Skip to main content
Top
Published in: BMC Primary Care 1/2014

Open Access 01-12-2014 | Research article

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

Author: Judy Yuen-man Siu

Published in: BMC Primary Care | Issue 1/2014

Login to get access

Abstract

Background

Although 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.

Methods

My study takes a qualitative approach, conducting 30 semi-structured individual interviews, with 30 overactive bladder patients in Hong Kong.

Results

My 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.

Conclusions

Overactive 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.
Literature
1.
go back to reference Lo AY, Hedley AJ, Pei GK, Ong SG, Ho LM, Fielding R, Cheng KK, Daniel L: Doctor-shopping in Hong Kong: implications for quality of care. Int J Qual Health Care. 1994, 6 (4): 371-381. 10.1093/intqhc/6.4.371.CrossRefPubMed Lo AY, Hedley AJ, Pei GK, Ong SG, Ho LM, Fielding R, Cheng KK, Daniel L: Doctor-shopping in Hong Kong: implications for quality of care. Int J Qual Health Care. 1994, 6 (4): 371-381. 10.1093/intqhc/6.4.371.CrossRefPubMed
2.
go back to reference Hagihara A, Tarumi K, Odamaki M, Nobutomo K: A signal detection approach to patient-doctor communication and doctor-shopping behaviour among Japanese patients. J Eval Clin Pract. 2005, 11 (6): 556-567. 10.1111/j.1365-2753.2005.00581.x.CrossRefPubMed Hagihara A, Tarumi K, Odamaki M, Nobutomo K: A signal detection approach to patient-doctor communication and doctor-shopping behaviour among Japanese patients. J Eval Clin Pract. 2005, 11 (6): 556-567. 10.1111/j.1365-2753.2005.00581.x.CrossRefPubMed
3.
go back to reference Macpherson AK, Kramer MS, Ducharme FM, Yang H, Bélanger FP: Doctor shopping before and after a visit to a paediatric emergency department. Paediatr Child Health. 2001, 6 (6): 341-346.PubMedPubMedCentral Macpherson AK, Kramer MS, Ducharme FM, Yang H, Bélanger FP: Doctor shopping before and after a visit to a paediatric emergency department. Paediatr Child Health. 2001, 6 (6): 341-346.PubMedPubMedCentral
4.
go back to reference Sansone RA, Sansone LA: Doctor shopping: A phenomenon of many themes. Innovat in Clin Neurosci. 2012, 9 (11–12): 42-46. Sansone RA, Sansone LA: Doctor shopping: A phenomenon of many themes. Innovat in Clin Neurosci. 2012, 9 (11–12): 42-46.
5.
go back to reference Pradel V, Delga C, Rouby F, Micallef J, Lapeyre-Mestre M: Assessment of abuse potential of benzodiazepines from a prescription database using "doctor shopping" as an indicator. CNS Drugs. 2010, 24 (7): 611-620. 10.2165/11531570-000000000-00000. doi:10.2165/11531570-000000000-00000CrossRefPubMed Pradel V, Delga C, Rouby F, Micallef J, Lapeyre-Mestre M: Assessment of abuse potential of benzodiazepines from a prescription database using "doctor shopping" as an indicator. CNS Drugs. 2010, 24 (7): 611-620. 10.2165/11531570-000000000-00000. doi:10.2165/11531570-000000000-00000CrossRefPubMed
6.
go back to reference Hariman KW, Lam SC, Lam YW, Luk KH, Poon KK, Li AM: Fever as a predictor of doctor shopping in the paediatric population. Hong Kong Med J. 2013, 19 (1): 6-12.PubMed Hariman KW, Lam SC, Lam YW, Luk KH, Poon KK, Li AM: Fever as a predictor of doctor shopping in the paediatric population. Hong Kong Med J. 2013, 19 (1): 6-12.PubMed
7.
