Læknablaðið - 15.09.1991, Blaðsíða 31

LÆKNABLAÐIÐ
271
Segja má að margar af þeim niðurstöðum
sem birtar hafa verið í þessari grein og hinum
fyrri í þessari rannsókn (1-4) hafi ekki komið
á óvart miðað við umræður og blaðaskrif
síðustu ára. Margar nýjar upplýsingar hafa
þó einnig komið upp á yfirborðið. Þetta
eru fyrstu tölulegu upplýsingamar um
skoðanaágreining lækna innan sérgreina og
við teljum að þær geti verið gagnlegar við
mótun heilbrigðisþjónustunnar á íslandi á
næstu árum.
ÞAKKIR
Rannsókn þessi var gerð með styrk frá
Rannsóknasjóði Háskóla íslands. Höfundar
vilja færa þátttakendum í könnuninni bestu
þakkir.
SUMMARY
Non-Physical Territoriality in Health Care
Organizations in lceland V.
During 1960 there was an expansion of
specialization and doctors working in hospitals in
Iceland. At the same time there was an increasing
lack of general practitioners (GP). In a report
from 1968 by a committee of the city council
of Reykjavik it was claimed that this evolution
was because of lack of status by GPs. After
1970, health authorities, The Icelandic Medical
Association and The Faculty of Medicine decided
to change this process by new legislation on
general practice, by building new health centers, by
establishing a chair at The Faculty of Medicine and
that vocational training in general practice could be
accepted as a speciality.
As planned and hopefully expected there was an
increase of young doctors who became specialists
in general practice. During the last decade
there was however much greater (and probably
unexpected) relative increase in the number of
specialists in other fields compared to that in
general practice. This background has led to
conflicts and debates between GPs and other
specialists on non-physical territoriality.
In 1986 a study was published by one of the
authors (LB) about non-physical territoriality in
the health care in Sweden. Similar studies were
later carried out in the other Nordic countries in
1988. This paper is the last of five subsequent
articles with the results from Iceland, dealing with
the questions of expansion of specialities, status of
general practice and health care programs.
A self-administrated questionnaire was mailed
to 185 physicians in seven specialities. Total
response rate was 81%. Many doctors, especially
oto-laryngologists were of the opinion that the
area of responsibility of general practice was
expanding at the expense of other specialities, and
this expansion would not be advantageous for the
patients. GPs disagreed on that opinion (p<0.001).
GPs themselves thought that their speciality had
a lower status than other specialities. General
agreement was on the statement that general
practice as a speciality would increase the status
of this discipline. Specialists in other disciplines
thought that it would increase the status of the
health centers if they were working there together
with GPs. The GPs were of the opposite opinion
(p<0.001) but agreed that such a cooperation
would not lower the status of the health centers!
73% of those who expressed their opinion agreed
that local health care programs, clarifying the
division of tasks between general practice and
other specialities were favourable regarding the
cooperation of these specialities.
We hope that this research on territoriality in
health care may lead to better understanding of the
behaviour and reactions of health care personnel
and advantage should be taken of these results in
the organization of health care in the future.
HEIMILDIR
1. Kristjánsson H, Sigurðsson JÁ, Magnússon G,
Berggren L. Skoðanir lækna á starfssviðum sérgreina
I. Læknablaðið 1990; 76; 295-8.
2. Kristjánsson H, Sigurðsson JÁ, Magnússon G,
Berggren L. Skoðanir lækna á starfssviðum sérgreina
II. Heildræn yfirsýn og óvinsæl viðfangsefni.
Læknablaðið 1990; 76: 329-33.
3. Kristjánsson H, Sigurðsson JÁ, Magnússon G.
Berggren L. Skoðanir lækna á starfssviðum sérgreina
III. Afstaða til tilvísana, heilsugæslu, sérfræðiþjónustu
og vitjana. Læknablaðið 1990; 76: 441-7.
4. Kristjánsson H, Sigurðsson JÁ, Magnússon G,
Berggren L. Skoðanir lækna á starfssviðum sérgreina
IV. Hverjir eiga að sjá um ákveðna sjúklingahópa og
heilsuvemd? Læknablaðið 1991; 77: 72-6.
5. Berggren L. Non-physical territoriality in health care
organizations. Doctoral Thesis. Department of Social
Medicine, Department of Environmental Hygiene,
University of Gothenburg 1986.
6. Læknisþjónustunefnd Reykjavíkur. Læknisþjónusta
utan sjúkrahúsa. Tillögur og greinargerð
Læknisþjónustunefndar Reykjavíkur. Apríl 1968.
7. Olafsson Ó, Haraldsson EÞ, Stefánsson JG, Jónsson
TÁ. Kennsla í heimilislækningum við læknadeild
Háskóla Islands. Læknablaðið 1977; 63: 167-74.
8. Bjamason Ö. Kennsla í heislugæzlugreinum.
Læknablaðið 1977; 63: 110-25.
9. Tómasson J. Plágan mikla. Læknablaðið/Fréttabréf
lækna 1990; 8 (6.tbl.): 4.
10. Handbók heilsugæslustöðva. Reykjavík:
Landlæknisembættið, 1984.