Andersson Stig J, Lindberg Gunnar, Troein Margareta
The NEPI Foundation, Malmö, Lund University, Sweden.
Fam Pract. 2002 Dec;19(6):623-31. doi: 10.1093/fampra/19.6.623.
The ways that GPs treat depressed patients have been criticized in a number of studies.
To explore factors that shape how GPs work with depressed patients.
Seventeen GPs from the county of Orebro, Sweden participated in a qualitative semi-structured interview study. GPs' conceptions of factors shaping their way of working with depressed patients, especially continuing medical education (CME), commercial information, inter-collegial support, collaboration with psychiatrists and GPs' gender were recorded.
Private life experiences as well as professional experiences from family medicine were more often stressed as formative factors than university education and training in psychiatry. Groups of GPs discussisng the doctor-patient relationship set out from real cases (Balint groups) and CME groups were regarded as good forms of education. Most GPs considered company-sponsored lectures valuable. Commercial drug information was seen as more powerful than non-commercial information and GPs wished for more non-commercial information. Collaboration with psychiatry consultants was perceived as insufficient, and GPs felt a need for more inter-collegial support. Traditional female qualities were generally seen as advantageous in the work with depressed patients.
Many GPs consider personal qualities and experiences, including those of gender, to be more influential than academic education and professional literature. This reflects a preference for individual 'tacit knowledge'. Although tacit knowledge is indispensable in consultations, the low priority given to theoretical CME may make GPs less inclined to make optimal use of different therapeutic alternatives and also less critical of commercial marketing. CME on depression should start with GPs' individual tacit knowledge and assume a more independent stance from the drug industry.
多项研究批评了全科医生治疗抑郁症患者的方式。
探讨影响全科医生治疗抑郁症患者方式的因素。
来自瑞典厄勒布鲁县的17名全科医生参与了一项定性半结构化访谈研究。记录了全科医生对影响其治疗抑郁症患者方式的因素的看法，特别是继续医学教育（CME）、商业信息、同行间支持、与精神科医生的合作以及全科医生的性别。
与大学精神病学教育和培训相比，私人生活经历以及家庭医学的专业经历更常被强调为形成性因素。从实际案例出发讨论医患关系的全科医生小组（巴林特小组）和继续医学教育小组被视为良好的教育形式。大多数全科医生认为公司赞助的讲座很有价值。商业药物信息被认为比非商业信息更有影响力，全科医生希望获得更多非商业信息。与精神科顾问的合作被认为不足，全科医生感到需要更多同行间支持。传统女性特质通常被视为在治疗抑郁症患者的工作中具有优势。
许多全科医生认为个人特质和经历，包括性别方面的特质和经历，比学术教育和专业文献更具影响力。这反映了对个人“隐性知识”的偏好。尽管隐性知识在诊疗中不可或缺，但对理论性继续医学教育的低重视程度可能使全科医生不太倾向于充分利用不同的治疗选择，对商业营销的批判性也较低。关于抑郁症的继续医学教育应以全科医生的个人隐性知识为起点，并在制药行业面前保持更独立的立场。
