Long-term Doctor-patient Relationship Research Articles

How are people with obesity managed in primary care? - results of a qualitative, exploratory study in Germany 2022.

Counselling and management of overweight and obesity are tasks for which general practitioners possess favourable qualifications. Based on a long-term doctor-patient relationship, GPs have various options for actions to deal with overweight problems. To date, however, there is only little evidence on the experiences which people with obesity have made with the primary physician model and the care needs and wishes they actually address to their GPs. This study investigated what experiences people with obesity have had with GP care and what care needs and wishes they communicated to their GPs. The results will be used to derive starting points for optimising the primary healthcare setting. A total of 32 individuals affected by obesity were recruited over 24 online health forums. With them, we conducted qualitative interviews in the time between April and October 2022. The respondents considered the primary care physician to be the central contact person when they sought advice and support with weight problems. The advice of the GP was associated with an increased willingness to deal with reducing one's own weight. Despite this positive perception, widespread drawbacks existed from the perspective of the respondents: (1) incidental or late discovery of obesity, (2) absence of continuous weight counselling, (3) no agreement on specific weight reduction goals, (4) no referrals to help and support services, (5) insensitive discussion. Only some of the respondents who have recently been able to reduce their weight sustainably attributed their success primarily to the support they received from their GP. GPs should be encouraged to address obesity consistently and promptly. In addition, concrete recommendations and realistic goals for weight loss should be formulated. Continuous and motivating discussions are crucial in this regard. A focus on nutrition and exercise counselling in the GP's office should also be encouraged. GPs should be strengthened in their role as mediators by integrating their patients into a network of further assistance as needed. The development of care structures for obesity management should be promoted.

Barriers and opportunities for implementation of a brief psychological intervention for post-ICU mental distress in the primary care setting – results from a qualitative sub-study of the PICTURE trial

BackgroundThe results of critical illness and life-saving invasive measures during intensive care unit treatment can sometimes lead to lasting physical and psychological impairments. A multicentre randomized controlled trial from Germany (PICTURE) aims to test a brief psychological intervention, based on narrative exposure therapy, for post-traumatic stress disorder symptoms following intensive care unit treatment in the primary care setting. A qualitative analysis was conducted to understand feasibility and acceptance of the intervention beyond quantitative analysis of the main outcomes in the primary study.MethodsQualitative explorative sub-study of the main PICTURE trial, with eight patients from the intervention group recruited for semi-structured telephone interviews. Transcriptions were analysed according to Mayring's qualitative content analysis. Contents were coded and classified into emerging categories.ResultsThe study population was 50% female and male, with a mean age of 60.9 years and transplantation surgery being the most frequent admission diagnosis. Four main factors were identified as conducive towards implementation of a short psychological intervention in a primary care setting: 1) long-term trustful relationship between patient and GP team; 2) intervention applied by a medical doctor; 3) professional emotional distance of the GP team; 4) brevity of the intervention.ConclusionThe primary setting has certain qualities such as a long-term doctor-patient relationship and low-threshold consultations that offer good opportunities for implementation of a brief psychological intervention for post-intensive care unit impairments. Structured follow-up guidelines for primary care following intensive care unit treatment are needed. Brief general practice-based interventions could be part of a stepped-care approach.Trial registrationThe main trial was registered at the DRKS (German Register of Clinical Trials: DRKS00012589) on 17/10/2017.

GP strategies to avoid imaging overuse. A qualitative study in Norwegian general practice

Objectives The aim of the study was to identify general practitioners’ (GPs) strategies to avoid unnecessary diagnostic imaging when encountering patients with such expectations and to explore how patients experience these strategies. Design, setting and subjects We conducted a qualitative study that combined observations of consultations and interviews with GPs and patients. A total of 24 patients visiting nine different GPs in two Norwegian urban areas were included in the study. Of these, 12 consultations were considered suitable for studying GP strategies and were therefore selected for a more thorough analysis. Main outcome measures GPs’ communication strategies to avoid unnecessary medical imaging and patients’ experiences with such strategies. Results Five categories of strategies were identified: (1) wait and see – or suggest an alternative; (2) the art of rejection; (3) seek support from a professional authority; (4) partnership and shared decision-making and (5) reassurance, normalisation and recognition. The GPs often used multiple strategies. Factors related to a long-term doctor–patient relationship seemed to influence both communication and how both parties experienced the decision. Three important factors were evident: the patient trusted the doctor, the doctor knew the patient’s medical history and the doctor knew the patient as a person. The patients seemed to be generally satisfied with the outcomes of the consultations. Conclusion GPs largely combine different strategies when meeting patients’ expectations of diagnostic imaging that are not strictly medically indicated. Continuity of the doctor–patient relationship with good personal knowledge and trust between doctor and patient appeared crucial for patients to accept the doctors' decisions. Key points GPs usually combine a broad range of strategies to avoid unnecessary medical imaging The patients appeared generally satisfied regardless of the strategy the strategy used by the GPs and even where their referral request were rejected Factors related to a long-term doctor–patient relationship appeared decisive

