Doctors should have a greater role in organising health services
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《英国医生杂志》
Doctors should be encouraged to engage in more open dialogue with the public and play a more active role in managing and designing health services, according to a UK report published last week that explored how doctors can maintain public confidence in their professionalism.
The report found that individual doctors were highly trusted by the public but that confidence in the profession as a whole had been undermined by recent scandals, including incompetence in paediatric heart surgery at Bristol (BMJ 2001;323:181), mass retention of children抯 organs by a pathologist at Alder Hey hospital (BMJ 2001;322:255), and the murder of more than 200 patients by a GP, Harold Shipman (BMJ 2002;325:181).
Broader challenges, including greater public access to health information, higher expectations of health care, government demands for more responsive public services, and performance targets meant that the traditional image of medical professionalism—"a selfless clinician, motivated by a strong ethos of service, equipped with unique skills and knowledge, in control of their work and practising all hours to restore full health to patients"—was outdated, the report argued.
The project, commissioned by the King抯 Fund, an independent charitable foundation which does health research and policy analysis, was based on a series of discussions between representatives from the medical profession, policy makers, government, health service managers, and patients?organisations.
The project concluded that many helpful changes had already been made, including reform of the doctors?regulatory body, the General Medical Council, and strategies to achieve closer work between doctors, patients, and the public.
But the project recommended action in three main areas to strengthen trust in the medical profession for the future—improving accountability to patients, developing ways of working that reflected this accountability, and doctors taking a lead in the design and management of health services.
The report suggested that the medical profession as a whole must take the lead in laying open professional dilemmas and highlighting conflicts of interest.
The author, Rebecca Rosen, fellow in health policy with the King抯 Fund and a GP in London, said, "To do this, doctors should enter into new alliances with patients; their representative groups; and, through media coverage and public debate, the wider public to identify how best to meet the complex interests that patients pursue."
For example, the report suggested that greater discussion might have helped reduce public concern about the ending of GPs?duty to provide out of hours cover. Patients?groups were not directly involved in the development of this policy, and a poll indicated that about a third of patients were unhappy with the arrangements.
GPs face a serious professional challenge in ensuring that the quality of out of hours services—now commissioned by primary care trusts—is sufficiently high to warrant handing over clinical responsibility of their registered patients each night, the report warned. More discussion at an early stage could have enabled the development of a service that was more acceptable to both doctors and patients.
The report also called for changes in the organisation of healthcare management to re-engage doctors in the improvement of health services and to develop better working relationships and more closely aligned objectives between clinical and non-clinical managers.
Coauthor Steve Dewar, director of development at the King抯 Fund, said, "Doctors, collectively and individually, need to acknowledge that being a doctor means taking responsibility not only for their own practice but for the wider system of which they are part. Quality, from the patient抯 view, is not only the work of one person but the system as a whole."(London Susan Mayor)
The report found that individual doctors were highly trusted by the public but that confidence in the profession as a whole had been undermined by recent scandals, including incompetence in paediatric heart surgery at Bristol (BMJ 2001;323:181), mass retention of children抯 organs by a pathologist at Alder Hey hospital (BMJ 2001;322:255), and the murder of more than 200 patients by a GP, Harold Shipman (BMJ 2002;325:181).
Broader challenges, including greater public access to health information, higher expectations of health care, government demands for more responsive public services, and performance targets meant that the traditional image of medical professionalism—"a selfless clinician, motivated by a strong ethos of service, equipped with unique skills and knowledge, in control of their work and practising all hours to restore full health to patients"—was outdated, the report argued.
The project, commissioned by the King抯 Fund, an independent charitable foundation which does health research and policy analysis, was based on a series of discussions between representatives from the medical profession, policy makers, government, health service managers, and patients?organisations.
The project concluded that many helpful changes had already been made, including reform of the doctors?regulatory body, the General Medical Council, and strategies to achieve closer work between doctors, patients, and the public.
But the project recommended action in three main areas to strengthen trust in the medical profession for the future—improving accountability to patients, developing ways of working that reflected this accountability, and doctors taking a lead in the design and management of health services.
The report suggested that the medical profession as a whole must take the lead in laying open professional dilemmas and highlighting conflicts of interest.
The author, Rebecca Rosen, fellow in health policy with the King抯 Fund and a GP in London, said, "To do this, doctors should enter into new alliances with patients; their representative groups; and, through media coverage and public debate, the wider public to identify how best to meet the complex interests that patients pursue."
For example, the report suggested that greater discussion might have helped reduce public concern about the ending of GPs?duty to provide out of hours cover. Patients?groups were not directly involved in the development of this policy, and a poll indicated that about a third of patients were unhappy with the arrangements.
GPs face a serious professional challenge in ensuring that the quality of out of hours services—now commissioned by primary care trusts—is sufficiently high to warrant handing over clinical responsibility of their registered patients each night, the report warned. More discussion at an early stage could have enabled the development of a service that was more acceptable to both doctors and patients.
The report also called for changes in the organisation of healthcare management to re-engage doctors in the improvement of health services and to develop better working relationships and more closely aligned objectives between clinical and non-clinical managers.
Coauthor Steve Dewar, director of development at the King抯 Fund, said, "Doctors, collectively and individually, need to acknowledge that being a doctor means taking responsibility not only for their own practice but for the wider system of which they are part. Quality, from the patient抯 view, is not only the work of one person but the system as a whole."(London Susan Mayor)