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Doctor shopping is a practice where patients consult multiple doctors to obtain prescription drugs, often for recreational use or resale. In Australia, doctor shopping is a significant concern for healthcare providers, particularly with the abuse of prescription medications, such as opioids. To combat this issue, the Australian government has introduced legislation, such as the Medicines, Poisons, and Therapeutic Goods Bill 2013, which mandates doctors and pharmacists to report suspected doctor shoppers and drug-dependent patients to the Health Department. These measures aim to prevent the harmful consequences of prescription drug abuse and ensure that patients receive appropriate medical care without facilitating drug addiction or illegal activities.
| Characteristics | Values |
|---|---|
| Doctor shopping defined | Seeking prescription drugs by visiting multiple doctors |
| Doctor shopping methods | Requesting a drug by name or specific dosage and refusing other therapeutic options; impersonating a policeman and claiming to need drugs for an "undercover case"; using an older patient on pain medication as a proxy |
| Doctor shopping consequences | Doctors must report suspected "oversupplied people" to the Health Department, which may place them on a drug addict register; doctors who fail to report within 48 hours risk a $1,000 fine |
| Doctor shopping prevention | Doctors can call Medicare Australia's Prescription Shopping Information Service to check what medicines have been supplied to a patient; doctors should record prescription amounts in words and numbers and put several lines through unused space on the prescription |
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What You'll Learn
- Doctor shoppers may request drugs by name or refuse other treatments
- Doctors can check a patient's prescription history by calling Medicare Australia
- Doctors must report suspected drug dependence to the Health Department
- Pharmacists can report suspected doctor shoppers under new laws
- Critics worry laws will damage the doctor-patient relationship
Doctor shoppers may request drugs by name or refuse other treatments
Doctor shopping, or prescription shopping, is when a patient deliberately visits several doctors to obtain more medicine than is clinically indicated. Doctor shoppers may request drugs by name or refuse other treatments, exhibiting signs of drug abuse such as dilated or constricted pupils, extreme excitability or fatigue, and poor personal hygiene. They may also have refused or failed to attend appointments with appropriate specialists for advice on managing their pain or addiction.
It is important for doctors to recognise the signs of drug-seeking behaviour to protect patients from harm and themselves from disciplinary action. Doctor shoppers may be drug-dependent, but they could also be patients in financial need who attempt to sell excess medication or criminals looking to sell prescription drugs to support their habits or make money.
If a doctor suspects a patient is a doctor shopper, they can call Medicare Australia's Prescription Shopping Information Service to obtain a summary of the patient's prescription history. Doctors must be registered with the service to do so. To refuse a patient's request for drugs, it is recommended to have a sign or practice policy indicating that it is a policy decision, not a personal one. Doctors should also encourage patients to go to one pharmacy for consistency in monitoring prescriptions.
In some cases, a doctor shopper may impersonate a member of authority or have an accomplice pose as a medical colleague to obtain prescription drugs. It is illegal for doctors to prescribe Schedule 8 medications, such as OxyContin, Fentanyl, MS Contin, and Xanax, to patients they suspect of being drug-dependent without prior written approval from the NSW Ministry of Health.
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Doctors can check a patient's prescription history by calling Medicare Australia
Doctor shopping, or the practice of seeing multiple doctors to obtain controlled medications, is a growing concern in Australia. To combat this, the Australian Government has implemented the National Real Time Prescription Monitoring (RTPM) system. This system allows doctors and pharmacists to access a patient's prescription history, helping to reduce the misuse of controlled medicines in Australia.
The RTPM system contains detailed information about a patient's prescription history, including the particular drugs prescribed, the dates and amounts prescribed, and information about the dispensing of those drugs. This information is accessible to authorised prescribers and dispensers, who can use it to make informed decisions about prescribing or dispensing controlled medicines.
While doctors do not receive a notification when a patient fills a prescription, they can actively check a patient's prescription history if they have the time and inclination. This varies by the type of medication, the state, and the software the doctor is using. Usually, a doctor would only check if a patient requests a repeat prescription earlier than expected.
In the past, doctors could call a hotline or receive surprise letters from Medicare to warn about potential drug-seeking behaviour. Now, with the RTPM system, doctors can access this information in real time, helping to improve patient care and safety. This system also ensures that patients are honest with their healthcare providers about the medications they are taking.
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Doctors must report suspected drug dependence to the Health Department
In Australia, doctors play a crucial role in identifying and managing drug dependence among patients. They are often the first point of contact for individuals seeking treatment, and their responsibilities include recognising signs of drug-seeking behaviour, providing appropriate care, and preventing the potential harm associated with prescription drug misuse.
Doctors must be vigilant in identifying drug-seeking behaviours as patients may employ sophisticated, manipulative, and demanding tactics to obtain drugs of dependence. These behaviours can vary widely, and there is no single profile of a patient who may become drug-dependent. Patients may feign pain and specifically request certain drugs, often short-acting, injectable drugs, or preparations that can be injected. They may also provide convincing descriptions of symptoms or exhibit old scars or other signs of injury to support their requests.