LeiKA: an optional German general practice teaching project for first-semester medical students: who is taking part and why? A cross-sectional study

ObjectivesThis study investigates students’ adoption of LeiKA, a new extracurricular longitudinal general practice (GP) teaching project. LeiKA aims to attract a broad range of students, not only those who are...

‘I’ve put diabetes completely on the shelf till the mental stuff is in place’. How patients with doctor-assessed impaired self-care perceive disease, self-care, and support from general practitioners. A qualitative study

Objective: This paper investigated patients’ experiences of disease and self-care as well as perceptions of the general practitioner’s role in supporting patients with impaired self-care ability.Design: Qualitative interviews with 13 patients with type 2 diabetes, concurrent chronic diseases, and impaired self-care ability assessed by a general practitioner. We analyzed our data using systematic text condensation. The shifting perspectives model of chronic illness formed the theoretical background for the study.Results: Although most patients experienced challenges in adhering to recommended self-care activities, many had developed additional, personal self-care routines that increased wellbeing. Some patients were conscious of self-care trade-offs, including patients with concurrent mental disorders who were much more attentive to their mental disorder than their somatic diseases. Patients’ perspectives on diseases could shift over time and were dominated by emotional considerations such as insisting on leading a normal life or struggling with limitations caused by disease. Most patients found support in the ongoing relationship with the same general practitioner, who was valued as a companion or appreciated as a trustworthy health informant.Conclusion: Patient experiences of self-care may collide with what general practitioners find appropriate in a medical regimen. Health professionals should be aware of patients’ prominent and shifting considerations about the emotional aspects of disease. Patients valued the general practitioner’s role in self-care support, primarily through the long-term doctor-patient relationship. Therefore, relational continuity should be prioritized in chronic care, especially for patients with impaired self-care ability who often have a highly complex disease burden and situational context.Key points Little is known about the perspectives of disease and self-care in patients with a doctor-assessed impaired ability of self-care. • Although patients knew the prescribed regimen they often prioritized self-care routines that increased well-being at the cost of medical recommendations. • Shifting emotional aspects were prominent in patients’ considerations of disease and sustained GPs’ use of a patient-centred clinical method when discussing self-care. • Relational continuity with general practitioners was a highly valued support and should be prioritized for patients with impaired self-care.

Factors influencing the decision to pursue emergency medicine as a career among medical students in Singapore.

The introduction of the residency programme in Singapore allows medical students to apply for residency in their graduating year. Our study aimed to determine the interest levels and motivating factors for pursuing emergency medicine (EM) as a career among medical students in Singapore. A self-administered questionnaire was distributed to Year 1-5 medical students in 2012. Participants indicated their interest in pursuing EM as a career and the degree to which a series of variables influenced their choices. Influencing factors were analysed using multinomial logistic regression. A total of 800 completed questionnaires were collected. 21.0% of the participants expressed interest in pursuing EM. Perceived personality fit and having done an elective in EM were strongly positive influencing factors. Junior medical students were more likely to cite the wide diversity of medical conditions and the lack of a long-term doctor-patient relationship to be negative factors, while senior medical students were more likely to cite personality fit and perceived prestige of EM as negative factors. Careful selection of EM applicants is important to the future development of EM in Singapore. Our study showed that personality fit might be the most important influencing factor in choosing EM as a career. Therefore, greater effort should be made to help medical students explore their interest in and suitability for a particular specialty. These include giving medical students earlier exposure to EM, encouraging participation in student interest groups and using appropriate personality tests for career guidance.

