The mental health of doctor-shoppers: experience from a patient-led fee-for-service primary care setting.
BACKGROUND
Doctor-shopping may reflect unmet patient needs and places a significant burden on health resources; however little is known about its underlying reasons and how it relates to mental illness and its recognition in an open access fee-for-service setting.


METHODS
In 2003-2004, consecutive patients of 46 French general practitioners (GPs), completed in the waiting room the self-report Patient Health Questionnaire and reported on service use in the past six months. During the consultation, GPs rated the severity of any physical and psychiatric disorders.


RESULTS
Of 1079 patients, those rated by the GP as having a common mental disorder were significantly more likely to be doctor-shoppers but only if visiting another GP because of dissatisfaction with previous care (OR=2.3, 95% CI: 1.4-3.7). A similar trend is observed for those identified as having a common mental disorder by the Patient Health Questionnaire. Among patients with a common mental disorder, 'dissatisfied' doctor-shoppers were significantly more likely to be recognised as cases by the GP, adjusting for covariates (OR=6, 95% CI: 2.1-17.2). This was not the case for those doctor-shopping for practical reasons alone.


CONCLUSIONS
Doctor-shopping behaviour is associated with higher rates of mental illness and, among cases, an increased likelihood of recognition by the GP, only however for doctor-shoppers dissatisfied with previous care. This suggests a benefit to letting patients choose their GP as is the case in France and change if not satisfied.
Inserm U888, Pathologies of the Nervous System, Montpellier, France. Joanna.norton@inserm.fr
Joanna
J
Norton
Guilhem
G
de Roquefeuil
Michel
M
David
Jean-Philippe
JP
Boulenger
Karen
K
Ritchie
Anthony
A
Mann
D000293:Adolescent; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D018588:Fee-for-Service Plans; D005260:Female; D005602:France; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult