Doctor for patients or doctor for society? Comparative study of GPs' and psychiatrists' assessments of clinical practice.

OBJECTIVE

To study general practitioners' (GPs') inclination to be the advocate of their patients or representatives of the society. The GPs' opinions were compared with those of psychiatrists.

DESIGN

A postal questionnaire with two case histories. Loyalty towards the social insurance or towards a patient in distress, and loyalty towards a patient seeking asylum or towards society were posited. The degree of distress and urgency of the patients' situation varied.

SUBJECTS AND SETTING

A random sample of Swedish GPs (n =167) and psychiatrists (n =112).

RESULTS

All doctors significantly changed their minds when asked to fake a psychiatric diagnosis compared with a somatic diagnosis. Compared with psychiatrists, general practitioners tend to be more pragmatic (p =0.016) and in addition female doctors in some cases in both groups seem to be more pragmatic (p =0.023). Good clinical practice seems to be of importance in both groups. If the patient's life is threatened doctors are, however, prepared to overrule their own professional interests. The interests of society seem not to have any strong support in either of the two groups or the two cases.

CONCLUSIONS

GPs as well as psychiatrists find it less improper to fake a psychiatric diagnosis than to fake a somatic. GP tends to be more pragmatic than psychiatrists and female doctors tend to be more pragmatic than male in both groups.