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- MATERIALS AND METHODS
Despite the high prevalence of dyspepsia in the community, the majority of dyspeptics do not consult a medical practitioner about their symptoms.1–13 British surveys revealed that only 22–25% of people with dyspepsia had consulted a doctor for symptoms within the previous 6 or 12 months and only 42% ever sought medical advice.6–9 In the United States, only 22–29% of dyspeptics consulted a doctor in the previous year.12 Reasons given by patients for consulting a medical practitioner about dyspepsia include: severity of symptoms; anxiety about symptoms; and fear of serious disease.8, 13–15 Factors found to be associated with consulting a doctor about dyspepsia include: increasing age; duration of dyspepsia; severity of symptoms; frequent dyspepsia; lower socio-economic status; and experience of stressful life events.6, 7, 9, 13, 15, 16, 17 An important question, not yet answered, is whether people with dyspepsia consult at a similar stage in their illness.
Little is known about the extent to which people with dyspepsia seek the advice of other non-medical health practitioners, such as allied or alternative health practitioners. One possible hypothesis explaining why patients seek care from non-medical practitioners is dissatisfaction with medical care. Verhoef et al. found that a sample of Canadian patients with upper gastrointestinal problems, who sought alternative health care in addition to medical care, were less satisfied with, and more sceptical about, conventional medicine.18 In a further study, patients’ dissatisfaction with their gastroenterologists was identified as a reason for seeking a second opinion.19 There is a scarcity of data about dyspepsia patients’ satisfaction with medical care.
Ascertaining the proportions and profiles of people who do or do not consult various health practitioners for dyspepsia provides important information about factors precipitating consultation and assists in understanding the extent to which consulters represent the population of people with dyspepsia. As part of a cross-sectional survey to determine the prevalence of dyspepsia in an Australian population, the proportions fitting into each of four different consulting patterns were identified. These were: dyspeptics who only consult medical practitioners; those who only consult non-medical health practitioners; those who consult both; and those who do not consult. The first null hypothesis was that the four consulting groups do not differ significantly in age, sex, duration, number and severity of symptoms, and overall physical and mental health status. Furthermore, it was hypothesized that dyspeptics who consult medical practitioners and those who consult both medical and non-medical practitioners do not differ significantly in the timing of their first presentation to a doctor or in their satisfaction with medical care. Additionally, it was hypothesized that dyspeptics who only consult non-medical practitioners and those who consult both medical and non-medical practitioners consult similar numbers and types of non-medical practitioners.
- Top of page
- MATERIALS AND METHODS
The results provide a profile of the characteristics and consulting behaviour of dyspeptics in Australia. The majority (56%) consulted a medical practitioner at some time for their dyspepsia. This result is in keeping with a general trend of high medical consultation rates by Australians for gastrointestinal conditions, overall.34, 35 Population studies in Britain and Sweden, which were similar in design to the present study, found lower ‘ever’ dyspepsia consulting rates of 42% and 45%, respectively.8, 36 Three UK population studies found that 25% of dyspeptics had consulted a medical practitioner in the previous 6 months.6, 7, 9 This is similar to our 3-month ‘recent’ consulting rate of 20%. Penston et al. reported that 22% of their British sample had consulted for dyspepsia in the previous year.8‘Ever’ consulting rates provide an indication of the incidence of consulting for dyspepsia. Thus the present results show that Australians are more likely than Swedish and British dyspeptics to consult at least once for dyspepsia. ‘Recent’ consulting rates provide a measure of the prevalence of consulting for dyspepsia as both first time and repeat consulters are included. Therefore, British dyspeptics appear slightly more likely than Australians to consult repeatedly for dyspepsia.6, 7, 9 Swedish dyspeptics with a reported recent consulting rate of only 5%, appear considerably less likely to repeatedly consult compared to Australians with dyspepsia.36
A key issue in relation to consulting behaviour is how long people with dyspepsia wait before consulting a medical practitioner. The majority (78%) of the current sample consulted within 3 years of first experiencing symptoms, most (54%) within 6 months. In a Finnish sample, 60% of dyspeptics who consulted a general practitioner did so within 4 weeks of experiencing symptoms, a considerably greater percentage than the 26% of dyspeptics in the current study who consulted within 1 month of symptom onset.37
Nearly one in three Australian dyspeptics sought advice from non-medical practitioners. No known research has examined the extent to which people with dyspepsia consult such practitioners. Around 8% of patients attending a Canadian gastroenterology out-patient clinic reported attending an alternative practitioner within the previous 2 years.18, 19 Only 2% of a British sample with organic upper gastrointestinal disorders had consulted an alternative health provider.38 It has been shown that consultations with alternative practitioners often occur in association with medical consultation.39, 40 Over one third of British people who consulted alternative practitioners in 1980/81 were simultaneously seeking advice from medical practitioners for the same problem.39 In the present study, the majority of dyspeptics who consulted a non-medical health practitioner also consulted a medical practitioner about their dyspepsia. It is likely that many doctors are unaware that patients are consulting other practitioners as patients are reluctant to divulge such information to their doctor.41 Few dyspeptics in this study sought care only from a non-medical practitioner.
