Medical professionalism among clinical physicians in two tertiary hospitals, China.

In order to investigate medical professional attitudes and behaviors in China and explore the influencing factors with a focus on hospital internal management, we developed a 13-item professional attitudes and 11-item behaviors inventory. Self-administered questionnaires were distributed to 390 physicians mainly in four specialties in two tertiary Chinese hospitals in 2011. 306 completed questionnaires were collected. More than 90% of respondents agreed with at least nine of the 13 specific statements about principles. However, responses on behaviors were not necessarily consistent with those on attitudes. 80.3% of respondents reported that they usually or always participated in quality improvement activities and 48.2% reported that they usually or always participated in peer evaluations of colleagues' quality of care. Some 47.8% had encountered incompetent colleagues and 17.7% had encountered significant medical errors caused by colleagues. Among those who had encountered incompetence or significant medical errors, almost two thirds had never reported their concerns to the hospital or other relevant authorities. Half of the physicians did not obtain enough continuing medical education credits. Physicians' professional reported behaviors were influenced by their personal and professional characteristics, professional attitudes, and assessment of hospital internal management constitutions. For example, participation in decision-making had a significant role in professional reported behaviors of protecting patient confidentiality, improving quality of care, and self-regulation, with those sometimes or often participating in decision-making indicating higher levels of reported behaviors than those who seldom participated (odds ratios: 1.84; 4.31, 2.44; 3.31). The results showed Chinese physicians demonstrated positive attitudes to professionalism principles. However, their reported behaviors were at times inconsistent with their attitudes, especially in the areas of competence, quality improvement, and self-regulation. One of effective strategies to facilitate Chinese physicians' professionalism may be to improving hospital management.