Non-physical territoriality in health care organizations in Iceland III

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Because of increasing number of GPs the last years they have taken over more and more tasks which other specialities had before. This has led to conflicts and debates about use of resources and groups of patients. A study was carried out in Gothenburg 1986 with the aim of developing and testing hypothesis on non-physical territoriality in health care organizations in Sweden. Similar studies have since been carried out in other Nordic countries. Questionnaires with 65 statements and some background variables were mailed to 185 physicians in seven specialities, in Iceland. The total response rate was 81,1%, ranging from 63% by pediatricians to 100% by GPs. Other specialities were: Gynaecologists, psychiatrists, oto-laryngologists, internists and geriatricians. Every specialist in question was included, except in intern medicine where the number were randomized. In this third paper one major hypothesis was tested: The members of a professional group want as big territoriality as possible for themselves. The results confirmed the theory. GPs (98%) support a demand of referral from the GP to another specialist. Other specialities are against it. GPs consider it riskier for the patient to consult »other specialists« first than to use the GP as the first contact-physician. Other specialities are ambivalent. GPs think that the primary care ought to be carried out mainly at health centres with only GPs employed full- time. Others favour more employing also »other specialists« full-time. Each speciality, except pediatrics, is against the idea of pediatricians as GPs for their clients. All groups of specialists are in favour of the GPs making home-calls. There is a considerable support for the idea that pediatricians, geriatricians, psychiatrists and other personnel from the geriatric and psychiatric clinics also make home-calls.Þessi grein er sú þriðja í röðinni af fimm sem fjalla um skoðanir lækna á starfssviðum sérgreina (1,2). Í fyrri greinum var hugtakið huglæg vallhöslun (non-physical territorial behaviour) skilgreint og sagt frá viðhorfum til heildrænnar yfirsýnar og óvinsælla viðfangsefna. Í þessari grein verður einkum skýrt frá afstöðu lækna til tilvísana og nauðsynjar þess að »stýra sjúklingaflæðinu«, til vitjana, hvort ráða eigi sérfræðinga aðra en heimilislækna í fullar stöður á heilsugæslustöðvar, hvort heimilislæknar séu að sinna verkefnum sem ættu frekar að vera í höndum sérfræðinga og öfugt