DOCTOR-SHOPPING PATIENTS AND USERS OF ALTERNATIVE MEDICINE AMONG JAPANESE PRIMARY-CARE PATIENTS

To describe the clinical characteristics of patients with doctor-shopp ing behavior (doctor-shopping patients) and users of alternative medic ine among Japanese primary care patients, 1088 patients from the gener al medicine outpatient clinic of a medical school hospital answered an original questionnaire and 30-item General Health Questionnaire (GHQ) . A random sample of patients was questioned in accordance with the Di agnostic interview Schedule modified for use in Japan (DIS-JM). Twenty -three percent of these patients met our criteria for doctor-shopping patients, and 7.9% had used alternative medicine. Multivariate analysi s showed no significant difference between the two groups of patients with regard to sex, age, residence, occupation, education, or marital status. The most striking characteristics of doctor-shopping patients were chronicity of illness (p < 0.005), inability to understand doctor s' explanations (p < 0.005), disbelief of the doctor's diagnosis and t reatment (p < 0.005), and high GHQ scores (p < 0.05). The major factor for alternative medicine users was high expectations of medical schoo l hospitals (p < 0.01). DIS-JM interviews showed that doctor-shopping patients had a high lifetime prevalence of mental disorders. The lifet ime prevalence of DSM-III somatization disorders was significantly hig her in the two study groups. These results suggest that the risk facto rs for doctor shopping are strongly associated with chronic conditions and the doctor-patient relationship. Also, users of alternative medic ine had high expectations of medical school hospitals as the symbol of modern medicine. Therefore, we emphasize the importance of accurate e xplanations and maintenance of good doctor-patient relationships by ph ysicians providing care. We also suggest that when obtaining the patie nt's medical history, doctors ask how many prior visits the patient ha s made to medical facilities with the same complaint, and how many rim es the patient has used alternative medicine.