go back to reference Wang MJ, Lin SP: Study on doctor shopping behavior: insight from patients with upper respiratory tract infection in Taiwan. Health Policy. 2010, 94 (1): 61-67. 10.1016/j.healthpol.2009.08.009. doi:10.1016/j.healthpol.2009.08.009CrossRefPubMed Wang MJ, Lin SP: Study on doctor shopping behavior: insight from patients with upper respiratory tract infection in Taiwan. Health Policy. 2010, 94 (1): 61-67. 10.1016/j.healthpol.2009.08.009. doi:10.1016/j.healthpol.2009.08.009CrossRefPubMed
8.
go back to reference Kroenke K: The Many C’s of Primary Care. J Gen Intern Med. 2004, 19 (6): 708-709. 10.1111/j.1525-1497.2004.40401.x. doi:10.1111/j.1525-1497.2004.40401CrossRefPubMedPubMedCentral Kroenke K: The Many C’s of Primary Care. J Gen Intern Med. 2004, 19 (6): 708-709. 10.1111/j.1525-1497.2004.40401.x. doi:10.1111/j.1525-1497.2004.40401CrossRefPubMedPubMedCentral
9.
go back to reference Mercer SW, Siu JY, Hillier SM, Lam CL, Lo YY, Lam TP, Griffiths SM: A qualitative study of the views of patients with long-term conditions on family doctors in Hong Kong. BMC Fam Pract. 2010, 11: 46-10.1186/1471-2296-11-46. doi:10.1186/1471-2296-11-46CrossRefPubMedPubMedCentral Mercer SW, Siu JY, Hillier SM, Lam CL, Lo YY, Lam TP, Griffiths SM: A qualitative study of the views of patients with long-term conditions on family doctors in Hong Kong. BMC Fam Pract. 2010, 11: 46-10.1186/1471-2296-11-46. doi:10.1186/1471-2296-11-46CrossRefPubMedPubMedCentral
10.
go back to reference Sato T, Takeichi M, Shirahama M, Fukui T, Gude JK: Doctor-shopping patients and users of alternative medicine among Japanese primary care patients. Gen Hosp Psychiatry. 1995, 17 (2): 115-125. 10.1016/0163-8343(94)00094-T.CrossRefPubMed Sato T, Takeichi M, Shirahama M, Fukui T, Gude JK: Doctor-shopping patients and users of alternative medicine among Japanese primary care patients. Gen Hosp Psychiatry. 1995, 17 (2): 115-125. 10.1016/0163-8343(94)00094-T.CrossRefPubMed
11.
go back to reference Hsieh CI, Chung KP, Yang MC, Li TC: Association of treatment and outcomes of doctor-shopping behavior in patients with hepatocellular carcinoma. Patient Preference and Adherence. 2013, 7: 693-701.CrossRefPubMedPubMedCentral Hsieh CI, Chung KP, Yang MC, Li TC: Association of treatment and outcomes of doctor-shopping behavior in patients with hepatocellular carcinoma. Patient Preference and Adherence. 2013, 7: 693-701.CrossRefPubMedPubMedCentral
12.
go back to reference Olsen DM, Kane RL, Kasteler J: Medical care as a commodity: an exploration of the shopping behavior of patients. J Community Health. 1976, 2 (2): 85-91. 10.1007/BF01319086.CrossRefPubMed Olsen DM, Kane RL, Kasteler J: Medical care as a commodity: an exploration of the shopping behavior of patients. J Community Health. 1976, 2 (2): 85-91. 10.1007/BF01319086.CrossRefPubMed
13.
go back to reference Norton J, de Roquefeuil G, David M, Boulenger JP, Ritchie K, Mann A: The mental health of doctor-shoppers: experience from a patient-led fee-for-service primary care setting. J Affect Disord. 2011, 131 (1–3): 428-432. doi:10.1016/j.jad.2010.12.009CrossRefPubMed Norton J, de Roquefeuil G, David M, Boulenger JP, Ritchie K, Mann A: The mental health of doctor-shoppers: experience from a patient-led fee-for-service primary care setting. J Affect Disord. 2011, 131 (1–3): 428-432. doi:10.1016/j.jad.2010.12.009CrossRefPubMed
14.
