Abstract:
OBJECTIVE:On the basis of emerging research evidence, this review aims to discuss the importance of the context surrounding the doctor-patient encounter for the success of treatment. DESIGN AND SETTING:Discussion paper based on placebo-nocebo and pain studies conducted in the western world. MAIN OUTCOME MEASURES:Literature-based theory about impact of communication elements on seriousness of symptoms in clinical practice. RESULTS:The therapeutic outcome seems to be impacted by rituals around a clinical encounter and by the doctor patient communication and relation. A warm, friendly and empathic attitude is crucial in the first contact with the practice and during the consultation as it influences the patient's perceived outcome. It is important to raise positive expectations when discussing the prognosis, conducting treatment and prescribing medications as the effect may be reduced if the physician expresses doubt about the effectiveness of the medication. Additionally, overly focus on side effects in the doctor-patient conversation about proposed treatments seems to influence the magnitude of perceived side effects in the patient. Thus, shared decision-making might be a desirable tool for ensuring better expectations in the patient and successful symptom relief. CONCLUSIONS:The context of the doctor-patient interplay matters. Placebo-nocebo research provides strong evidence for this link. The therapeutic context induces biomedical processes in the patient's brain that may enhance or reduce the effects of chosen interventions. The context thus works as a drug, with real effects and side effects. KEY POINTS Increased awareness of the context drug may help GPs alleviate symptoms and better motivate patients for treatment. Treatment is affected by multiple types of context, as also confirmed by placebo-nocebo research. The therapeutic context influences the biomedical processes, which may enhance or reduce intervention effects on symptoms. The impact of context should be considered in daily general practice as it may serve as a drug, with real effects and side effects.
journal_name
Scand J Prim Health Carejournal_title
Scandinavian journal of primary health careauthors
Lucassen P,Olesen Fdoi
10.1080/02813432.2016.1249065subject
Has Abstractpub_date
2016-12-01 00:00:00pages
428-433issue
4eissn
0281-3432issn
1502-7724journal_volume
34pub_type
杂志文章,评审abstract::Background: Despite the potential benefits of physician-staffed Helicopter Emergency Medical Service (HEMS), many dispatches to primary HEMS missions in Norway are cancelled before patient encounter. Information is sparse regarding the health consequences when medically indicated HEMS missions are cancelled and the pa...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813432.2019.1608056
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:Feasibility of comparing risk profiles by questionnaire of participants and nonparticipants in a cervical screening programme: does asking information on sexual behaviour by means of a questionnaire lead to high non-response? is the non-response selective (related to participation in the screening) and if so ...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439409003700
更新日期:1994-09-01 00:00:00
abstract:OBJECTIVE:To develop a valid and reliable assessment tool able to measure quality of communication, patient safety and efficiency in out-of-hours (OOH) telephone triage conducted by both general practitioners (GP) and nurses. DESIGN:The Dutch KERNset tool was translated into Danish and supplemented with items from oth...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813432.2019.1568712
更新日期:2019-03-01 00:00:00
abstract::This study which focused on the 169 approved certificates for patients applying for the right for "free" medication in a sickness insurance district during one year in Finland shows two interesting findings. These, cannot of course be generalized because of the low number of observations and of doctors involved (total...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438409017717
更新日期:1984-11-01 00:00:00
abstract::This study explores the diagnostic process of general practitioners confronted with ill-defined and ambiguous complaints, which eventually appeared to be caused by a malignancy. Three aspects were rated: (a) the adequacy of the initial problem definition; (b) the carefulness of further diagnostic methods; and (c) how ...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438909103670
更新日期:1989-03-01 00:00:00
abstract::Insulin resistance was evaluated in 807 middle-aged subjects at a health survey, with use of an index measured in 75 g oral glucose tolerance tests. The mean value of insulin resistance was higher in a hypertensive group than among the normotensives, independent of body mass index, physical activity, smoking sex, age,...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439109026582
更新日期:1991-03-01 00:00:00
