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Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices

Journal of Human Hypertension volume 18, pages 769–773 (2004)Cite this article

Abstract

Until now, no information is available about the effect of the presence of a doctor-in-training on a patient's blood pressure. We tested the hypothesis that the presence of a last year medical student might increase the blood pressure of the patient, in addition to the possible pressor response to the doctor-trainer. Normotensive and hypertensive patients with a minimum age of 25 years, visiting for any reason, were recruited at 22 teaching general practices. Patients were randomised into a ‘trainee’ group (n=133) and a ‘no trainee’ (n=129) group. The blood pressure was measured at two subsequent contacts. In the ‘trainee’ group, a student was present at the first visit only. In the ‘no trainee’ group, both visits were without student. Both groups had similar anthropometric characteristics at entry. At the first visit, systolic pressure was higher in the ‘trainee’ group than in the control group (139.5 vs 133.1 mmHg, P=0.004), with a similar trend for diastolic pressure (80.2 vs 77.8 mmHg, P=0.07). From the first contact to the follow-up visit, blood pressure decreased in the trainee group by 4.8 mmHg systolic (P<0.001) and 1.7 mmHg diastolic (P=0.03), whereas the corresponding changes in the control group were −0.1 mmHg (P=0.90) and +1.5 mmHg (P=0.03). Thus, the between group differences in these trends averaging 4.7 mmHg (CI 1.5–7.9, P=0.005) systolic and 3.2 mmHg (CI 1.1–5.3, P=0.003) diastolic were statistically significant. We conclude that in teaching-practices, the presence of a doctor-in-training has a significant pressor effect when an experienced general practitioner measures a patient's blood pressure. If confirmed, our findings imply that doctors should be cautious to initiate or adjust antihypertensive treatment when blood pressure readings are obtained in the presence of a student.

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Acknowledgements

We thank the following colleagues for collecting the data: Dirk Anseeuw, Hugo Arnout, Anne-Marie Braeckman, Rudi Bruyninckx, Koen Cornelli, Annie Goeman, Renaat Crevits, Jean-Paul De Corte, Geert Deneckere, Rudy Derave, Willy De Schepper, Sabine Gilleman, André Hernalsteen, Hendrik Huybrechts, Gabriël Loncke, Roland Van Acker, Marc Van De Putte, Jan Van Elsen, Jan Verplanken, Lilly Willems, Marc Wybaillie, and Dirk Zanders.

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  1. Conflict of interest: None

Authors and Affiliations

  1. Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium

    J Matthys, M De Meyere & J De Maeseneer

  2. Department of Psychology, Ghent University, Ghent, Belgium

    I Mervielde

  3. Department of General Practice, University of Maastricht, Maastricht, The Netherlands

    J A Knottnerus

  4. Department of Molecular and Cardiovascular Research, University Hospital, Campus Gasthuisberg, Leuven, Belgium

    E Den Hond & J A Staessen

  5. Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA

    D Duprez

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  1. J Matthys
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  2. M De Meyere
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  4. J A Knottnerus
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  5. E Den Hond
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Correspondence to J Matthys.

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Matthys, J., De Meyere, M., Mervielde, I. et al. Influence of the presence of doctors-in-training on the blood pressure of patients: a randomised controlled trial in 22 teaching practices. J Hum Hypertens 18, 769–773 (2004). https://doi.org/10.1038/sj.jhh.1001744

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