go back to reference Clemens JQ, Bogart LM, Liu K, Pham C, Suttorp M, Berry SH: Perceptions of "urgency" in women with interstitial cystitis/bladder pain syndrome or overactive bladder. Neurourol Urodyn. 2011, 30 (3): 402-405. 10.1002/nau.20974. doi:10.1002/nau.20974CrossRefPubMed Clemens JQ, Bogart LM, Liu K, Pham C, Suttorp M, Berry SH: Perceptions of "urgency" in women with interstitial cystitis/bladder pain syndrome or overactive bladder. Neurourol Urodyn. 2011, 30 (3): 402-405. 10.1002/nau.20974. doi:10.1002/nau.20974CrossRefPubMed
15.
go back to reference Easton WA: Overactive bladder symptoms in women: Current concepts in patient management. Can J Urol. 2010, 17 (Suppl 1): 12-17.PubMed Easton WA: Overactive bladder symptoms in women: Current concepts in patient management. Can J Urol. 2010, 17 (Suppl 1): 12-17.PubMed
16.
go back to reference Allahdin S, Oo N: An overview of treatment of overactive bladder syndrome in women. J Obstet Gynaecol. 2012, 32 (3): 217-221. 10.3109/01443615.2011.649317. doi:10.3109/01443615.2011.649317CrossRefPubMed Allahdin S, Oo N: An overview of treatment of overactive bladder syndrome in women. J Obstet Gynaecol. 2012, 32 (3): 217-221. 10.3109/01443615.2011.649317. doi:10.3109/01443615.2011.649317CrossRefPubMed
18.
go back to reference Lavelle JP, Karram M, Chu FM, Dmochowski R, MacDiarmid SA, Staskin DR, Sand PK, Appell R, Erdem N: Management of incontinence for family practice physicians. Am J Med Genet. 2006, 119 (3 Suppl 1): 37-40. Lavelle JP, Karram M, Chu FM, Dmochowski R, MacDiarmid SA, Staskin DR, Sand PK, Appell R, Erdem N: Management of incontinence for family practice physicians. Am J Med Genet. 2006, 119 (3 Suppl 1): 37-40.
19.
go back to reference Coyne KS, Sexton CC, Kopp ZS, Ebel-Bitoun C, Milsom I, Chapple C: The impact of overactive bladder on mental health, work productivity and health-related quality of life in the UK and Sweden: Results from EpiLUTS. BJU Int. 2011, 108 (9): 1459-1471. 10.1111/j.1464-410X.2010.10013.x. doi:10.1111/j.1464-410X.2010.10013CrossRefPubMed Coyne KS, Sexton CC, Kopp ZS, Ebel-Bitoun C, Milsom I, Chapple C: The impact of overactive bladder on mental health, work productivity and health-related quality of life in the UK and Sweden: Results from EpiLUTS. BJU Int. 2011, 108 (9): 1459-1471. 10.1111/j.1464-410X.2010.10013.x. doi:10.1111/j.1464-410X.2010.10013CrossRefPubMed
20.
go back to reference Nilsson M, Lalos O, Lindkvist H, Lalos A: How do urinary incontinence and urgency affect women’s sexual life?. Acta Obstetricia et Gynaecologica Scandinavica. 2011, 90 (6): 621-628. 10.1111/j.1600-0412.2011.01120.x. doi:10.1111/j.1600-0412.2011.01120CrossRef Nilsson M, Lalos O, Lindkvist H, Lalos A: How do urinary incontinence and urgency affect women’s sexual life?. Acta Obstetricia et Gynaecologica Scandinavica. 2011, 90 (6): 621-628. 10.1111/j.1600-0412.2011.01120.x. doi:10.1111/j.1600-0412.2011.01120CrossRef
21.
go back to reference Anger JT, Nissim HA, Le TX, Smith AL, Lee U, Sarkisian C, Litwin MS, Raz S, Rodriguez LV, Maliski SL: Women’s experience with severe overactive bladder symptoms and treatment: Insight revealed from patient focus groups. Neurourol Urodyn. 2011, 30 (7): 1295-1299. doi:10.1002/nau.21004PubMedPubMedCentral Anger JT, Nissim HA, Le TX, Smith AL, Lee U, Sarkisian C, Litwin MS, Raz S, Rodriguez LV, Maliski SL: Women’s experience with severe overactive bladder symptoms and treatment: Insight revealed from patient focus groups. Neurourol Urodyn. 2011, 30 (7): 1295-1299. doi:10.1002/nau.21004PubMedPubMedCentral
22.
