Bagshaw Philip, Barnett Pauline
Clinical Associate Professor, University of Otago, Christchurch.
Health Sciences Centre, University of Canterbury, Christchurch.
N Z Med J. 2017 Dec 1;130(1466):83-89.
Physician advocacy occurs when doctors speak up for the health and healthcare of patients and communities. Historically, this was strong in some Western countries with doctors finding that it enhanced their authority, prestige and power. But it weakened in the 20th century when the biomedical model of heath triumphed and medicine became a dominant profession. In the second part of the 20th century, this dominance was threatened by political, technological and socioeconomic forces. These weakened medicine's state support, brought it under managerial control and undermined the social contract on which trust between doctors and the community was based. Defence of the profession was assumed by medical colleges, societies and associations. They had some success in retaining professional autonomy but did not undertake open advocacy, particularly on social justice issues, and did not therefore enhance their standing in the community. Opinion is divided on the level of advocacy that it is ethically proper for the medical profession to employ. Some contend doctors should only advise authorities when expert opinion is requested. Others contend doctors should speak out proactively on all health issues, and that collective action of this type is a hallmark of professionalism. This lack of consensus needs to be debated. Recent developments such as clinical leadership have not revitalised physician advocacy. However, continued deterioration of the UK National Health Service has led some English medical colleges to take up open advocacy in its defence. It is to be seen whether medical colleges elsewhere follow suit, as and when their healthcare systems are similarly threatened.
当医生为患者和社区的健康及医疗保健发声时，就会出现医生倡导行为。从历史上看，这种情况在一些西方国家较为突出，医生们发现这提升了他们的权威、声望和权力。但在20世纪，随着生物医学健康模式取得胜利且医学成为主导专业，这种情况有所减弱。在20世纪后半叶，这种主导地位受到政治、技术和社会经济力量的威胁。这些力量削弱了医学所获得的国家支持，将其置于管理控制之下，并破坏了医生与社区之间信任所基于的社会契约。对该专业的捍卫由医学院校、学会和协会承担。它们在保留专业自主权方面取得了一些成功，但没有进行公开倡导，尤其是在社会正义问题上，因此也没有提升它们在社区中的地位。对于医学专业在伦理上应采用何种程度的倡导，存在不同意见。一些人认为，只有在被要求提供专家意见时，医生才应向当局提供建议。另一些人则认为，医生应该就所有健康问题积极发声，而且这种集体行动是专业精神的一个标志。这种缺乏共识的情况需要进行辩论。诸如临床领导力等近期发展并未重振医生倡导行为。然而，英国国家医疗服务体系的持续恶化已导致一些英国医学院校为捍卫它而采取公开倡导行动。其他地方的医学院校在其医疗保健系统受到类似威胁时是否会效仿，还有待观察。
