The second-opinion behavior in doctor-seeking process in Taiwan.
Date Issued
2006
Date
2006
Author(s)
Chiang, Hui-Chen
DOI
zh-TW
Abstract
The limited medical care resources has made “doctor-shopping” behavior among the general public a target for criticism, yet the possible function of safeguarding against undesirable outcomes that may be inherent in this commonly practiced precautions has long been overlooked. This study aims to understand how the laypersons themselves assure patient safety and quality of care by examining the “second opinion behavior” (SOB) in the health seeking process.
A mixed-method design combing qualitative and quantitative data collection approaches was employed to explore the nature of the SOB and its distribution and determinants. In-depth interviewing with 18 patients who were facing life-and death decisions for the treatment of their illness was carried out from November 2004 thought April 2005. Based on the findings of the qualitative data, structured items to measure SOB and its correlates were constructed. Through a nation-wide telephone survey, valid responses from 1057 adults aged 18 years and older were collected, with a response rate of 93.7%.
The major findings are:
1. The SOB is a strategy for pursuing health care and self-assuring patient safty, which is motivated by coping with medical uncertainty and the deficit of medical information, and a distrust in physicians.
2. By means of seeking second opinions form professionals and making lay consultations within one’s own social network, i.e., a social comparison process, the laypersons integrate the information they acquired to enhance their understanding of the nature and the prognosis of the disease and, furthermore, to choose the best institution for the on-going treatment.
3. Basically two stages can be differentiated in the health seeking process before the institution for treatment was chosen finally. The task of the first stage is confirming the diagnosis and taking in related knowledge and information, which means to safeguard against the process aspect of quality. Once the diagnosis was confirmed, in the second stage, the main task is finding a competent doctor in a renowned medical care institution, which pinpoints to the structure and outcome aspects of the quality. It is in the second stage that the consumerism was in operation obviously.
4. The overall negative outlook on the health care system may bring about the general distrust between patients and physicians. As a result, the gereral public themselves may initiate precautious strategies by multiple consultations and confirmations.
In conclusion, the SOB is a rational action, which reflects that the gereral public are capable of supervising the quality of care and actively participate in the medical care process, and that they express their awareness of their rights of being informed and making decision. However, all actions taken by the general public characterize merely “exit” (going out) but without “voice,” which hardly poses any opportunity for health care reforming or re-structuring. It is therefore suggested that the government should provide channels for the general public to voice their discontents to the quality of care.
Subjects
第二意見行為
逛醫師
信任
醫療消費主義
second opinion behavior
doctor shopping
trust
medical consumerism
Type
thesis
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