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Apr 12, 1986 - As a national system for providing medical care, the NHS is still very good. 255 (50) ..... special health authorities, and professional bodies.
BRITISH MEDICAL JOURNAL

VOLUME 292

1025

12 APRIL 1986

TALKING POINT Doctors' attitudes, medical philosophy, and political views RICHARD E WAKEFORD, LYNNE ALLERY In 1981 Harris illustrated the existence of medical specialty stereotypes in the minds of medical students.' For example, on starting and when leaving the medical course students categorised surgeons as "domineering and arrogant" and psychiatrists as "emotionally unstable." Such persistent stereotypes may well play a part in specialty choice, a subject on which we are conducting research. But are the stereotypes reflected-and thus possibly generated-by differences in attitudes and orientations exhibited by doctors in different specialties? To examine this question, we undertook a study of the attitudes of selected groups of doctors towards some current moral and practice issues. Some of these were known to be controversial among doctors, and thus should show differences between specialties if such exist. We also asked doctors about their political orientation and philosophy of medical practice.

Method A questionnaire was developed and pilot tested with the aid of local medical colleagues. It comprised 12 attitude items, and to each of these respondents were invited to tick one of: "agree"; "tend to agree"; "no opinion/mixed feelings/don't know"; "tend to disagree"; or "disagree." Five of these items related to medicomoral matters, such as surrogate motherhood, six related to practice issues-for example, the desirability of a limited list of drugs in general practice-and one was an attitude item used in a previous study to discriminate between doctors with a humanistic medical philosophy and those with a technological one. "a The questionnaire finally asked the respondent to give his or her specialty, to indicate his age, and, to set his views in context, to classify his political outlook. It took the form of a sheet of card, perforated vertically down the centre, with the questions on the left and the response spaces on the right. On completion the side containing the responses was detached and then formed a reply paid postcard. Three main samples of potential respondents were drawn from pages of the Medical Directory. Using random number tables to select the pages, the first doctor listed in each of the following three categories was picked: (a) consultant physicians (including medical subspecialties); (b) consultant surgeons (including surgical subspecialties); and (c) identifiable general practitioners, or those with no stated specialisation-in this case, that they were general practitioners was checked by reference to local family practitioner committee lists.

Cambridge University School of Clinical Medicine, Cambridge CB2 2QQ RICHARD E WAKEFORD, MA, senior research associate LYNNE ALLERY, MA, research assistant Correspondence to: Mr Wakeford, Clinical School Offices, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ.

The size of each of these samples was 200. In addition and by a similar method two further, smaller samples of 75 doctors each were drawn from (d) those listed as consultant psychiatrists (this to relate to earlier work undertaken on this specialty); and (e) women doctors in any specialty, or none (this to gain an indication of the views of an important group of doctors who would inevitably form a small proportion of the other samples). Doctors with foreign or evident accommodation addresses were excluded. To make the sample representative of established, working senior doctors, only those who qualified between 1943 and 1972 were included. The questionnaire was mailed with a covering letter on 18 February 1985. To encourage responses from doctors who might be away-for example, on holiday-no return date was indicated. No follow up was attempted because of the anonymous nature of the study. Analysis took place after two months: the X2 test was used for the analysis of categorical and ordinal data with a confidence level of 2%.

Results Five hundred and seven completed questionnaires were returned. Ten further ones were returned marked "dead" (two), "gone away" (six), or "not applicable-retired" (two). Excluding these, the overall response rate from living, practising, locatable doctors was an acceptable 69%. This did not vary markedly between the groups of doctors. Table I shows the doctors' responses to the six items relating to practice issues. There were no important differences between groups on four of the items-those concerning contingency planning for the acquired immune deficiency syndrome (AIDS), the adequacy of doctors' training in communication skills, transfer of patient care to the community, and the efficacy of the National Health Service as a system of medical care. Differences in response to the limited list item arose out of a somewhat lower enthusiasm for the proposal from the general practitioners compared with hospital doctors, but each specialty group was at least three to one in favour. The significant difference on the final item-whether being a doctor was a rewarding occupation-was accounted for by a slightly less fulsome agreement with the proposition from the general practitioners and psychiatrists. (In this and the other tables percentages are rounded off.) Responses to the moral issues are presented in table II. On only one of these were there significant differences between the groups of doctors-on the justification for the loss of animal life in pharmaceutical research. Surgeons were strongest in support, while general practitioners, psychiatrists, and women doctors were less firm in their views-but each group, overall, strongly supported this

proposition. A comparison of the medical philosophy of the groups of respondents is given in table III. Here, the percentages of each group giving the most extreme responses, "agree" or "disagree," to the attitude item "Scientific advances in medicine have led to a dehumanised attitude by some doctors towards patients" is given as an indication of this. Surgeons were the most firmly technological,

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BRITISH MEDICAL JOURNAL

VOLUME

292

12 APRIL 1986

TABLE I-Responses to practice issues. (Values are numbers (%) of responses) Statement

Some form of limited list of drugs in general practice is desirable (not necessarily the list presently being proposed)* Urgent contingency planning should be undertaken at local levels to contain a possible widespread outbreak of AIDS Medical students and doctors are not sufficiently trained in the skills of doctor-patient communication We should try to transfer yet more of the care of patients from the hospital to the GP's surgery and the community As a national system for providing medical care, the NHS is still very good Overall, I find being a doctor is a personally rewarding occupation**

Agree

Tend to agree

No opinion/mixed feelings/ don't know

Tend to disagree

Disagree

294(58)

119(23)

11 (2)

34 (7)

49 (10)

129 (25) 219 (43)

106(21) 147 (29) 41 (8)

104(21)

93(18) 71(14)

75(15) 29 (6)

197 (39) 255 (50) 427 (84)

133 (26) 167 (33) 56 (11)

61(12) 26 (5) 15 (3)

66 (13) 42 (8) 5 (1)

50(10) 17 (3) 4 (1)

Disagree

Significant differences between groups of doctors (specialties): *y2 =18 35, df=8, p