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. One hundred and seven 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. 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. 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.

中文翻译：

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使用患者主动向家庭医生发送的信函来描述和理解医患关系的重要组成部分：一种诠释学方法

医生内部的沟通和行为-使用各种技术检查了患者的遭遇；但是，很少有患者自发给家庭医生的文章的性质的报道。因此，本文旨在探讨此类通信的内容和动机。考虑给一位家庭医生的一百零七篇有关在四年期间提供的护理的著作。单变量分析用于确定以个性化方式，以何种方式以及以何种方式向医生写个性化注释的患者或家庭成员的特征。诠释学方法有助于查看笔记的内容，用于描述相遇或关心的特定单词或情感以及可能的写作动机。单词或短语的反复审阅产生了主题，这些主题总结了赞赏的医师或相关属性以及写作动机。笔记大多是手写的，主要是女性手写的，并且经常与假期和寿命事件相吻合。赞赏的医生的特征和行为是（1）优质护理；和医师（2）能力；（3）物理存在；（4）积极的个人特质；（5）提供情感支持；（六）精神影响。写作动机被归纳为以下愿望：（1）对建立的关系表示赞赏；（2）确认持续护理所带来的价值/收益；（3）寻求宣泄，情绪舒缓或封闭；（4）反思终止照料；（5）验证结合了希波克拉底传统和阿斯克莱皮亚医治的护理；（6）分享个人的反思，经验或影响。不请自来的著作提供了从患者到医生的个性化链接，表达了可能难以面对面分享的想法。它们提供了作为有关医患关系内容的教学工具的潜力；例如，研究的作者对能胜任，体贴和支持情感和精神需求的高质量连续性护理表示赞赏。