Sato T, Takeichi M, Shirahama M, Fukui T, Gude J K
Department of Psychiatry, Saga Medical School, Japan.
Gen Hosp Psychiatry. 1995 Mar;17(2):115-25. doi: 10.1016/0163-8343(94)00094-t.
To describe the clinical characteristics of patients with doctor-shopping behavior (doctor-shopping patients) and users of alternative medicine among Japanese primary care patients, 1088 patients from the general 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 Diagnostic 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 analysis 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 doctors' explanations (p < 0.005), disbelief of the doctor's diagnosis and treatment (p < 0.005), and high GHQ scores (p < 0.05). The major factor for alternative medicine users was high expectations of medical school hospitals (p < 0.01). DIS-JM interviews showed that doctor-shopping patients had a high lifetime prevalence of mental disorders. The lifetime prevalence of DSM-III somatization disorders was significantly higher in the two study groups. These results suggest that the risk factors for doctor shopping are strongly associated with chronic conditions and the doctor-patient relationship. Also, users of alternative medicine had high expectations of medical school hospitals as the symbol of modern medicine. Therefore, we emphasize the importance of accurate explanations and maintenance of good doctor-patient relationships by physicians providing care. We also suggest that when obtaining the patient's medical history, doctors ask how many prior visits the patient has made to medical facilities with the same complaint, and how many times the patient has used alternative medicine.
为描述日本基层医疗患者中存在“寻医问药”行为的患者（即“寻医问药”患者）及使用替代医学的患者的临床特征，一所医学院附属医院普通内科门诊的1088名患者回答了一份自编问卷和30项的一般健康问卷（GHQ）。按照为在日本使用而修改的诊断访谈日程表（DIS-JM）对患者进行随机抽样询问。这些患者中有23%符合我们对“寻医问药”患者的标准，7.9%使用过替代医学。多变量分析显示，两组患者在性别、年龄、居住地、职业、教育程度或婚姻状况方面无显著差异。“寻医问药”患者最显著的特征是疾病的慢性（p<0.005）、无法理解医生的解释（p<0.005）、对医生的诊断和治疗不信任（p<0.005）以及GHQ得分高（p<0.05）。使用替代医学的主要因素是对医学院附属医院期望高（p<0.01）。DIS-JM访谈显示，“寻医问药”患者精神障碍的终生患病率高。两个研究组中，DSM-III躯体化障碍的终生患病率显著更高。这些结果表明，“寻医问药”的危险因素与慢性病和医患关系密切相关。此外，使用替代医学的患者对作为现代医学象征的医学院附属医院期望高。因此，我们强调医生在提供医疗服务时准确解释和维持良好医患关系的重要性。我们还建议，在获取患者病史时，医生应询问患者因相同症状此前去医疗机构就诊的次数，以及患者使用替代医学的次数。
