Doctor shopping

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Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions. It is a common practice of people with substance use disorders, suppliers of addictive substances, [1] hypochondriacs [2] [3] or patients of factitious disorder and factitious disorder imposed on another. [4] [5] A doctor who, for a price, will write prescriptions without the formality of a medical exam or diagnosis is known as a "writer" or "writing doctor". [6]

Contents

Description

A doctor shopper will visit multiple health care providers as a "new patient" or "visiting from out of town," and will exaggerate or feign medical problems to obtain prescription medications [7] or a wanted medical opinion, diagnosis or treatment with no specific material gain. [2] [3] [4] [5]

This is illegal in Canada under S. 4(2) of the CDSA [8]

For prescription drugs

Frequently involved in prescription fraud are narcotics, stimulants, barbiturates, benzodiazepines, tranquilizers and other psychoactive substances manufactured for use in legitimate medical treatment. Law enforcement officers spend a significant amount of time investigating cases involving prescription fraud, many of which also involve insurance, Medicare, or Medicaid fraud. [7]

Prescription drug diversion occurs by faking, forging, or altering a prescription; obtaining bogus prescriptions from criminal medical practitioners; or buying drugs diverted from health care facilities by personnel. Pharmacy thefts are increasing throughout the United States to feed the growing demand for prescription drugs. The rising cost of prescription drugs has also enticed senior citizens to join in the diversion and to sell their prescriptions. [7]

Doctor shopping is a kind of malingering with the specific goal of procuring prescription drugs. Malingering is underdiagnosed, often because of the physician's fear of making false accusations. Covert surveillance has indicated that as many as 20% of pain clinic patients misrepresent the extent of their disability. [ citation needed ] The judgment of the morality of malingering is largely a matter of the observer and circumstances. Most people would regard defrauding an insurance company, by reporting a false injury, as an antisocial act. In contrast, the malingering of a prisoner-of-war, who is attempting to manipulate his or her captors, would be seen by most compatriots as a skillful coping mechanism. [9]

In hypochondriasis and factitious disorders

Some patients of hypochondria, factitious disorder and factitious disorder imposed on another will visit multiple health care providers to find a medical opinion, diagnosis or treatment that they feel the need to get, [2] [3] [4] [5] not specifically in search of prescription drugs, for no material benefit [10] [11] and even incurring in significant costs, debts or losses. This kind of doctor shopping lacks intention to commit malingering for material gain and is the result of such mental conditions.

See also

Related Research Articles

Factitious disorder imposed on self, also known as Munchausen syndrome, is a factitious disorder in which those affected feign or induce disease, illness, injury, abuse, or psychological trauma to draw attention, sympathy, or reassurance to themselves. Munchausen syndrome fits within the subclass of factitious disorder with predominantly physical signs and symptoms, but patients also have a history of recurrent hospitalization, travelling, and dramatic, extremely improbable tales of their past experiences. The condition derives its name from the fictional character Baron Munchausen.

<span class="mw-page-title-main">Substance abuse</span> Harmful use of drugs

Substance abuse, also known as drug abuse, is the use of a drug in amounts or by methods that are harmful to the individual or others. It is a form of substance-related disorder. Differing definitions of drug abuse are used in public health, medical, and criminal justice contexts. In some cases, criminal or anti-social behavior occurs when the person is under the influence of a drug, and long-term personality changes in individuals may also occur. In addition to possible physical, social, and psychological harm, the use of some drugs may also lead to criminal penalties, although these vary widely depending on the local jurisdiction.

<span class="mw-page-title-main">Hypochondriasis</span> Medical condition

Hypochondriasis or hypochondria is a condition in which a person is excessively and unduly worried about having a serious illness. Hypochondria is an old concept whose meaning has repeatedly changed over its lifespan. It has been claimed that this debilitating condition results from an inaccurate perception of the condition of body or mind despite the absence of an actual medical diagnosis. An individual with hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.

