Are you indulging in medical shopping?

The line that divides “second opinion” from “medical shopping” is a blurred one.

“Second opinion” is the seeking of another medical opinion to verify or validate what the first doctor had diagnosed or advised, and is often quite a valuable step. Most in their normal senses would not seek another opinion for a common cold. On the contrary if the diagnosis is of a sinsister kind such as cancer, or if the  treatment advised is of the risky or expensive kind, such as a heart surgery, it is quite natural for a patient  to seek a confirmation or endorsement by another expert in the field. Indeed, good physicians and surgeons often advise their patients to consult a second physician so as to get convinced of the unpleasant diagnosis and then return with greater motivation to embark on a treatment that is challenging.

The diagnosis of cancer is certainly one such situation. It often comes as a shock and evokes a sense disbelief and denial in patients with thoughts like “it just can’t be true, I just had symptoms of indigestion” or “it cannot be happening to me”. A second evaluation by a competent doctor re-confiring the diagnosis helps the patient to accept the unpleasant truth.

A similar situation often occurs with patients undergoing coronary angiography for evaluation of heart symptoms. Detection of narrowing of arteries comes as unpleasant news, but if all 3 arteries are found to be thinned out and the cardiologist advises coronary bypass surgery rather than angioplasty, the patient usually gropes for a second opinion before subjecting himself to the operation.

Medical shopping on the other hand is quite akin to what we do while buying vegetables, going from one grocer to another enquiring the rates of cauliflowers, seeing their size,  and at times bargaining, before making our purchase. There are people who in their contrived habit of seeking the cheapest will enquire about the cost of endoscopy in 5 centres before going in for one. It may not always be the price, but the popularity of the doctor or the market-stature of the clinic instead.

Once a “noveau riche” businessman’s wife in her 40s, brought her 12 year old daughter, who had been complaining of abdominal pain for a month, to me. The child seemed to be in no distress as she sat smilingly across the table. As I went through her history and scanned the results of the innumerable ultrasound and CT scan tests she had gone through, the mother proudly told me that she had consulted 18 of the top pediatricians, surgeons and gastroenterologists of the city before coming to me.

I discovered in the course of history-taking that the pain came in the mornings before school, and once allowed her to stay back home, it subsided, permiting her to accompany her mother later to the shopping mall. I could see the disappointment in her face as she left in a huff with her daughter to seek their 20^th medical opinion.

As published in HT City (Hindustan Times) dated 29 January, 2012.