abstract:OBJECTIVE:Cluster headache (CH) may cause excruciating pain and not all patients get satisfactory help. Patient dissatisfaction with general practitioners (GPs) and neurologists, and use of complementary and alternative treatment (CAM) may reflect this. The authors studied patient satisfaction with doctors' treatment a...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813432.2014.944410
更新日期:2014-09-01 00:00:00
abstract:OBJECTIVE:To study the distribution of prenatal and postnatal risk factors for sudden infant death syndrome (SIDS). DESIGN:A questionnaire-based survey for SIDS risk factors; family interviews were performed among the parents of SIDS victims and symptom-free infants. SETTING:The survey was conducted in paediatric pri...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134301316982414
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:Self-rated health (SRH) measures one's current general health and is a widely used health indicator. Sleep problems, somatic health complaints, and unmet needs in interpersonal relationships are suspected to influence SRH, but studies in primary health care settings are sparse. OBJECTIVE:To examine the asso...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813432.2018.1499590
更新日期:2018-09-01 00:00:00
abstract::Objective: To examine health service (HS) utilization profiles among a non-depressive population and patients with depressive symptoms (DS) with and without clinical depression. Design, subjects and setting: The study population was based on primary care patients with DS scoring ≥10 in the 21-item Beck Depression Inve...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813432.2019.1639904
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVE:To assess the effect on referral rate when GPs are given a better opportunity to send their patients to specialists for consultation. DESIGN:Intervention study with a control group. SETTING AND SUBJECTS:A 34-month experiment in the City of Turku. The experimental group consisted of 10 GPs working in municip...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134301750235295
更新日期:2001-06-01 00:00:00
abstract::Ten study populations sampled from a total of 86 communities in a rural Ethiopian area, have been registered and followed for a period of four years. A baseline census revealed a median age of 15 years, a literacy rate of 24%, poor housing and environmental conditions, and low utilization of the existing health care f...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439209014061
更新日期:1992-09-01 00:00:00
abstract:OBJECTIVE:To analyse the relation of ethnicity, social deprivation (Underprivileged area, UPA-score), social class V, unemployment and overcrowding on age- and sex-standardized mortality ratio (SMR). DESIGN:This ecological study used the SMR for people under the age of 65 years as dependent variable. Mortality data fo...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439608997075
更新日期:1996-06-01 00:00:00
abstract:OBJECTIVE:To investigate the association between serum total cholesterol and all-cause mortality in elderly individuals aged > or = 75 years. Design. A prospective cohort study with a six-year follow-up. SETTING AND SUBJECTS:A random sample (n = 700) of all persons aged > or = 75 years living in Kuopio, Finland. After...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813432.2010.487371
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:To study factors of importance for participation in parental education within routine child health care. DESIGN:All parents of children born during 1 year were invited by the district nurse to participate in parental education; their participation during the infant year was registered. SETTING:Catchment are...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813430310000555
更新日期:2003-03-01 00:00:00
abstract:OBJECTIVE:To investigate the prevalence of headache and its association with lifestyle among schoolchildren and to test an intervention programme. DESIGN:A cross-sectional survey of all pupils in the school who were asked to complete a questionnaire about headache and lifestyle factors. SETTING:School health care at ...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134301750235349
更新日期:2001-06-01 00:00:00
abstract::The clinical set-up in primary health care, with a specially trained nurse, a dietician, and a chiropodist under the supervision of general practitioners and giving patient education high priority, is evaluated after ten years in practice. Of the 391 patients cared for, 352 had non-insulin-dependent diabetes mellitus,...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813439008994925
更新日期:1990-03-01 00:00:00
abstract:OBJECTIVE:To explore the negative predictive value (NPV), positive predictive value (PPV), sensitivity, and specificity of natriuretic peptides, cut-off levels, and the impact of gender and age in elderly patients with systolic heart failure (HF). DESIGN:Cross-sectional exploratory study. SETTING:One primary healthca...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813430903345074
更新日期:2010-03-01 00:00:00
