Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, UK.
BMJ Qual Saf. 2011 Jun;20(6):515-21. doi: 10.1136/bmjqs.2010.048173. Epub 2011 Mar 7.
BACKGROUND The authors aimed to determine US and UK doctors' professional values and reported behaviours, and the extent to which these vary with the context of care. METHOD 1891 US and 1078 UK doctors completed the survey (64.4% and 40.3% response rate respectively). Multivariate logistic regression was used to compare responses to identical questions in the two surveys. RESULTS UK doctors were more likely to have developed practice guidelines (82.8% UK vs 49.6% US, p<0.001) and to have taken part in a formal medical error-reduction programme (70.9% UK vs 55.7% US, p<0.001). US doctors were more likely to agree about the need for periodic recertification (completely agree 23.4% UK vs 53.9% US, p<0.001). Nearly a fifth of doctors had direct experience of an impaired or incompetent colleague in the previous 3 years. Where the doctor had not reported the colleague to relevant authorities, reasons included thinking that someone else was taking care of the problem, believing that nothing would happen as a result, or fear of retribution. UK doctors were more likely than US doctors to agree that significant medical errors should always be disclosed to patients. More US doctors reported that they had not disclosed an error to a patient because they were afraid of being sued. DISCUSSION The context of care may influence both how professional values are expressed and the extent to which behaviours are in line with stated values. Doctors have an important responsibility to develop their healthcare systems in ways which will support good professional behaviour.
作者旨在确定美国和英国医生的专业价值观和报告行为,并确定这些价值观和行为在多大程度上因护理环境而异。
1891 名美国医生和 1078 名英国医生完成了调查(分别为 64.4%和 40.3%的回复率)。多变量逻辑回归用于比较两项调查中相同问题的回答。
英国医生更有可能制定实践指南(82.8%的英国医生 vs 49.6%的美国医生,p<0.001)和参与正式的医疗错误减少计划(70.9%的英国医生 vs 55.7%的美国医生,p<0.001)。美国医生更有可能同意需要定期重新认证(完全同意 23.4%的英国医生 vs 53.9%的美国医生,p<0.001)。近五分之一的医生在过去 3 年中直接接触过有缺陷或不称职的同事。在医生未向相关当局报告同事的情况下,原因包括认为有人正在处理该问题、认为不会因此发生任何事情,或担心报复。英国医生比美国医生更有可能认为应始终向患者披露重大医疗错误。更多的美国医生报告说,他们没有向患者披露错误,因为他们担心被起诉。
护理环境可能会影响专业价值观的表达方式以及行为与规定价值观的一致性程度。医生有责任以支持良好专业行为的方式发展他们的医疗保健系统。