Factors influencing career choice in otorhinolaryngology among medical students at King Abdulaziz University, Jeddah, Saudi Arabia

Background: Objective: The study was designed to investigate factors influencing career choice among medical students interested in Otorhinolaryngology (ORL) at Faculty of Medicine, King Abdulaziz University (KAU), Jeddah, Saudi Arabia. Methods: In this cross-sectional study, a total of 531 medical students participated. A questionnaire was used to collect the data. Data were analyzed using SPSS-16. Results: A total 531 participating medical students belonged to 4th, 5th, and 6th year. Two hundred twenty-one (41.6%) were interested in ORL specialty. Almost all of the students (95%) agreed that a patient’s ear, nose, throat, and head & neck health plays an important role in their overall health. The majority of the participants (68%) disagreed that that ORL is less important than other specialties. There were several reasons for selecting ORL as career choice such as: a secured and respected job (71%), well-paid job (63%), rewarding work, grateful patients (69%), opportunity to meet people of different age groups and various backgrounds (68%), a window into ordinary people’s everyday life (52%), comprehensive doctor-patient relationships (54%), versatile, challenging work (54%), and long-term doctor-patient relationships (58%). Conclusion: Overall participants’ responses were overwhelmingly positive to pursue a career in ORL specialty.

The experience of the long-term doctor-patient relationship in consultant nephrologists.

There is evidence to suggest that the long-term doctor-patient relationship is crucial in the management of chronic illness such as chronic kidney disease. While previous research has focused on patient views of the doctor-patient relationship, research exploring the doctor's experiences of this unique dynamic is lacking, leading to a gap in our understanding. Therefore, an enhanced appreciation of the experience of the doctor is important and could have potential implications for medical training and service organisation. In this paper, we report the first known study exploring the experience of consultant nephrologists in the long-term doctor-patient relationship. Seven male consultant nephrologists (mean age of 48 years) took part in semi-structured interviews, and data were analysed using interpretative phenomenological analysis (IPA). Three main themes were identified from the analysis: 'Defining my professional identity', 'Relating to the patient' and 'Coping with the job'. Participants had difficulty in defining their role as doctors, discussing themselves as being more than a doctor and comparing themselves with other medical specialties to help them define their identity. Although participants enjoyed forming long-term relationships with patients and the closeness this involved, they discussed the acute scenarios of saving lives as the most rewarding aspect of their job and used coping mechanisms that enabled them to remain detached in the relationship.

Corporate medicine is usurping the doctor-patient relationship in America

Not since the time of Hippocrates has the importance of the doctor-patient relationship been questioned. However, in the US a multitude of special interest groups - who benefit financially from the current system - continue to lobby for dismantling the long-term doctor-patient relationship in favor of a corporate model for health care delivery. More than even the teacher or the religious leader, the bears a responsibility that transcends pure financial gain. To understand how corporate, profit-driven medicine has evolved, one begins with the student entering medical school. Most incoming medical students are motivated to help others, but they quickly learn the consequences of putting the patient before the profit. In an academic position, one must bring in sufficient revenue to the university medical center or lose one's appointment; in private practice, one must be successful at both revenue generation and collection (dealing with dozens or more different insurance companies) or go bankrupt. The patient's health and welfare is virtually irrelevant to the doctor's economic survival. Doctors in the US are being bombarded by corporate influences on their relationship with their patients. Television, the internet and other media are increasingly used for direct-to-patient marketing of expensive new prescription drugs, devices, and surgical procedures. Poorly-informed patients may seek the who is willing to meet their demands rather than the who takes the time to educate the patient on the most effective treatment. Moreover, since health care insurance companies have no guarantee their insured patients will continue with their company, there is no incentive for doctors to pursue preventive care. Corporate medicine is replacing the primary family doctor - who follows the patient from infancy through adult life, both in and out of the hospital - with doc-in-the-box outpatient clinics and teams of hospitalist physicians. Both quality of care and cost of care suffer from this lack of continuity. A parallel development on both sides of the Atlantic has been limitation on the hours that physicians-in-training may work (both daily and weekly). Interestingly, the greatest push-back against these work hour limitations in the US has been from those in specialty training (e.g., neurosurgery) - the very people who it was argued are the most overworked. Neurosurgeons-in-training realize that neurosurgical disorders and their treatment do not adhere to a 9-to-5 schedule; these salaried physicians appear truly motivated to learn to provide the best care for their patients. Physician medical societies in the US have transformed their primary role over the past decade from continuing medical education to continuing financial education. From the American Medical Association (AMA) to state specialty medical societies (e.g., CANS - the California Association of Neurological Surgeons) to local physician organizations (e.g., SJSS - the San Jose (California) Surgical Society), political action committees (PACs) have been formed to solicit contributions from their physician members to support lobbyists in Washington DC and state capitols, and consultants have been hired who can advise their physician members on how to maximize their personal financial gain. Until doctors and patients demand major overhaul of the US health care system, the doctor-patient relationship - and the health of the entire country - will continue to suffer.

