Fones C S, Kua E H, Goh L G
Department of Psychological Medicine, National University of Singapore, Singapore.
Singapore Med J. 1998 Dec;39(12):537-42.
The concept of the 'good doctor' was systematically studied by determining the view of doctors and non-physicians regarding the qualities and attributes of an ideal physician.
A list of characteristics of a good doctor was compiled from a Medline search, and from opinions generated by three focus groups (medical school academics, general practitioners and non-medical professionals). This was qualitatively categorised into five domains: 1. Cognitive, 2. Conative, 3. Emotional, 4. Interpersonal, and 5. Moral-ethical. An inventory comprising 25 statements, which reflected the most commonly and consistently identified characteristics was administered to 274 doctors and 400 members of the public. Each item was scored on a Likert scale (0 = not important, to 4 = absolutely essential).
The public regarded being 1. knowledgeable and 2. keeping up-to-date most important; physicians regarded being 1. honest and 2. responsible and trustworthy as the two most important items. There was significant difference (p < 0.001) between physicians 'and the public' item ratings for 13 of the 25 items. The public rated cognitive qualities most highly; the ethical domain was most important to doctors. Healthcare consumers were significantly more concerned than doctors about domains of emotional regulation, and communication. Overall, the two groups had strong agreement on the rank order of both items and domains (Spearman r, 0.88 and 0.91).
Medical education should inculcate the values and qualities desired by both the medical profession and public. Basic medical knowledge and reasoning are of prime importance; moral-ethical issues and communication skills should also be emphasised. Selection criteria for admission to medical school should also consider humanistic, non-cognitive traits.
通过确定医生和非医生对理想医生的品质和特质的看法,系统地研究“好医生”的概念。
从医学文献数据库检索以及三个焦点小组(医学院学者、全科医生和非医学专业人员)提出的意见中编制出一份好医生的特征清单。将其定性地分为五个领域:1. 认知领域;2. 意动领域;3. 情感领域;4. 人际领域;5. 道德伦理领域。向274名医生和400名公众发放了一份包含25条陈述的问卷,这些陈述反映了最常被一致认同的特征。每个项目采用李克特量表评分(0 = 不重要,至4 = 绝对必要)。
公众认为最重要的是1. 知识渊博和2. 与时俱进;医生则认为最重要的两项是1. 诚实和2. 负责且值得信赖。25个项目中有13个项目,医生和公众的项目评分存在显著差异(P < 0.001)。公众对认知品质的评分最高;伦理领域对医生最为重要。医疗消费者比医生更关注情绪调节和沟通领域。总体而言,两组在项目和领域的排序上有很强的一致性(斯皮尔曼相关系数r分别为0.88和0.91)。
医学教育应灌输医学专业和公众都期望的价值观和品质。基础医学知识和推理至关重要;道德伦理问题和沟通技巧也应得到强调。医学院校的录取选拔标准也应考虑人文、非认知特质。