<span class="mw-page-title-main">Substance-related disorder</span> Medical condition

Substance-related disorders, also known as substance use disorders, can lead to large societal problems. It is found to be greatest in individuals ages 18–25, with a higher likelihood occurring in men compared to women, and urban residents compared to rural residents. On average, general medical facilities hold 20% of patients with substance-related disorders, possibly leading to psychiatric disorders later on. Over 50% of individuals with substance-related disorders will often have a "dual diagnosis," where they are diagnosed with the substance use, as well as a psychiatric diagnosis, the most common being major depression, personality disorder, anxiety disorders, and dysthymia.

Malingering is the fabrication, feigning, or exaggeration of physical or psychological symptoms designed to achieve a desired outcome, such as relief from duty or work, avoiding arrest, receiving medication, and mitigating prison sentencing.

<span class="mw-page-title-main">Somatization disorder</span> Mental disorder consisting of clinically significant somatic symptoms

Somatization disorder was a mental and behavioral disorder characterized by recurring, multiple, and current, clinically significant complaints about somatic symptoms. It was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated somatoform disorder to become somatic symptom disorder, a diagnosis which no longer requires a specific number of somatic symptoms. ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems, still includes somatization syndrome.

Drug rehabilitation is the process of medical or psychotherapeutic treatment for dependency on psychoactive substances such as alcohol, prescription drugs, and street drugs such as cannabis, cocaine, heroin or amphetamines. The general intent is to enable the patient to confront substance dependence, if present, and stop substance misuse to avoid the psychological, legal, financial, social, and physical consequences that can be caused.

A factitious disorder is a condition in which a person, without a malingering motive, acts as if they have an illness by deliberately producing, feigning, or exaggerating symptoms, purely to attain a patient's role. People with a factitious disorder may produce symptoms by contaminating urine samples, taking hallucinogens, injecting fecal material to produce abscesses, and similar behaviour.

Ganser syndrome is a rare dissociative disorder characterized by nonsensical or wrong answers to questions and other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state of consciousness. The syndrome has also been called nonsense syndrome, balderdash syndrome, syndrome of approximate answers, hysterical pseudodementia or prison psychosis.

Drug diversion is a medical and legal concept involving the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. The definition varies slightly among different jurisdictions, but the transfer of a controlled substance alone usually does not constitute a diversion, since certain controlled substances that are prescribed to a child are intended to be administered by an adult, as directed by a medical professional. The term comes from the "diverting" of the drugs from their original licit medical purpose. In some jurisdictions, drug diversion programs are available to first time offenders of diversion drug laws, which "divert" offenders from the criminal justice system to a program of education and rehabilitation.

Factitious disorder imposed on another (FDIA), also known as fabricated or induced illness by carers (FII), and first named as Munchausen syndrome by proxy (MSbP), is a condition in which a caregiver creates the appearance of health problems in another person, typically their child. This may include injuring the child or altering test samples. The caregiver then presents the person as being sick or injured. Permanent injury or death of the victim may occur as a result of the disorder. The behaviour occurs without a specific benefit to the caregiver.

An angel of mercy or angel of death is a type of criminal offender who is usually employed as a caregiver and intentionally harms or kills people under their care. The angel of mercy is often in a position of power and may decide the victim would be better off if they no longer suffered from whatever severe illness is plaguing them. This person then uses their knowledge to kill the victim. In some cases, as time goes on, this behavior escalates to encompass the healthy and the easily treated.

<span class="mw-page-title-main">Iatrogenesis</span> Causation of harm by any medical activity

Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. First used in this sense in 1924, the term was introduced to sociology in 1976 by Ivan Illich, alleging that industrialized societies impair quality of life by overmedicalizing life. Iatrogenesis may thus include mental suffering via medical beliefs or a practitioner's statements. Some iatrogenic events are obvious, like amputation of the wrong limb, whereas others, like drug interactions, can evade recognition. In a 2013 estimate, about 20 million negative effects from treatment had occurred globally. In 2013, an estimated 142,000 persons died from adverse effects of medical treatment, up from an estimated 94,000 in 1990.

In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, depending on state requirements, other potentially abusable prescription drugs. PMPs are meant to help prevent adverse drug-related events such as opioid overdoses, drug diversion, and substance abuse by decreasing the amount and/or frequency of opioid prescribing, and by identifying those patients who are obtaining prescriptions from multiple providers or those physicians overprescribing opioids.

