{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:12:25Z","timestamp":1791465145570,"version":"4.3.4"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T00:00:00Z","timestamp":1571270400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T00:00:00Z","timestamp":1571270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"St. George's Masonic Lodge Fund of St. Mary's Hospital Foundation Montreal","award":["none"],"award-info":[{"award-number":["none"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Fam Pract"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Communication and behavior within doctor - patient encounters have been examined using varied techniques; however the nature of unsolicited writings from patients to their family doctors has rarely been reported. This paper therefore aimed to explore the content of, and motivation for, such correspondence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>One hundred and\u00a0seven writings to one family physician about care provided during a four decade period were considered. Univariate analyses were used to identify features of patients or family members who wrote personalized notes to the doctor, when, and in what fashion. A hermeneutic approach helped look at the content of the notes, the specific words or sentiments used to describe encounters or care received, and possible motivations for writing. Iterative review of words or phrases generated themes which summarized appreciated physician or relational attributes, as well as motivations for writing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Notes were mostly handwritten, predominantly by women, and frequently coinciding with holidays and life span events. Appreciated doctor characteristics and behaviors were (1) quality care; and physician (2) competence; (3) physical presence; (4) positive personal traits; (5) provision of emotional support; and (6) spiritual impact. Motivations for writing were grouped as desire to (1) express appreciation for an established relationship; (2) acknowledge value \/ benefit experienced from continuity of care; (3) seek catharsis, emotional relief or closure; (4) reflect on termination of care; (5) validate care that incorporates both Hippocratic tradition and Asklepian healing; and (6) share personal reflection, experience, or impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Unsolicited writings provide personalized links from patients to physicians, expressing thoughts perhaps difficult to share face to face. They offer potential as teaching tools about the content of doctor-patient relationships; for example, the writers studied expressed appreciation for quality continuity care that was competent, considerate, and supportive of emotional and spiritual needs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12875-019-1024-6","type":"journal-article","created":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T10:59:24Z","timestamp":1571309964000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Use of patients\u2019 unsolicited correspondence to a family doctor to describe and understand valued components of a doctor-patient relationship: A Hermeneutics approach"],"prefix":"10.1186","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5488-1972","authenticated-orcid":false,"given":"Mark J.","family":"Yaffe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard B.","family":"Hovey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charo","family":"Rodriguez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,10,17]]},"reference":[{"issue":"9","key":"1024_CR1","first-page":"796","volume":"49","author":"M Stewart","year":"2000","unstructured":"Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, et al. The impact of patient-centred care on outcomes. J Fam Pract. 2000;49(9):796\u2013804.","journal-title":"J Fam Pract"},{"key":"1024_CR2","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1136\/bmj.323.7318.908","volume":"323","author":"P Little","year":"2001","unstructured":"Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908\u201311.","journal-title":"BMJ."},{"issue":"4","key":"1024_CR3","first-page":"27","volume":"6","author":"M Stewart","year":"2011","unstructured":"Stewart M, Ryan BL, Bodea C. Is patient-centred care associated with lower diagnostic costs? Healthcare Policy. 2011;6(4):27\u201331.","journal-title":"Healthcare Policy"},{"issue":"1","key":"1024_CR4","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.jclinepi.2011.05.011","volume":"65","author":"RM Eveleigh","year":"2012","unstructured":"Eveleigh RM, Muskens E, van Ravesteijn H, van Dijk I, van Rijswijk E, Lucassen P. An overview of 19 instruments assessing the doctor-patient relationship: different models or concepts are used. J Clin Epidemiol. 2012;65(1):10\u20135.","journal-title":"J Clin Epidemiol"},{"issue":"15","key":"1024_CR5","doi-asserted-by":"publisher","first-page":"1897","DOI":"10.1001\/jama.286.15.1897","volume":"286","author":"R Charon","year":"2001","unstructured":"Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA. 2001;286(15):1897\u2013902.","journal-title":"JAMA."},{"key":"1024_CR6","doi-asserted-by":"publisher","unstructured":"Ridd M, Shaw A, Lewis G, Salisbury C. The patient-doctor relationship: a synthesis of the qualitative literature on patients\u2019 perspectives. Br J Gen Pract. 2009. https:\/\/doi.org\/10.3399\/bigp09X420248 .","DOI":"10.3399\/bigp09X420248"},{"issue":"1","key":"1024_CR7","first-page":"38","volume":"10","author":"J Fong Ha","year":"2010","unstructured":"Fong Ha J, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010;10(1):38\u201343.","journal-title":"Ochsner J"},{"key":"1024_CR8","unstructured":"Broyard A, ed. Intoxicated by my illness: and other writings on life and death. New York, NY: Fawcett Columbine; 1992."},{"key":"1024_CR9","volume-title":"A life in medicine: a literary anthology","year":"2002","unstructured":"Coles R, Testa R, editors. A life in medicine: a literary anthology. New York, NY: The New Press; 2002."},{"key":"1024_CR10","volume-title":"On doctoring: stories, poems, essays","author":"RC Reynolds","year":"2010","unstructured":"Reynolds RC, Stone J, Nixon LL, Wear D. On doctoring: stories, poems, essays. 3rd ed. New York, NY: Simon and Schuster; 2010.","edition":"3"},{"key":"1024_CR11","doi-asserted-by":"publisher","first-page":"461","DOI":"10.3122\/jabfm.2008.05.070186","volume":"21","author":"B Merenstein","year":"2008","unstructured":"Merenstein B, Merenstein J. Patient reflections; saying good-bye to a retiring family doctor. J Am Board Fam Med. 2008;21:461\u20135.","journal-title":"J Am Board Fam Med"},{"key":"1024_CR12","volume-title":"Truth and method. 2nd rev","author":"H-G Gadamer","year":"1989","unstructured":"Gadamer H-G, Weinsheimer J, Marshall DG. Truth and method. 2nd rev. New York, NY: Continuum; 1989."},{"key":"1024_CR13","doi-asserted-by":"crossref","DOI":"10.1353\/book5103","volume-title":"Unquiet understanding: Gadamer\u2019s philosophical hermeneutics","author":"N Davey","year":"2006","unstructured":"Davey N. Unquiet understanding: Gadamer\u2019s philosophical hermeneutics. 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Oxford: Oxford University Press; 2000."}],"container-title":["BMC Family Practice"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-019-1024-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12875-019-1024-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12875-019-1024-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,21]],"date-time":"2023-09-21T16:05:21Z","timestamp":1695312321000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcfampract.biomedcentral.com\/articles\/10.1186\/s12875-019-1024-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,17]]},"references-count":16,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2019,12]]}},"alternative-id":["1024"],"URL":"https:\/\/doi.org\/10.1186\/s12875-019-1024-6","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.2.10781\/v3","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.10781\/v4","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.10781\/v5","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.10781\/v6","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.10781\/v1","asserted-by":"object"},{"id-type":"doi","id":"10.21203\/rs.2.10781\/v2","asserted-by":"object"}]},"ISSN":["1471-2296"],"issn-type":[{"value":"1471-2296","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10,17]]},"assertion":[{"value":"4 June 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 September 2019","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 October 2019","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The Research Ethics Committee of St. Mary\u2019s Hospital Center granted this study exemption from research ethics review (September 28, 2017). The study complies with local guidelines that state consent is not needed for this type of study, specifically Article 2.1 and 2.6 of the Tri-Council Policy Statement (TCPS 2):","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"MJY was the physician who received the correspondence examined in this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"136"}}