What do GPs actually know about their patients as persons?

Background and Aims: Life experience and existential circumstances have an impact on health. Within medicine, however, the significance to patient care of person-related, biographical knowledge receives only rudimentary emphasis and its substantial theoretical underpinnings are inadequately understood and infrequently applied. This study explores the types and extent of some Norwegian general practitioners’ (GPs’) person-related knowledge, exemplified by patients on the GPs respective lists who are currently in a state of frail health. Methods: Nine GPs were interviewed regarding 1 of their patients who had recently been admitted to the rehabilitation unit of a nursing home. Subsequent interviews with the individual patients served both to validate the GPs’ information and as a starting point for further inquiry into patient life stories. Interview transcripts were analyzed within a phenomenological-hermeneutical framework. Results: Most GPs were able adequately to characterize the personality of their patients and had acquired substantial knowledge about their occupation and closest family relationships. The GPs tended to have less knowledge regarding patients’ interests, hobbies, social network and their relationships to their parents and siblings. They had the least knowledge about patients’ childhood, upbringing and social background. Some GPs reacted with surprise or embarrassment when becoming aware of potentially significant “knowledge holes” regarding patients whom they had known for years. Conclusions and implications: We document limitations to healthcare professionals’ eliciting of knowledge about their patients as persons. A long-term doctor-patient relationship seems to enable GPs to identify and articulate their patients’ personal characteristics. It does not ensure that the GPs will accumulate knowledge regarding those biographical facts or experiences that, particularly during transitions to other caretakers, might prove most salient to their patients’ health and treatment. We believe the findings to have relevance both for clinical practice and medical education, but further research and reflection is needed before formal changes in current practice are to be recommended.

Early community-based family practice elective positively influences medical students’ career considerations – a Pre-post-comparison

BackgroundDemographic change and recruitment problems in family practice are increasingly threatening an adequate primary care workforce in many countries. Thus, it is important to attract young physicians to the field. The purpose of the present study was to examine the effect of an early community-based 28-h family practice elective with one-to-one mentoring on medical students’ consideration of family practice as a career option, their interest in working office-based, and several perceptions with regard to specific aspects of a family physician’s work.MethodsFirst- and second-year medical students completed questionnaires before and after a short community-based family practice elective, consisting of a preparatory course and a community-based practical experience with one-to-one mentoring by trained family physicians.ResultsWe found a significantly higher rate of students favoring family practice as a career option after the elective (32.7% vs. 26.0%, p = 0.039). Furthermore, the ranking of family practice among other considered career options improved (p = 0.002). Considerations to work office-based in the future did not change significantly. Perceptions regarding a family physician’s job changed positively with regard to the possibility of long-term doctor-patient relationships and treatment of complex disease patterns. The majority of the students described identification with the respective family physician tutor as a professional role model and an increased interest in the specialty.ConclusionsOur results indicate that a short community-based family practice elective early in medical education may positively influence medical students’ considerations of a career in family practice. Furthermore, perceptions regarding the specialty with significant impact on its attractiveness may be positively adjusted. Further research is needed to evaluate the influence of different components of a family practice curriculum on the de facto career decisions of young physicians after graduation.

Association of the Length of Doctor-Patient Relationship with Primary Care Quality in Seven Family Practices in Korea

Countries with historically unlimited patient choice of medical provider, such as Korea, have been promoting rational health care pathways. Factors related to the length of doctor-patient relationship (DPR) for enhancing primary care in those countries should be studied. Participants were patients who had visited their family practices on six or more occasions over a period of more than 6 months. Five domains (21 items) of the Korean Primary Care Assessment Tool (first contact, coordination function, comprehensiveness, family/community orientation, and personalized care) and general questions were administered in the waiting rooms. From seven practices, the response rate was 83.7% (495/591). The older the age, the lower the income, the shorter the duration of education, the more the number of diseases the patients had, and in provincial cities rather than in Seoul, the longer length of DPR ( ≥ 4 yr) was shown. The long-term DPR was associated with total primary care quality score (upper [ ≥ 71.4] vs lower [ < 71.4], OR, 1.74; 95% CI, 1.10-2.76), especially with coordination function (OR, 1.01; 95% CI, 1.00-1.02), being adjusted for confounding variables. Strengthening the coordination function may have to be the first consideration in primary care policy in countries like Korea.

