Falkum E, Førde R
The Research Institute, Norwegian Medical Association, Oslo.
Soc Sci Med. 2001 Jan;52(2):239-48. doi: 10.1016/s0277-9536(00)00224-0.
Sixteen statements on physician attitudes in the physician-patient relationship were presented to a representative sample of Norwegian physicians (N=990). Three moderately correlated theoretical dimensions were identified in a principal component analysis: paternalism, patient autonomy, and moral deliberation. The paternalism scores increased significantly with age, and psychiatrists scored significantly lower than physicians in somatic specialties. Psychiatrists had the highest scores on the patient autonomy dimension, whereas surgeons scored the lowest. Moral deliberation scores increased slightly with age. To explore the pattern of scores across the three dimensions, the scores were dichotomized and combined in eight different ways. The resulting typology included five different physician profiles: (1) classical paternalists (high scores on paternalism, low scores on both patient autonomy and moral deliberation), (2) modern paternalists (high scores on both paternalism and deliberation, low scores on patient autonomy), (3) autonomists ( high scores on patient autonomy, low scores on both paternalism and deliberation), (4) deliberationists (high scores on deliberation and patient autonomy, low scores on paternalism), and (5) ambivalents (high or low scores on all dimensions, or high or low scores on both paternalism and patient autonomy). The four groups of physicians with 'consistent' attitudes contained between 12 and 19% of the total sample, whereas 37% belonged to the 'ambivalent' group. Laboratory doctors and surgeons belonged significantly more often in the group of classical paternalists than did general practitioners, whereas male physicians were more often modern paternalists than were female physicians. Among the autonomists, women were more numerous than men, doctors in their 40s clearly more numerous than those in their 60s, and psychiatrists clearly more numerous than residents.
向挪威医生的一个代表性样本（N = 990）呈现了16条关于医患关系中医生态度的陈述。在主成分分析中确定了三个中度相关的理论维度：家长主义、患者自主性和道德审议。家长主义得分随年龄显著增加，精神科医生的得分显著低于躯体专科医生。精神科医生在患者自主性维度上得分最高，而外科医生得分最低。道德审议得分随年龄略有增加。为了探究三个维度得分的模式，将得分进行二分并以八种不同方式组合。由此产生的类型学包括五种不同的医生类型：（1）经典家长主义者（家长主义得分高，患者自主性和道德审议得分低），（2）现代家长主义者（家长主义和审议得分高，患者自主性得分低），（3）自主主义者（患者自主性得分高，家长主义和审议得分低），（4）审议主义者（审议和患者自主性得分高，家长主义得分低），以及（5）矛盾者（在所有维度上得分高或低，或在家长主义和患者自主性两者上得分高或低）。态度“一致”的四组医生占总样本的12%至19%，而37%属于“矛盾”组。实验室医生和外科医生比全科医生更常属于经典家长主义者组，而男性医生比女性医生更常是现代家长主义者。在自主主义者中，女性比男性多，40多岁的医生明显比60多岁的医生多，精神科医生明显比住院医生多。