go back to reference MacDiarmid S, Rosenberg M: Overactive bladder in women: Symptom impact and treatment expectations. Curr Med Res Opin. 2005, 21 (9): 1413-1421. 10.1185/030079905X59076.CrossRefPubMed MacDiarmid S, Rosenberg M: Overactive bladder in women: Symptom impact and treatment expectations. Curr Med Res Opin. 2005, 21 (9): 1413-1421. 10.1185/030079905X59076.CrossRefPubMed
23.
go back to reference Smith AL, Nissim HA, Le TX, Khan A, Maliski SL, Litwin MS, Sarkisian CA, Raz S, Rodríguez LV, Anger JT: Misconceptions and miscommunication among aging women with overactive bladder symptoms. Urology. 2011, 77 (1): 55-59. 10.1016/j.urology.2010.07.460. doi:10.1016/j.urology.2010.07.460CrossRefPubMed Smith AL, Nissim HA, Le TX, Khan A, Maliski SL, Litwin MS, Sarkisian CA, Raz S, Rodríguez LV, Anger JT: Misconceptions and miscommunication among aging women with overactive bladder symptoms. Urology. 2011, 77 (1): 55-59. 10.1016/j.urology.2010.07.460. doi:10.1016/j.urology.2010.07.460CrossRefPubMed
26.
go back to reference Bernard HR: Research Methods in Anthropology: Qualitative and Quantitative Approaches. 2002, Walnut Creek, CA: AltaMira Press Bernard HR: Research Methods in Anthropology: Qualitative and Quantitative Approaches. 2002, Walnut Creek, CA: AltaMira Press
27.
go back to reference Green J, Thorogood N: Qualitative Methods for Health Research. 2004, London, UK: SAGE Publications Green J, Thorogood N: Qualitative Methods for Health Research. 2004, London, UK: SAGE Publications
28.
go back to reference Liamputtong P, Ezzy D: Qualitative Research Methods. 2005, Melbourne, VIC: Oxford University Press Liamputtong P, Ezzy D: Qualitative Research Methods. 2005, Melbourne, VIC: Oxford University Press
29.
go back to reference Lee A, Siu S, Lam A, Tsang C, Kung K, Li PK: The concepts of family doctor and factors affecting choice of family doctors among Hong Kong people. Hong Kong Med J. 2010, 16 (2): 106-115.PubMed Lee A, Siu S, Lam A, Tsang C, Kung K, Li PK: The concepts of family doctor and factors affecting choice of family doctors among Hong Kong people. Hong Kong Med J. 2010, 16 (2): 106-115.PubMed
30.
go back to reference Dickinson JA: Estate doctors and policy on family medicine. Hong Kong Med J. 1998, 4 (3): 311-314.PubMed Dickinson JA: Estate doctors and policy on family medicine. Hong Kong Med J. 1998, 4 (3): 311-314.PubMed
31.
go back to reference Kasteler J, Kane RL, Olsen DM, Thetford C: Issues underlying prevalence of "doctor-shopping" behavior. J Health Soc Behav. 1976, 17 (4): 329-339.CrossRefPubMed Kasteler J, Kane RL, Olsen DM, Thetford C: Issues underlying prevalence of "doctor-shopping" behavior. J Health Soc Behav. 1976, 17 (4): 329-339.CrossRefPubMed
32.
go back to reference Gudzune KA, Bleich SN, Richards TM, Weiner JP, Hodges K, Clark JM: Doctor shopping by overweight and obese patients is associated with increased healthcare utilization. Obesity (Silver Spring). 2013, 21 (7): 1328-1334. 10.1002/oby.20189. doi:10.1002/oby.20189CrossRef Gudzune KA, Bleich SN, Richards TM, Weiner JP, Hodges K, Clark JM: Doctor shopping by overweight and obese patients is associated with increased healthcare utilization. Obesity (Silver Spring). 2013, 21 (7): 1328-1334. 10.1002/oby.20189. doi:10.1002/oby.20189CrossRef
33.
go back to reference Desjarlais-Deklerk K, Wallace JE: Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics. BMC Health Serv Res. 2013, 13: 261-10.1186/1472-6963-13-261. doi:10.1186/1472-6963-13-261CrossRefPubMedPubMedCentral Desjarlais-Deklerk K, Wallace JE: Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics. BMC Health Serv Res. 2013, 13: 261-10.1186/1472-6963-13-261. doi:10.1186/1472-6963-13-261CrossRefPubMedPubMedCentral
