Chirayath Heidi Taylor
Bates College, Lewiston, Maine 04240, USA.
Health (London). 2006 Jul;10(3):259-82. doi: 10.1177/1363459306064477.
Using a national sample of 466 doctors, this work is the first to determine how sociodemographic characteristics, family lives, educational experiences and work environments combine over the life course to shape physician attitudes and behaviors toward serving the medically indigent. Survey data reveal that most physicians have positive experiences with indigent patients, and feel responsible for providing care for the needy. On average, one-quarter of doctors' patients are medically indigent, and physicians provide six hours of charity care per week. Multivariate regression and path analyses indicate that disparate social forces predict humanitarian attitudes and behaviors of physicians. Physician attitudes toward the indigent are shaped largely by socializing forces, including medical education and relationships with mentors. In contrast, care of indigent patients is driven by physician attitudes and by characteristics of medical practice such as specialty and practice setting. Implications for scholarship and for medical education, practice and health policy are discussed.
本研究以466名医生组成的全国性样本为对象，首次探究了社会人口特征、家庭生活、教育经历和工作环境如何在人生历程中相互作用，从而塑造医生对待贫困患者的态度和行为。调查数据显示，大多数医生与贫困患者接触的体验良好，并认为有责任为贫困患者提供医疗服务。平均而言，医生的患者中有四分之一是贫困患者，医生每周提供6小时的慈善医疗服务。多元回归分析和路径分析表明，不同的社会因素可以预测医生的人道主义态度和行为。医生对贫困患者的态度很大程度上受社会化因素影响，包括医学教育以及与导师的关系。相比之下，对贫困患者的医疗服务则由医生的态度以及医疗实践的特征（如专业和执业环境）所驱动。本文还讨论了该研究对学术研究、医学教育、医疗实践和卫生政策的启示。