abstract:OBJECTIVE:Low plasma (p)-albumin and p-calcium concentrations are associated with increased mortality in hospitalised patients. There are few studies addressing this in primary care. Low p-calcium has been associated with mortality, but it is not known whether this applies to p-albumin. Could p-albumin and p-calcium be...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813432.2020.1843809
更新日期:2020-12-01 00:00:00
abstract:OBJECTIVE:The aim was to analyse differences between female and male general practitioners (GPs) in health status and lifestyle and compared with the general population in health-related quality of life. DESIGN:A simple random sample of 1004 GPs from the whole of Sweden (71.2%) participated in a survey in May 1996 abo...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134399750002692
更新日期:1999-06-01 00:00:00
abstract:OBJECTIVE:Patient-provider relationships with primary care and need for hospitalisations are related within the complex networks comprising healthcare. Our objective was to analyse mean days hospitalised, using registration status (active or passive listing) with a provider and number of consultations as proxies of pat...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813432.2018.1499514
更新日期:2018-09-01 00:00:00
abstract::Descriptions of twenty different clinical situations, most of which included cancer related symptoms and signs, were assessed by 329 patients. The patients showed a satisfactory level of alertness in response to the clinical situations. Lumps and bumps and visible bleeding gave the quickest response. An inverse relati...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438709013987
更新日期:1987-05-01 00:00:00
abstract::A Regional Health University is planned at the University of Linköping, Sweden. To evaluate new educational principles, a trial project was carried out in which medical and nursing students trained together in a two-week full-time course aimed at patient-oriented clinical social medicine and epidemiological field work...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438509013940
更新日期:1985-09-01 00:00:00
abstract::A substantial proportion of GPs' patients are women who suffer from "unexplained" pain conditions, often from the musculoskeletal system. Few medical findings are revealed, although the symptoms lead to extensive suffering and disability. Two experienced Swedish GPs, Katarina Hamberg and Eva E Johansson, took their ow...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134398750002945
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:To determine which treatment strategy offers the most cost-effective option in managing acute sinusitis. DESIGN:The modelling procedure included five clinical strategies, varying from "wait and see for a week", to "prescribing antibiotics selectively" to "prescribing antibiotics immediately" and to "performi...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/028134301300034729
更新日期:2001-03-01 00:00:00
abstract::The present study investigates the feasibility of the clinical differentiation between patients with beta-haemolytic streptococcal pharyngitis from those with pharyngitis caused by other agents, based on the patients' symptoms, symptom duration, and the clinical findings. Twenty-four general practitioners recruited 22...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813438809009320
更新日期:1988-11-01 00:00:00
abstract:OBJECTIVE:To describe the management of dyslipidaemia in patients with high risk of cardiovascular disease (CVD) and patients with a history of CVD identified by screening for diabetes in general practice in Denmark, concentrating on prescription of lipid-lowering drugs. Moreover, to analyse predicting factors for star...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.3109/02813430903335216
更新日期:2010-03-01 00:00:00
abstract::The Swedish trial in old patients with hypertension was initiated by the Swedish League against Hypertension. It will be conducted as a prospective multicentre study in Swedish primary health care, and will comprise approximately 2 000 patients on active treatment and 2 000 on placebo to be studied for three years. Th...
journal_title:Scandinavian journal of primary health care
pub_type: 临床试验,杂志文章
doi:10.3109/02813438609014824
更新日期:1986-09-01 00:00:00
abstract:OBJECTIVE:To compare how newly initiated treatment with benzodiazepines, Z-hypnotics or both associates with the reception of disability pension among 40,661 individuals of a working age. DESIGN:Prescription register study. SETTING:Norwegian nationwide prescriptions socio-economic and disability status data. METHODS...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813432.2017.1358436
更新日期:2017-09-01 00:00:00
abstract:OBJECTIVE:Consultation time has a serious impact on physicians' work and patient satisfaction. No systematic study of consultation time in general practice in Slovenia has yet been carried out. The aim of the present study was to measure consultation time, to identify the factors influencing it, and to study the influe...
journal_title:Scandinavian journal of primary health care
pub_type: 杂志文章
doi:10.1080/02813430701760789
更新日期:2008-01-01 00:00:00