College of Health and Medicine, Australian National University, Canberra, Australia.
Emeritus Faculty, Centre for Educational Development and Academic Methods, Australian National University, Building 1c, 24 Balmain Crescent, Acton, 2601, Australia.
Health Care Anal. 2024 Sep;32(3):224-242. doi: 10.1007/s10728-024-00484-0. Epub 2024 May 23.
This study examined variation in medical practitioners' practice-based conceptions of what it means to be a doctor, based on interviews with 30 clinicians who were also medical educators. Participants included general practitioners, surgeons and physicians (non-surgical specialists). Participants were asked to draw a concept map of 'being a doctor', followed by semi-structured interviews using a phenomenographic research design. Three conceptions were identified, varyingly focused on (1) treating patients' medical problems; (2) maximising patients' well-being; and (3) maximising community health. Each conception was distinguished by variation in awareness of six underlying dimensions of being a doctor: (1) doctors' actions; (2) treatment success; (3) patients' actions; (4) patients' well-being; (5) community needs; and (6) social justice. Whilst all participants included dimensions 1 and 2 in their described practice, numerous participants did not include dimensions 3 and 4, i.e. did not take the patients' role and the impact of patients' psychosocial context into account in their practice. This is concerning, especially amongst medical educators, given the widely acknowledged importance of patient-centred care in medical practice. Similarly, only some of the participants considered community health needs and felt a broader social responsibility beyond their responsibility to individual patients. These findings highlight aspects of the medical profession that need to be further emphasised in medical training and continuing professional development.
本研究通过对 30 名既是临床医生又是医学教育者的从业者进行访谈，考察了他们在行医实践中对医生角色的理解的差异。参与者包括全科医生、外科医生和内科医生（非外科专家）。要求参与者绘制一幅“医生”的概念图，然后采用现象学研究设计进行半结构化访谈。确定了三种概念，它们分别侧重于：（1）治疗患者的医疗问题；（2）最大化患者的幸福感；（3）最大化社区健康。每种概念都以对医生角色的六个潜在维度的认识的差异为特征：（1）医生的行为；（2）治疗效果；（3）患者的行为；（4）患者的幸福感；（5）社区需求；（6）社会正义。虽然所有参与者都将维度 1 和 2 包含在他们的实践中，但许多参与者没有包括维度 3 和 4，即没有考虑到患者的角色和患者的心理社会背景对他们实践的影响。这令人担忧，尤其是在医学教育者中，因为患者为中心的医疗实践在医学实践中得到了广泛认可。同样，只有部分参与者考虑到了社区健康需求，并感到除了对个体患者的责任之外，还承担着更广泛的社会责任。这些发现突出了医学专业中需要在医学培训和继续教育中进一步强调的方面。
