Culture de l'autonomie du médecin et du patient

Questionnaire par mail adressé à 120 généralistes Suédois tirés au sort, 82 réponses obtenues. Le questionnaire est centré sur les tensions ressenties entre plaire et écouter les patients, et préserver par ailleurs une conformité réglementaire et une autonomie de décision médicale. Il utilise deux mises en situation. 47 médecins ont répondu aussi à un entretien par téléphone.
Premier cas clinique : Male, 55 years old. Smoker. Financial manager. He is found to have hypertension (190/105 mmHg) at a medical check. Blood pressure control by the occupational health service shows diastolic BP of 100–105 mmHg. The patient is referred to your surgery but he has cancelled two scheduled appointments, he is very busy. You have called him by phone, but you only spoke to his secretary and you have not heard from him anymore.Will you as a physician continue offering him new appointments or try to get in contact with him in any other way?
Second cas Clinique : Female, 23 years old. Regular exerciser. Visited her GP 1 month ago, complaining of low back pain. Examination without neurological signs. Symptoms and physical findings as poor back muscle tonus. She was referred for physiotherapy. The patient calls you and ask for a referral for a lumbar MRT. A new and careful examination gives the same results as at the first examination, except for a minimal sensibility impairment laterally on the right foot. The patient insists on a referral for MRT, but you find no medical reason for such an examination. Will you as a physician refer the patient for a lumbar MRT?
Résultats : dans le premier cas, les médecins ont massivement refusé de continuer à aider ce patient, alors qu’ils ont finalement plutôt écouté le patient dans le second cas.