Nya utmaningar, gamla strategier - om distriktsläkares yrkesroll och attityder till samarbete

Abstract

Background: Being confronted by patients with incurable chronic and psychosocially complicated conditions constitutes one of the major challenges for today’s General Practitioners (GP). The traditional biomedical disease model is often insufficient. Furthermore, today’s patients are educated, self-assured and make demands. One feasible response would be for GPs to improve their knowledge of medical sociology, psychology and anthropology to enable them to handle the multidimensionality of the diseases. Another would be to share their responsibilities by collaborating with other professionals. Yet, the discussion of new strategies is quite uncommon among GPs; possibly because it is not a part of their professional role. Aims: To describe what GPs consider as the essence of their profession and their tasks (I). To understand why GPs’ are dubious about teamwork (II). To compare GPs’ and district nurses’ (DNs’) attitudes toward collaboration and to see if these attitude are influenced by gender, age and high professional self-esteem (III). To study whether medical students’ attitudes toward nurse-doctor collaboration are influenced by interprofessional training during their medical education (IV). Methods: Individual and focus-group interviews with experienced GPs were used (I-II). A simple random sample of 600 GPs and DNs were asked to answer two questionnaires, the Jefferson scale of attitudes towards collaboration between doctors and nurses ant the PSDF (III). The Jefferson questionnaire also was used for comparison of students’ attitudes towards collaboration at Gothenburg and Linköping Universities. The latter has had ongoing interprofessional training since 1986. Results: A major theme was the insecurity of GP’s in the professional role produced by the need to balance different perspectives; the humanistic position against the role of medical expert role, cure against care, short against long consultations, being the patient’s doctor against being the servant of society. Another major theme was the ambiguity of the doctor’s role as a team member and conflicts between seeing teamwork as a waste of time contra time-saving, sharing responsibility contra having everything under one’s control, medical expert contra generalist, and in becoming a learner contra being almighty. DNs seemed to have a more positive attitude towards collaboration and a higher self-esteem in their professional role than GPs. The attitudes of male and female and older and younger GPs respectively were the same. Nor was there any difference in attitudes towards collaboration between students who had or had not attended a special interprofessional training program during their medical education. Female students were more positive to collaboration than their male counterparts. Final year students were significantly less positive towards collaboration than their younger fellow students. Conclusions: One of the future major tasks for GPs is to reconcile the humanistic and the medical perspectives within health care. To be able to introduce teamwork it is necessary to consider GPs’ understanding of their professional role and to highlight the advantages. Training in interprofessional collaboration should start already during medical school. However, for medical students it seems more important to be accepted in their professional role than to collaborate with other health professionals.