one of the commonest joint problems in our country. She had been taking the oral medications regularly but the symptoms persisted, she went through two more doctors before landing at my office, by which time 9 months had elapsed. I had the advantage of hindsight, but at the same time, if we are not getting the result as expected, we should be thinking why and where have we gone wrong. Starting from the basic relook into her history as well as diagnostics, what I noticed was there was a progression of the disease, which prompted me to do a biopsy and it turned out to be a cancerous lesion. She expired a few months after. In such scenarios, it would be ideal if the doctor suggests a second opinion so that a fresh pair of eyes and ears can give a different perspective and may pick what the primary doctor has overlooked or missed.
The third and the most common cause in other countries, but less studied in our country is the abuse of prescription drugs, which leads to a patient visiting the doctor multiple times to get a prescription.
These three are the most common causes of doctor shopping, and what do we do about it? Among the doctors, there is a negative connotation to such a habit, let us try to understand why this happens, we may not be able to eliminate it, but should aim to reduce the occurrence. If the doctor-patient relationship is good and faith in the medical profession improves, doctor shopping will reduce.
A good physician treats the disease, a great physician treats the patient who has the disease.
- Sir William Osler
