Kenny D, Adamson B
Faculty of Health Sciences, University of Sydney.
Aust Health Rev. 1992;15(3):319-34.
Medical dominance of health care has traditionally been the organising principle in health care delivery. Medical power is manifested through the professional autonomy of doctors, through their pivotal role in the economics of health services, through dominance over allied health occupational groups, through administrative influence, and through the collective influence of medical associations. Using Friedson's four factor definition of medical dominance, a structured interview schedule was developed to examine one aspect of medical dominance, that is, doctors' control over the allied health professions. Ninety interviews were carried out with a sample of nurses, physiotherapists, occupational therapists, speech pathologists and psychologists working in various health care settings in metropolitan Sydney, seeking their perceptions on the way in which the medical profession interacts with their occupational group. The findings indicate that a significant proportion (73%) of health professionals did not feel regarded as professional equals by doctors. Nor did they feel that doctors had an adequate knowledge and understanding of their professions (73%). However, the majority (74%) felt that they had sufficient autonomy and were able to discuss doctors' instructions and offer advice or suggestions to doctors. Length of service significantly contributed to perceptions of professional autonomy amongst allied health professionals. These results support the view that the increased autonomy of the allied health professions has not impinged on medical dominance in the health care delivery system. Recommendations for further research and the training of medical and allied health professionals are made.
医疗保健领域的医学主导地位传统上一直是医疗服务提供的组织原则。医学权力通过医生的职业自主权、他们在卫生服务经济中的关键作用、对相关健康职业群体的主导、行政影响力以及医学协会的集体影响力得以体现。运用弗里德森对医学主导地位的四因素定义，制定了一份结构化访谈提纲，以考察医学主导地位的一个方面，即医生对相关健康职业的控制。对悉尼大都市不同医疗环境中工作的护士、物理治疗师、职业治疗师、言语病理学家和心理学家样本进行了90次访谈，了解他们对医学专业与他们职业群体互动方式的看法。研究结果表明，相当比例（73%）的卫生专业人员认为医生没有将他们视为职业上的平等者。他们也觉得医生对他们的专业缺乏足够的了解（73%）。然而，大多数（74%）人觉得他们有足够的自主权，并且能够讨论医生的指示并向医生提供建议。服务年限对相关健康专业人员的职业自主权认知有显著影响。这些结果支持了这样一种观点，即相关健康职业自主权的增加并未对医疗服务提供系统中的医学主导地位产生影响。文中还提出了进一步研究以及医学和相关健康专业人员培训的建议。
