Walters V
Soc Sci Med. 1984;19(8):811-21. doi: 10.1016/0277-9536(84)90398-8.
Company doctors have been criticized for poor standards of care and bias towards their employers interests. This paper reports on interviews with 24 company doctors in the province of Ontario, Canada. It uses company doctors' accounts of their work and careers to highlight aspects of corporate medicine which may help to produce questionable standards of care and present obstacles to doctors' attempts to increase their legitimacy. Apparent variations in the quality of care in contract practice and full-time employment in a company are discussed and it is suggested that greater attention may need to be devoted to improving the standards of care in smaller companies. Patterns of recruitment, doctors' beliefs about the changing nature of occupational medicine, as well as contradictory definitions of the proper sphere of occupational medicine may also have an effect on standards of care and the degree of legitimacy accorded to company doctors. The responses of doctors to charges of bias are discussed and it is suggested that they may neglect the major reason for such charges--that they are employed by companies and are thereby constrained to favour their employers' interests. The paper proposes the need for further research on standards of occupational medical care, whether these vary with respect to context of practice and whether there are appreciable differences in standards of practice among doctors employed by companies, unions, universities and government. Modest proposals for future health policy are also indicated.
公司医生因医疗护理标准不高以及偏袒雇主利益而受到批评。本文报道了对加拿大安大略省24名公司医生的访谈情况。文章利用公司医生对其工作和职业经历的描述，突出企业医疗中可能导致可疑医疗护理标准的方面，以及给医生提升其合法性的努力带来障碍的方面。文中讨论了合同制医疗服务以及在公司全职工作中护理质量明显存在的差异，并指出可能需要更加关注提高小公司的医疗护理标准。招聘模式、医生对职业医学不断变化的性质的看法，以及职业医学适当领域相互矛盾的定义，也可能影响医疗护理标准以及赋予公司医生的合法性程度。文中讨论了医生对偏见指控的回应，并指出他们可能忽略了此类指控的主要原因——他们受雇于公司，因此不得不偏袒雇主的利益。本文提出有必要进一步研究职业医疗护理标准，这些标准是否因执业环境而异，以及受雇于公司、工会、大学和政府的医生在执业标准上是否存在明显差异。文中还提出了对未来卫生政策的适度建议。
