Occupational Health, Northern Health and Social Care Trust, Antrim Hospital, Antrim BT41 2RL, Northern Ireland, UK.
School of Nursing and Midwifery, Queen's University Belfast, University Road, Belfast BT7 1NN, Northern Ireland, UK.
Soc Sci Med. 2014 Apr;107:52-60. doi: 10.1016/j.socscimed.2014.01.044. Epub 2014 Jan 31.
In this paper, we use qualitative research techniques to examine the role of general practitioners in the management of the long-term sickness absence. In order to uncover the perspectives of all the main agents affected by the actions of general practitioners, a case study approach focussing on one particular employment sector, the public health service, is adopted. The role of family physicians is viewed from the perspectives of health service managers, occupational health physicians, employees/patients, and general practitioners. Our argument is theoretically framed by Talcott Parsons's model of the medical contribution to the sick role, along with subsequent conceptualisations of the social role and position of physicians. Sixty one semi-structured interviews and three focus group interviews were conducted in three Health and Social Care Trusts in Northern Ireland between 2010 and 2012. There was a consensus among respondents that general practitioners put far more weight on the preferences and needs of their patients than they did on the requirements of employing organisations. This was explained by respondents in terms of the propinquity and longevity of relationships between doctors and their patients, and by the ideology of holistic care and patient advocacy that general practitioners viewed as providing the foundations of their approach to patients. The approach of general practitioners was viewed negatively by managers and occupational health physicians, and more positively by general practitioners and patients. However, there is some evidence that general practitioners would be prepared to forfeit their role as validators of sick leave. Given the imperatives of both state and capital to reduce the financial burden of long-term sickness, this preparedness puts into doubt the continued role of general practitioners as gatekeepers to legitimate long-term sickness absence.
在本文中，我们使用定性研究技术来考察全科医生在管理长期病假方面的作用。为了揭示所有主要代理人对全科医生行为的看法，我们采用了一种案例研究方法，重点关注一个特定的就业领域，即公共卫生服务。家庭医生的角色从卫生服务管理者、职业健康医生、员工/患者和全科医生的角度来看待。我们的论点是从塔尔科特·帕森斯（Talcott Parsons）的医学对病态角色的贡献模型以及随后对医生的社会角色和地位的概念化理论框架出发的。在 2010 年至 2012 年期间，在北爱尔兰的三个健康和社会保健信托基金中进行了 61 次半结构化访谈和 3 次焦点小组访谈。受访者一致认为，全科医生比雇佣组织更看重患者的偏好和需求。受访者用医生和患者之间关系的接近度和长久性以及全科医生认为是其治疗患者方法基础的整体护理和患者倡导理念来解释这一点。全科医生的方法受到管理者和职业健康医生的负面看待，而受到全科医生和患者的更积极看待。然而，有一些证据表明，全科医生愿意放弃他们作为病假有效证明人的角色。鉴于国家和资本都有减少长期病假经济负担的迫切需要，这种准备工作对全科医生作为合法长期病假的把关人的持续作用提出了质疑。
