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横断面探索巴瓦-加尔巴案对医生专业行为和对监管机构态度的影响。

Cross-sectional exploration of the impact of the Dr Bawa-Garba case on doctors' professional behaviours and attitudes towards the regulator.

机构信息

Research Department of Medical Education, University College London, London, UK

UCL Institute of Health Informatics, University College London, London, UK.

出版信息

BMJ Open. 2021 Aug 18;11(8):e045395. doi: 10.1136/bmjopen-2020-045395.

Abstract

OBJECTIVE

This paper examines the impact on doctors' attitudes towards the General Medical Council (GMC) and on professional behaviours (reflective practice and raising concerns) following the Dr Bawa-Garba case.

DESIGN

A cross-sectional survey designed using the theoretical lens of the theory of planned behaviour (TPB) was administered from September 2017 to February 2019. By chance, this coincided with critical events in the Dr Bawa-Garba case.

SETTING

Primary and secondary care settings across a broad geographical spread in England.

PARTICIPANTS

474 doctors.

OUTCOME MEASURES

Attitudes towards the GMC and two professional behaviours in TPB dimensions.

RESULTS

Attitudes towards the GMC became more negative during the period that the Medical Practitioners Tribunal Service and GMC suspended and subsequently erased Dr Bawa-Garba from the medical register. Specifically, confidence that doctors are well regulated by the GMC and that the GMC's disciplinary procedures produce fair outcomes was rated more negatively. After this period, overall attitudes start to recover and soon returned close to baseline; however, confidence in how the GMC regulates doctors and their disciplinary procedures improved but still remained below baseline. There was no change in doctors' attitudes or intention to reflect or raise concerns.

CONCLUSIONS

The lack of change in doctors' attitudes towards the GMC's guidance, the approachability of the regulator, defensive practice and professional behaviours as a response to the Dr Bawa-Garba case demonstrates the resilient and indelible nature of medical professionalism. At the time, professional bodies reported that repairing doctors' trust and confidence would take time and a significant effort to restore. However, this study suggests that attitudes are more fluid. Despite the high-profile nature of this case and concerns articulated by medical bodies regarding its impact on trust, the actual decline in doctors' overall attitudes towards the GMC was relatively short lived and had no measurable impact on professionalism.

摘要

目的

本文研究了在 Bawa-Garba 医生案之后,对医生对英国医学总会(GMC)的态度以及对专业行为(反思实践和提出关切)的影响。

设计

使用计划行为理论(TPB)的理论视角设计了横断面调查,并于 2017 年 9 月至 2019 年 2 月进行。巧合的是,这与 Bawa-Garba 医生案的关键事件同时发生。

地点

英格兰广泛地理区域的初级和二级保健机构。

参与者

474 名医生。

结果衡量标准

TPB 维度中对 GMC 的态度和两种专业行为。

结果

在医疗从业者法庭服务机构和 GMC 暂停并随后将 Bawa-Garba 医生从医疗登记册中删除的期间,对 GMC 的态度变得更加负面。具体而言,对医生受到 GMC 良好监管以及 GMC 的纪律处分程序产生公平结果的信心评价较低。在此期间之后,整体态度开始恢复,很快接近基线;然而,对 GMC 监管医生及其纪律处分程序的信心有所改善,但仍低于基线。医生的态度或反思或提出关注的意愿没有改变。

结论

医生对 GMC 指导、监管机构的可接近性、防御性实践以及对 Bawa-Garba 医生案的专业行为的态度没有改变,这表明医学专业精神具有弹性和不可磨灭的性质。当时,专业机构报告说,修复医生的信任和信心需要时间和大量努力才能恢复。然而,本研究表明,态度更为灵活。尽管此案备受关注,医学机构对其对信任的影响表示关注,但医生对 GMC 的整体态度实际上下降相对短暂,对专业精神没有可衡量的影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4412/8375764/580927ff8768/bmjopen-2020-045395f01.jpg

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