Chapple Alison, Campbell Stephen, Rogers Anne, Roland Martin
National Primary Care Research and Development Centre, The University of Manchester, UK.
Soc Sci Med. 2002 Apr;54(8):1215-24. doi: 10.1016/s0277-9536(01)00091-0.
Much emphasis is now being placed on the quality of medical care, and various ways are being developed to assess the medical knowledge of general practitioners. It is increasingly recognised that the users perspective on health care is important, and that the views of health care professionals do not and cannot represent patients' views. In order to explore whether or not a large-scale survey, which asked people to rate their doctors' medical knowledge, yielded meaningful results, this paper draws on findings from a study involving in-depth interviews with 26 lay people who had already completed the General Practice Assessment Survey questionnaire. When completing the questionnaires, patients had been asked to consider the 'technical care' provided by their general practitioners and to make a judgement about their doctors' medical knowledge. When interviewed at a later date, some people explained that they defined medical knowledge as knowledge of 'disease and treatments', while others defined it as knowledge of the 'whole person', and some defined a knowledgeable doctor as one who would acknowledge uncertainty. Patients appeared to have made judgements about their general practitioners' medical knowledge based on many factors, such as their experience of illness, perceptions of professional training, contact with other health care professionals in both primary and secondary care, and exposure to the media. The paper discusses the nature of medical knowledge, and concludes that although patient surveys are useful for the evaluation of interpersonal care and access to care, asking patients about their general practitioners' medical knowledge may yield invalid results. This is partly because patients defined medical knowledge in different ways, and partly because it appears that relatively few patients had enough knowledge about their own particular illnesses, or about possible alternative treatments, to make informed judgements about their general practitioners' medical knowledge.
现在人们非常重视医疗保健质量，并且正在开发各种方法来评估全科医生的医学知识。人们越来越认识到医疗保健使用者的观点很重要，而且医疗保健专业人员的观点并不能也无法代表患者的观点。为了探究一项要求人们对医生的医学知识进行评分的大规模调查是否产生了有意义的结果，本文借鉴了一项研究的结果，该研究对26位已经完成全科医疗评估调查问卷的非专业人士进行了深入访谈。在填写问卷时，患者被要求考虑全科医生提供的“技术护理”，并对医生的医学知识做出判断。在后续访谈中，一些人解释说他们将医学知识定义为“疾病与治疗”方面的知识，而另一些人将其定义为关于“整个人”的知识，还有一些人将知识渊博的医生定义为会承认不确定性的医生。患者似乎基于多种因素对全科医生的医学知识做出了判断，比如他们的患病经历、对专业培训的看法、在初级和二级医疗保健机构与其他医疗保健专业人员的接触以及对媒体的接触。本文讨论了医学知识的本质，并得出结论，尽管患者调查对于评估人际护理和获得护理的情况很有用，但询问患者关于他们全科医生的医学知识可能会产生无效结果。部分原因是患者对医学知识的定义各不相同，部分原因是似乎相对较少的患者对自己特定的疾病或可能的替代治疗有足够的了解，从而无法对全科医生的医学知识做出明智的判断。
