McAllister Ashley, Leeder Stephen R
Department of Public Health Sciences, Karolinska Institutet, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
Menzies Centre for Health Policy, Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia. Email.
Aust Health Rev. 2018 Aug;42(4):475-480. doi: 10.1071/AH16092.
Objective The aim of the present study was to describe how policy makers (bureaucrats and politicians) in Australia and Ontario (Canada) perceive evidence provided by doctors to substantiate applications for disability income support (DIS) by their patients with mental illnesses. Because many mental illnesses (e.g. depression) lack diagnostic tests, their existence and effects are more difficult to demonstrate than most somatic illnesses. Methods Semi-structured interviews were conducted with 45 informants, all influential in the design of the assessment of DIS programs. The informants were subcategorised into advocates, legal representatives, doctors (general practitioners (GPs) and specialists (e.g. psychiatrists)), policy insiders and researchers. Informants were found through snowball sampling. Following the principles of grounded theory, data collection and analysis occurred in tandem. Results Informants expressed some scepticism about doctors' evidence. Informants perceived that doctors could, due to lack of diagnostic certainty, 'write these things [evidence] however [they] want to'. Psychiatrists, perceived as having more time and skills, were considered as providing more trustworthy evidence than GPs. Conclusion Doctors, providing evidence to support applications, play an important role in determining disability. However, policy makers perceive doctors' evidence about mental illnesses as less trustworthy than evidence about somatic illnesses. This affects decisions by government adjudicators. What is known about the topic? Doctors (GPs and psychiatrists) are often asked to provide evidence to substantiate a DIS application for those with mental illnesses. We know little about the perception of this evidence by the policy makers who consider these applications. What does this paper add? Policy makers distrust doctors' evidence in relation to mental illnesses. This is partly because many mental illnesses lack diagnostic proof, in contrast with evidence for somatic conditions, where the disability is often visible and proven through diagnostic tests. Furthermore, GPs' evidence is considered less trustworthy than that of psychiatrists. What are the implications for practitioners? Although doctors' evidence is often required, the utility of their evidence is limited by policy makers' perceptions.
目的 本研究旨在描述澳大利亚和安大略省（加拿大）的政策制定者（官僚和政治家）如何看待医生提供的证据，这些证据用于证实其患有精神疾病的患者申请残疾收入支持（DIS）的理由。由于许多精神疾病（如抑郁症）缺乏诊断测试，它们的存在和影响比大多数躯体疾病更难证明。方法 对45名受访者进行了半结构式访谈，他们都在DIS项目评估设计中具有影响力。受访者被细分为倡导者、法律代表、医生（全科医生（GPs）和专科医生（如精神科医生））、政策内部人士和研究人员。通过滚雪球抽样找到受访者。遵循扎根理论的原则，数据收集和分析同步进行。结果 受访者对医生的证据表示出一些怀疑。受访者认为，由于缺乏诊断确定性，医生“可以随心所欲地撰写这些东西（证据）”。被认为有更多时间和技能的精神科医生，其提供的证据比全科医生更值得信赖。结论 医生提供支持申请的证据，在确定残疾方面起着重要作用。然而，政策制定者认为医生关于精神疾病的证据不如关于躯体疾病的证据值得信赖。这影响了政府裁决者的决策。关于该主题已知的情况是什么？医生（全科医生和精神科医生）经常被要求提供证据，以证实患有精神疾病者的DIS申请。我们对考虑这些申请的政策制定者对该证据的看法知之甚少。本文补充了什么？政策制定者不信任医生关于精神疾病的证据。部分原因是许多精神疾病缺乏诊断证据，这与躯体疾病的证据形成对比，躯体疾病的残疾通常是可见的，并通过诊断测试得到证实。此外，全科医生的证据被认为不如精神科医生的证据值得信赖。对从业者有何影响？尽管经常需要医生的证据，但其证据的效用受到政策制定者看法的限制。