To assist doctors in making informed prescribing decisions and identifying drug-seeking behaviours, all states and territories in Australia have implemented real-time prescription monitoring services. These systems enable doctors to access a patient's prescription history, helping them recognise potential doctor-shopping behaviours and identify circumstances where a patient may be at risk of harm from misusing medications. In Victoria, Queensland, South Australia, and the Northern Territory, it is mandatory for doctors to check a patient's prescription history before prescribing a "monitored medicine".
When dealing with suspected drug dependence, doctors must follow specific clinical considerations and legal obligations. In some cases, they may need to contact the Drugs of Dependence Unit or the Prescription Shopping Information Service for further guidance. Additionally, it is important for doctors to firmly refuse to prescribe any drugs of dependence, even if the patient is insistent. Non-opioid drugs, such as clonidine, can be prescribed in acute situations to provide symptomatic relief of withdrawal symptoms. Referrals to specialist clinics or accredited MATOD prescribers are also recommended for assessment and ongoing management of drug dependence.
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Pharmacists can report suspected doctor shoppers under new laws
Doctor shopping, or the practice of visiting multiple doctors to obtain controlled substances, is illegal in Australia. All states and territories have implemented laws prohibiting this practice, with penalties varying depending on the case and the state. To combat this issue, prescription drug monitoring programs (PDMPs) have been established. These electronic systems track prescriptions of controlled substances, allowing providers and pharmacists to identify potential cases of doctor shopping.
Pharmacists play a crucial role in preventing doctor shopping and have the authority to report suspected cases under these new laws. By monitoring for fake or altered prescriptions and patients with multiple prescriptions from different doctors, pharmacists can identify possible doctor shoppers. Additionally, many pharmacies have hotlines to alert others in the area about detected prescription fraud.
PDMPs provide pharmacists with a powerful tool to identify doctor shopping. These programs require pharmacists to record each prescription filled in a government database, making it easier to spot suspicious patterns. This information can then be used to intervene and prevent potential overdoses or substance use disorders, as doctor shopping often indicates addiction or prescription drug abuse.
By utilising PDMPs and reporting suspected cases, pharmacists can actively contribute to combating prescription drug abuse and protecting their patients from the harmful consequences of substance misuse. These measures help ensure that controlled substances are obtained safely and legitimately, improving patient care and reducing the potential for fraud or misuse.
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Critics worry laws will damage the doctor-patient relationship
While patient protection efforts are necessary, they may not always strengthen the doctor-patient relationship. Patients enrolled in managed care plans often worry that their health plan is more concerned about saving money than providing the best treatment for them. This concern is heightened by media coverage of individuals harmed by health plans' cost-cutting measures. Patients may hesitate to discuss these concerns directly with their doctors, instead making repeated requests for specialty referrals or expensive tests. This can impair pre-visit trust in physicians and lead to strained interactions, negatively impacting patient outcomes and future visits.
Additionally, patients may be reluctant to discuss their physicians' bonuses and how they might influence treatment recommendations. While most people want disclosure of bonuses, many fear that bringing up the topic would be awkward or anger their doctor. This dynamic can further complicate the doctor-patient relationship and hinder open communication.
The context in which care is delivered is crucial to understanding the doctor-patient interaction. Physicians are frustrated by the impact of managed care on their practice and their ability to provide optimal care. This frustration, combined with patient anxiety, can lead to disagreements and communication challenges. Efforts to promote patient protection, such as the right to external review and the right to sue health plans, may not adequately address these complex dynamics and could fall short of strengthening the doctor-patient relationship.
To improve the situation, patients need to feel secure in their right to seek external reviews without retribution. Additionally, awareness and comfort with external review programs should be enhanced, as they are not typically included in patient protection bills. While patients have the right to sue health plans that cause harm, this often occurs after an injury and can take years to resolve, providing little comfort to worried patients.
In conclusion, while patient protection efforts are important, they must be carefully designed to address the complex dynamics between patients and physicians. Strengthening the doctor-patient relationship requires addressing concerns about cost containment, improving communication, and ensuring patients feel secure and informed about their rights and options.
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Frequently asked questions
Doctor shopping is when a patient visits multiple doctors to obtain prescriptions for a drug that can be subject to abuse. This practice is also known as 'fossil farming'.
Doctor shopping is not explicitly mentioned as illegal in Australia. However, there are laws in place to prevent it. Doctors are required to report drug-dependent patients and suspected doctor shoppers to the Health Department. They can also call Medicare Australia's Prescription Shopping Information Service to check what medicines have been supplied to a patient.
Doctor shoppers may request a specific drug or dosage and refuse other therapeutic options. They may also exhibit physical signs of drug abuse, such as dilated or constricted pupils, extreme excitability or fatigue, and poor personal hygiene.