Addiction psychiatry is a medical subspecialty within psychiatry that focuses on the evaluation, diagnosis, and treatment of people who have one or more disorders related to addiction. This may include disorders involving legal and illegal drugs, gambling, sex, food, and other impulse control disorders. Addiction psychiatrists are substance use disorder experts. Growing amounts of scientific knowledge, such as the health effects and treatments for substance use disorders, have led to advancements in the field of addiction psychiatry. These advancements in understanding the neurobiology of rewarding behavior, along with federal funding, has allowed for ample opportunity for research in the discipline of addiction psychiatry. Addiction psychiatry is an expanding field, and currently there is a high demand for substance use disorder experts in both the private and public sector.

Somatic symptom disorder, also known as somatoform disorder, is defined by one or more chronic physical symptoms that coincide with excessive and maladaptive thoughts, emotions, and behaviors connected to those symptoms. The symptoms are not purposefully produced or feigned, and they may or may not coexist with a known medical ailment. Manifestations of Somatic symptom disorder are variable and symptoms can be widespread, specific, and often fluctuate. Somatic symptom disorder corresponds to the way an individual views and reacts to symptoms as rather than the symptoms themselves. Somatic symptom disorder may develop in those who suffer from an existing chronic illness or medical condition.

Online doctor is a term that emerged during the 2000s, used by both the media and academics, to describe a generation of physicians and health practitioners who deliver healthcare, including drug prescription, over the internet.

<span class="mw-page-title-main">Loren Pankratz</span> American psychologist (born 1940)

Loren Pankratz is a consultation psychologist at the Portland VA Medical Center and professor in the department of psychiatry at Oregon Health & Science University (OHSU).

<span class="mw-page-title-main">Prescription drug addiction</span> Medical condition

Prescription drug addiction is the chronic, repeated use of a prescription drug in ways other than prescribed for, including using someone else’s prescription. A prescription drug is a pharmaceutical drug that may not be dispensed without a legal medical prescription. Drugs in this category are supervised due to their potential for misuse and substance use disorder. The classes of medications most commonly abused are opioids, central nervous system (CNS) depressants and central nervous stimulants. In particular, prescription opioid is most commonly abused in the form of prescription analgesics.

References

  1. Tom Dalzell (2009), The Routledge Dictionary of Modern American Slang and Unconventional English (8th ed.), Routledge, p. 299
  2. 1 2 3 "Hypochondriasis (DSM-IV-TR #300.7)" (PDF). Brown University.
  3. 1 2 3 Maria Sandra Cely-Serrano, MD. "Pediatric Hypochondriasis Clinical Presentation". Medscape.
  4. 1 2 3 Marc D. Feldman, M.D. (2004), Playing Sick? Untangling the Web of Munchausen Syndrome, Munchausen by Proxy, Malingering, and Factitious Disorder, Routledge, pp. 188, 210
  5. 1 2 3 Elizabeth M. Varcarolis RN MA; Margaret Jordan Halter PMHCNS (2014), Essentials of Psychiatric Mental Health Nursing: A Communication Approach to Evidence-Based Care (2nd ed.), Elsevier, p. 195{{citation}}: CS1 maint: multiple names: authors list (link)
  6. Tom Dalzell (2009), "writing doctor", The Routledge Dictionary of Modern American Slang and Unconventional English, Routledge, pp. 1065–1066, ISBN   978-0-415-37182-7
  7. 1 2 3 Kären M. Hess; Christine Hess Orthmann (2010), "Other Challenges to the Criminal Investigator", Criminal Investigation (9th ed.), Delmar, p. 546
  8. Santini, Tara (2021). Read between the lines. Montreal, Quebec, Canada: Stella, l'aime de m'aimie. p. 25.
  9. Charles V. Ford (2008), "Factitious Disorders and Malingering", in Michael H. Ebert; Peter T. Loosen; Barry Nurcombe; et al. (eds.), Current Diagnosis & Treatment: Psychiatry (2nd ed.), McGraw-Hill, ISBN   978-0-07-142292-5
  10. Dr. Guy E Brannon MD. "Factitious Disorder Imposed on Another - Etiology". Medscape, WebMD . Retrieved 19 June 2016.
  11. "Diseases and conditions - Factitious disorders". Cleveland Clinic . Retrieved 19 June 2016.