The results identified the characteristics of dyspeptics who had adopted the four patterns of consulting behaviours. The most common patterns were not to consult (37%) or only to consult medical practitioners (34%). Compared to dyspeptics in all, or most other consulting groups, those who had only consulted doctors tended to be older, have a moderate number of symptoms, have poorer overall physical health but better mental health and be more satisfied with their medical care. Subjects who had consulted both types of practitioners were similar to those who had consulted only doctors, in their poor physical health. They had the highest number of symptoms of any group, poorer mental health than group M and were more dissatisfied with their medical care. These last three factors probably contributed to their decision to seek non-medical care, although it is impossible to say which were causes or effects and for which subjects. The dissatisfaction which group M + N members expressed about their medical management was not reflected in the timing of either their initial or recent medical consultations, which were no different than those of group M. Consultation with the two types of practitioners seems to have occurred concurrently, although further investigation is needed as to the inter-relationships of multiple consultations. Overall, poor physical health as measured by the SF12 and number of dyspepsia symptoms, is associated with consultation with a medical practitioner, although the average severity of symptoms, an imprecise measure of total discomfort which a dyspeptic is experiencing, does not.
Dyspeptics who only sought non-medical care tended to be younger and have better overall physical health than groups M and M + N. They had fewer symptoms than group M + N, but more than those who did not consult. Non-medical consulters’ mental health was poorer than those in group M. Their overall physical health, which was better than that of groups M and M + N, may have contributed to their not seeking medical care. However, their psychological symptoms (as suggested by their poorer mental health) may have led them to regard non-medical care as more appropriate. People in group M + N consulted more types of non-medical health practitioner than did those in group N. There was no evidence that group N favoured more alternative type practitioners, such as naturopaths, or that group M + N preferred practitioners from professions more allied to medicine, such as pharmacists.
Those who did not consult resembled those who consulted non-medical practitioners only in their younger age and better physical health. Their mental health status did not differ significantly from that of any of the other groups and they had fewer dyspepsia symptoms than all other groups. Their failure to consult may be largely due to the fact that they did not have as many dyspepsia symptoms as groups M and M + N and that they had better physical health than was the case in groups M and M + N. Both groups N and NO may change their consulting behaviour over time. A prospective study of people with dyspepsia could examine the history of their consulting behaviour.
The results of a 1981 British survey of alternative health practitioners supported the stereotype of young people and women as those who seek alternative health care.39 In that survey, alternative practitioners reported that two-thirds of their patients were young or middle-aged women.39 In the current study, dyspeptics who consulted both medical and non-medical practitioners (group M + N) were of similar age and sex to those who only consulted doctors. However, the small group N comprised the youngest group in our study. Verhoef et al., in their study of gastrointestinal out-patients, found no significant differences in socio-demographic factors or health status in those who had consulted alternative practitioners and those who had not done so.18 That study did not separate alternative consulters into those who consulted these practitioners alone and those who also consulted a medical practitioner, which may explain their failure to observe differences apparent in the present study.
Little is known about the effectiveness or otherwise of alternative therapies in treating dyspepsia symptoms. There is randomized controlled trial evidence that acupuncture produces a significant decrease in sham feeding stimulated acid output.42 Yet such evidence of the effectiveness of acupuncture to accelerate ulcer healing is not available.43 As more and more patients seek out alternative health care, investigation into the potential benefits of such treatments is warranted. There also needs to be investigation into why dyspeptics decide to consult practitioners of all types. What help do they consider they receive from non-medical practitioners? How satisfied are they with the help they receive? Will they have ongoing consultations with these practitioners? It may be that while alternative practitioners are not able to offer more effective treatments for patients’ symptoms, their holistic approach, including listening to, validating and addressing patients’ concerns about their symptoms and the impact that these have on patients’ quality of life, is of therapeutic value.