Teaching the value of continuity of care: A case conference on long-term healing relationships.

The Continuity Case Conference provides a model for teaching family medicine residents the value, importance, and impact of developing long-term doctor-patient relationships. A resident's presentation of challenging patient cases and the ensuing group interaction with resident peers, faculty, and medical staff are designed to offer residents alternate perspectives on complex, multiproblem cases while validating the often emotional process of patient care. This learning model is designed to demonstrate how a physician, in the context of the cumulative progression of contacts with a patient, can better manage myriad health issues, chronic and acute, and improve patient outcomes. The description of the 1-hr, once-a-month conference format contained herein includes details on preconference preparation, examples.

Challenges in the management of patients with medically unexplained symptoms in Poland: a qualitative study

Patients with medically unexplained symptoms (MUS) are highly prevalent in primary care. There are no guidelines for treatment and management of this group of patients in the Polish health care system and the establishment of a long-term doctor-patient relationship, which is the crux of the therapy, is impeded. To establish what challenges Polish GPs encounter while dealing with patients with MUS. A thematic analysis of 4 focus groups (14 GPs altogether), using a three-level coding of data. Three main themes surfaced in the analysis: negative emotions among the investigated GPs, their insufficient training in the management of patients with MUS and the lack of guidelines and the influence of the changed health care environment on the management of patients with MUS. Four major influences of the changed health care environment emerged: GPs' negative image as professionals, barriers to building a continuous doctor-patient relationship, limited resources and limited access to specialists and lack of a multidisciplinary primary care team. Treatment and management of patients with MUS should make provision for a personalized approach to the patient within the Polish primary health care system. This can be enhanced by providing additional training in the biopsychosocial model during medical education and establishing a GP multidisciplinary team. Allocating increased financial resources for primary health care and facilitating access to psychologists and psychotherapists could also prove beneficial.

A gender-specific evaluation of a care-oriented curricular change in a Dutch medical school

Background: Patients with chronic diseases need doctors who have the appropriate skills to maintain a long-term doctor–patient relationship with an orientation towards care rather than cure and focused on the patient's role in managing their condition. As the number of chronically ill patients is rising, medical education has to develop and evaluate instructional formats to prepare future doctors to provide care tailored to these patients.Aim: To examine the possibly gender-specific effects on students’ orientations of a patient-oriented programme.Methods: Three consecutive cohorts of third-year medical students at least twice completed the Ideal Physician questionnaire, which measures care versus cure orientation. Two cohorts participated in a care-oriented curriculum intervention, the third cohort did not. Analysis of variance was used to examine trends in the students’ orientation.Results: Starting from a rather neutral care-cure orientation, a small but consistent trend towards increased cure orientation was found, which was unaffected by the educational intervention. Female students were more patient centred (p = 0.00) but became increasingly cure oriented.Conclusion: Our programme was unable to curb the increased cure orientation in students. In addition to appropriate health-care innovations, other or more intensive curricular interventions are probably needed to serve the current and the future influx of chronically ill patients.

Achieving the AAAs of Ambulatory Care: Aptitude, Appeal, and Appreciation

In the current health care environment more patient care has moved from in-hospital care to the ambulatory primary care settings; however, fewer internal medicine residents are pursuing primary care careers. Barriers to residents developing a sense of competency and enjoyment in ambulatory medicine include the complexity of practice-based systems, patients with multiple chronic diseases, and the limited time that residents spend in the outpatient setting. In an effort to accelerate residents' ambulatory care competence and enhance their satisfaction with ambulatory practice, we sought to change the learning environment. Interns were provided a series of intensive, focused, ambulatory training sessions prior to beginning their own continuity clinic sessions. The sessions were designed to enable them to work confidently and effectively in their continuity clinic from the beginning of the internship year, and it was hoped this would have a positive impact on their perception of the desirability of ambulatory practice. Improvement needs assessment after a performance, so we developed a structured, competency-based, multidisciplinary curriculum for initiation into ambulatory practice. The curriculum focused on systems-based practice, patient safety, quality improvement, and collaborative work while emphasizing the importance of continuity of care and long-term doctor-patient relationships. Direct observation of patient encounters was done by an attending physician to evaluate communication and physical examination skills. Systems of care commonly used in the clinic were demonstrated. Resources for practice-based learning were used. The immersion of interns in an intensive, hands-on experience using a structured ambulatory care orientation curriculum early in training may prepare the intern to be a successful provider and learner in the primary care ambulatory setting.