34.
go back to reference Roberts CA, Aruguete MS: Task and socioemotional behaviors of physicians: a test of reciprocity and social interaction theories in analogue physician-patient encounters. Soc Sci Med. 2000, 50 (3): 309-315. 10.1016/S0277-9536(99)00245-2.CrossRefPubMed Roberts CA, Aruguete MS: Task and socioemotional behaviors of physicians: a test of reciprocity and social interaction theories in analogue physician-patient encounters. Soc Sci Med. 2000, 50 (3): 309-315. 10.1016/S0277-9536(99)00245-2.CrossRefPubMed
35.
go back to reference Ohira Y, Ikusaka M, Noda K, Tsukamoto T, Takada T, Miyahara M, Funakoshi H, Basugi A, Keira K, Uehara T: Consultation behaviour of doctor-shopping patients and factors that reduce shopping. J Eval Clin Pract. 2012, 18 (2): 433-440. 10.1111/j.1365-2753.2010.01605.x. doi:10.1111/j.1365-2753.2010.01605CrossRefPubMed Ohira Y, Ikusaka M, Noda K, Tsukamoto T, Takada T, Miyahara M, Funakoshi H, Basugi A, Keira K, Uehara T: Consultation behaviour of doctor-shopping patients and factors that reduce shopping. J Eval Clin Pract. 2012, 18 (2): 433-440. 10.1111/j.1365-2753.2010.01605.x. doi:10.1111/j.1365-2753.2010.01605CrossRefPubMed
36.
go back to reference Cheung WW, Khan NH, Choi KK, Bluth MH, Vincent MT: Prevalence, evaluation and management of overactive bladder in primary care. BMC Fam Pract. 2009, 10: 8-10.1186/1471-2296-10-8. doi:10.1186/1471-2296-10-8CrossRefPubMedPubMedCentral Cheung WW, Khan NH, Choi KK, Bluth MH, Vincent MT: Prevalence, evaluation and management of overactive bladder in primary care. BMC Fam Pract. 2009, 10: 8-10.1186/1471-2296-10-8. doi:10.1186/1471-2296-10-8CrossRefPubMedPubMedCentral
37.
go back to reference Goepel M, Hoffmann JA, Piro M, Rübben H, Michel MC: Prevalence and physician awareness of symptoms of urinary bladder dysfunction. Eur Urol. 2002, 41 (3): 234-239. 10.1016/S0302-2838(02)00014-3.CrossRefPubMed Goepel M, Hoffmann JA, Piro M, Rübben H, Michel MC: Prevalence and physician awareness of symptoms of urinary bladder dysfunction. Eur Urol. 2002, 41 (3): 234-239. 10.1016/S0302-2838(02)00014-3.CrossRefPubMed
38.
go back to reference Weizman AV, Ahn E, Thanabalan R, Leung W, Croitoru K, Silverberg MS, Steinhart AH, Nguyen GC: Characterisation of complementary and alternative medicine use and its impact on medication adherence in inflammatory bowel disease. Aliment Pharmacol Ther. 2012, 35 (3): 342-349. 10.1111/j.1365-2036.2011.04956.x. doi:10.1111/j.1365-2036.2011.04956CrossRefPubMed Weizman AV, Ahn E, Thanabalan R, Leung W, Croitoru K, Silverberg MS, Steinhart AH, Nguyen GC: Characterisation of complementary and alternative medicine use and its impact on medication adherence in inflammatory bowel disease. Aliment Pharmacol Ther. 2012, 35 (3): 342-349. 10.1111/j.1365-2036.2011.04956.x. doi:10.1111/j.1365-2036.2011.04956CrossRefPubMed
Metadata
Title
"Seeing a doctor is just like having a date": a qualitative study on doctor shopping among overactive bladder patients in Hong Kong
Author
Judy Yuen-man Siu
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2014
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/1471-2296-15-27

Other articles of this Issue 1/2014

BMC Primary Care 1/2014 Go to the issue