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Changes in the quality of doctor–patient communication between 1982 and 2001: an observational study on hypertension care as perceived by patients and general practitioners
  1. Ligaya Butalid1,
  2. Peter F M Verhaak1,
  3. Fred Tromp2,
  4. Jozien M Bensing1
  1. 1NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
  2. 2Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
  1. Correspondence to Ligaya Butalid; l.butalid{at}


Background The rise of evidence-based medicine may have implications for the doctor–patient interaction. In recent decades, a shift towards a more task-oriented approach in general practice indicates a development towards more standardised healthcare.

Objective To examine whether this shift is accompanied by changes in perceived quality of doctor–patient communication.

Design GP observers and patient observers performed quality assessments of Dutch General Practice consultations on hypertension videotaped in 1982–1984 and 2000–2001. In the first cohort (1982–1984) 81 patients were recorded by 23 GPs and in the second cohort (2000–2001) 108 patients were recorded by 108 GPs. The GP observers and patient observers rated the consultations on a scale from 1 to 10 on three quality dimensions: medical technical quality, psychosocial quality and quality of interpersonal behaviour. Multilevel regression analyses were used to test whether a change occurred over time.

Results The findings showed a significant improvement over time on all three dimensions. There was no difference between the quality assessments of GP observers and patient observers. The three different dimensions were moderately to highly correlated and the assessments of GP observers showed less variability in the second cohort.

Conclusions Hypertension consultations in general practice in the Netherlands received higher quality assessments by general practitioners and patients on medical technical quality, psychosocial quality and the quality of interpersonal behaviour in 2000–2001 as compared with the 1980s. The shift towards a more task-oriented approach in hypertension consultations does not seem to detract from individual attention for the patient. In addition, there is less variation between general practitioners in the quality assessments of more recent consultations. The next step in this line of research is to unravel the factors that determine patients' quality assessments of doctor–patient communication.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • To cite: Butalid L, Verhaak PFM, Tromp F, et al. Changes in the quality of doctor–patient communication between 1982 and 2001: an observational study on hypertension care as perceived by patients and general practitioners. BMJ Open 2011;1:e000203. doi:10.1136/bmjopen-2011-000203

  • Funding This work was supported by the Dutch Ministry of Education, Culture and Science. The previous studies in which the recording of the consultations was performed were financed by the Dutch Ministry of Health, Welfare and Sport; the Netherlands Organisation for Health Research and Development (ZonMw) and the research fund of the Innovation Fund of Health Insurers (RVVZ).

  • Competing interests None.

  • Ethics approval The studies were carried out according to Dutch privacy legislation. The privacy regulation was approved by the Dutch Data Protection Authority. According to Dutch legislation, approval by a medical ethics committee was not required for these observational studies.

  • Contributors LB coordinated the patient observers' assessments, formulated the study questions, discussed core ideas, analysed the data and wrote the paper. PV designed the original study, discussed core ideas and edited the paper. FT coordinated the second cohort GP observers' assessments, and commented on the paper. JB coordinated the first cohort GP observers' assessments, designed the original study, discussed core ideas, and edited the paper. All authors approved the final submitted version of the manuscript.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Consent for data sharing was not obtained from study participants, but the presented data are anonymised and there is no risk of identification. Access to the dataset is available from the corresponding author (l.butalid{at} in STATA format for academic researchers interested in undertaking a formally agreed collaborative research project.