It's all about recognition! Qualitative study of the value of interpersonal continuity in general practice.

BackgroundContinuity of care has traditionally been regarded as a core quality of general practice, but the long-term doctor-patient relationship has been put under pressure. In many places practices are expanding, with larger teams and more registered patients, thereby threatening the possibility of patients staying with their own general practitioner (GP). GPs often take it for granted that interpersonal continuity is valuable. However, little is known about how patient satisfaction is related to interpersonal continuity. The purpose of this study is to explore the creation of patient satisfaction or dissatisfaction in the interpersonal relation with the GP, and in a comprehensive way to investigate how this is related to continuity of care.MethodsQualitative study based on 22 interviews with patients from two practices in Denmark. A total of 12 patients saw a regular doctor and 10 saw an unfamiliar doctor. The patients were selected after an observed consultation and sampled purposefully according to reason for encounter, age and sex. Interpretative phenomenological analysis (IPA) was used to study how patients perceive meeting either a regular or an unfamiliar GP. The analysis explored the patients' perception of their interpersonal relationship with their GP, and interpreted the accounts by using social psychological theories.ResultsA long-term continuous relationship with the GP could be satisfactory, but it could also be the reverse. The same pattern was shown in case of an unfamiliar GP. Therefore, patient satisfaction and interpersonal continuity were not causally related. On the contrary, there was a general pattern of how the satisfactory and trustful doctor-patient relationship from the patients' point of view could be created, maintained or destroyed. A pattern where the process of recognition, by respecting and remembering, on the one hand created and maintained satisfaction while humiliation on the other hand destroyed satisfaction in the relationship.ConclusionIt was not valuable to have a continuous relationship unless the GP recognized the patient. The social psychological concept of recognition had two different meanings and the GP had to do both, respect and remember the patient, in order to create and sustain the trustful relationship. The added value of interpersonal continuity had to be combined with recognition.

Digital Afterthoughts on Single Sign-on Technology

Digital Afterthoughts on Single Sign-on Technology

Medical family: a new view of the relationship between chronic dialysis patients and staff arising from discussions about advance directives.

Journal of Women's Health & Gender-Based MedicineVol. 8, No. 9 Medical Family: A New View of the Relationship between Chronic Dialysis Patients and Staff Arising from Discussions about Advance DirectivesRICHARD D. SWARTZ and ERICA PERRYRICHARD D. SWARTZSearch for more papers by this author and ERICA PERRYSearch for more papers by this authorPublished Online:8 May 2009https://doi.org/10.1089/jwh.1.1999.8.1147AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byTHE EXPERIENCE OF THE LONG-TERM DOCTOR-PATIENT RELATIONSHIP IN CONSULTANT NEPHROLOGISTS17 September 2014 | Journal of Renal Care, Vol. 41, No. 2The Performance of Dialysis Care: Routinization and Adaptation on the FloorHealth Communication, Vol. 22, No. 2Palliative careAmerican Journal of Kidney Diseases, Vol. 43, No. 1 Volume 8Issue 9Nov 1999 To cite this article:RICHARD D. SWARTZ and ERICA PERRY.Medical Family: A New View of the Relationship between Chronic Dialysis Patients and Staff Arising from Discussions about Advance Directives.Journal of Women's Health & Gender-Based Medicine.Nov 1999.1147-1153.http://doi.org/10.1089/jwh.1.1999.8.1147Published in Volume: 8 Issue 9: May 8, 2009PDF download

One doctor's 25-year experience of beta-blocker treatment to the same group of hypertensive women

To assess the importance of long-term doctor-patient relationship, and to assess the effect of long-term treatment with beta-blockers of hypertensive women. A 25-year follow-up study of hypertensive women, compared with participants in a prospective population study of women of the same age. Gothenburg, Sweden. 57 hypertensive women and 1462 participants in the population study. The women's blood pressure was well-controlled over the years, and no serious side-effects occurred. There was no increased mortality in these groups of hypertensive women compared with women in the general population of the same age. The favourable effects over the years with respect to the management of blood pressure and survival indicate the beneficial effect of a stable doctor-patient relationship and the beneficial long-term effect of beta-blockers as a base for antihypertensive treatment.