| Summary: | 博士 === 國立臺灣大學 === 健康政策與管理研究所 === 99 === Background
Public attitudes to doctors are changing. The professional image of physicians has been overshadowed by a series of scandals of malpractice and fraud. Leaders in medicine denounced these wrongdoings as examples of “deterioration in medical ethics” and “a destructive force that has shattered the reputation of physicians”. Physicians are no longer just health care workers as many aspired celebrity physicians strive to gain visibility and media exposure. In the meantime, the press is filled with negative stories about self-interest driven physicians. The white coat that symbolizes humanism and professionalism has seemingly been tainted.
How have the people’s perceptions of doctors have changed? Are doctors still well-respected life-saving professionals? The objective of this dissertation is to understand the change of professional image of physicians over time in Taiwan and whether it has been affected by the establishment of the National Health Insurance (NHI) program?
Method
Based on literature review, this thesis first identifies eight essential factors of physicians’ professional image, including competence, autonomy, dominance, authority, altruism, de-professionalization, corporatization and commercialization. Content analysis technique is then deployed to assess any change in physicians’ professional image over time, as well as before and after the inception of the NHI program, through examination of two types of media:
1. Newspapers: newspapers reflect the attitudes of the general public. Subjects of analysis include United Daily News, China Times, Liberty Times and Apple Daily. A sample of 1,372 reported stories between 1954 and 2009 was selected.
2. Medical Journal: Taiwan Medical Journal, published by the Taiwan Medical Association, was chosen to reflect physicians’ perspectives. A total of 52 articles of editorials or special reports between 1958 and 2009 were elected.
In addition to reporting descriptive statistics of frequency, topics, sources and length of the reports, a score between -10 to +10 is also given to each report based on its ratings on the eight factors of professional image.
Results
Altruism, autonomy, authority and competence are four of the most commonly identified factors of professional image among articles in the Taiwan Medical Journal. These four factors are also the key elements in the traditional definition of medical professionalism, which is typically recognized and associated with physicians’ professional image by both the public and physicians themselves. However, in contrast, competence, authority and altruism became less frequently mentioned in the newspapers.
Since the inception of the NHI, physicians’ professional image had drastically transformed. With respect to the frequency of discussion of the eight factors in the newspaper, except commercialization which had experienced a slight increase, the numbers of reports on other factors—competence, autonomy, dominance, authority, altruism, de-professionalization and corporatization were all declining, especially for altruism and competence. This suggests a significant impact of the NHI on the professional image of physicians.
On the other hand, the numbers of articles on competence, dominance and authority in the Taiwan Medical Journal had reduced after the implementation of the NHI, with competence having the most decrease. On the contrary, the numbers for autonomy, altruism, corporatization and commercialization had increased while that of de-professionalization remained the same. It has been suggested that the NHI has a critical effect on physicians’ professional autonomy, altruistic behavior, and commercialization, as well as the market concentration of medical institutions. Consequently, the numbers of related articles on these four factors also increased substantially in the medical journals.
Conclusion
For the general public, physicians are still very much competent, authoritative, life-saving professionals and the image has not shifted too much away from paternalism. However, the attitudes are changing as a result of the growing commercialization of health care, which raises concerns over the ethical implications of profit-seeking and self-interest driven medical practice. The NHI program may have also catalyzed the transformation of physicians’ professional image through its effect on the overall market. Medical educators and policy-makers must carefully consider these changes and their implications in their future planning of the health systems.
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