It was developed using Netscape Communicator 4. The questionnaire was edited in simple HTML without any java applets or special scripts in order to enable a maximum of the addressed users to view it with their browsers. In addition to the questionnaire itself, there was an introduction page saying hello to the user and introducing the study very briefly. All pages contain a mail-to link that enabled the user to send an email to the author. After filling out the questionnaire and sending it to the author, a "thank you" page appears. In order to guarantee anonymity to the respondents, the completed questionnaires were sent back to the author via a U.
To a large extent, the age Table 2 and the sex Table 1 distribution in the examined group corresponded to the expectations from the general information on medical Internet users. The distribution of the specialties in the examined group Table 3 did not surprise us after the figures presented in the theoretical section of this paper.
The high percentage of physicians engaged in professional organizations Table 14 was remarkable in the examined group. More than 20 percent of the respondents held a position in a professional organization. The median time in practice of a little more than ten years Table 6 with a substantially smaller modus of five years permits the assumption that the number of physicians who present their practice on the WWW will further grow in the future. Due to the economic conditions for the operation of a medical practice, as expected especially young practices count on this new method of advertising.
This can also be concluded from the fact that many of the websites of the respondents had only been online for less than one year Table However, winning new patients is a less important motive for running a website than retaining existing patients by offering a new or better service to them. The hypotheses could only partly be confirmed by the results of the survey:. Physicians of different specialties deal with their own website differently. The specialty of a physician could be considered an indicator to how and how intensively he uses the advertising method of a website.
It can be assumed that apart from the IT- and Internet open-mindedness, there are other decisive factors that were not examined in this study. The Internet familiarity of the physicians Table 10 is responsible for the importance they attach to advertisement on the web and particularly to the own website. This hypothesis could be confirmed and suggests at the same time that the WWW will gain in importance as an advertising medium for established physicians. More than a third of the respondents had used the Internet for less than two years Table 9 ; with the explosive growth of the Internet the number of new physician users will increase and with the growth, develop new websites.
Surprisingly, the attitude towards the advertising prohibition results apparently less from economic considerations than from age-conditioned opinions. The key factor is the age of the physician, not the age of the practice, although naturally young physicians tend to be associated with younger practices.
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Not surprisingly, the tendency to try winning new patients by means of advertisement and a pronounced economic consciousness are stronger among owners of younger practices. The size of a medical practice Table 5 did not influence the attitude of the physicians towards their own website.
However, the type of practice in which a physician works played a crucial role in this context Table 4. In conclusion, it appears that the importance of the Internet for the recruitment of new patients is still small, but it will continue to expand in the future. This is indicated the results presented in this study, by the general development of the Internet, by the European direction of markets and juridical systems, and by the examples from other countries.
The few website operators among the established physicians are doing the pioneering work in Cyberspace. It is hoped for them - the respondents of this survey - that their pioneer spirit will be rewarded. Conflicts of Interest: None declared. National Center for Biotechnology Information , U. J Med Internet Res. Published online Aug 5. Reviewed by John Mack and Hans van der Slikke. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Apr 23; Accepted Apr This article has been cited by other articles in PMC.
Abstract Background In the last few years, the number of Internet users has increased explosively. Objectives This study was conducted to answer the following questions: Who are the pioneers among the German practice owners presenting themselves to the public with their own website?
How do they differ from their colleagues not advertising on the WWW? What motives and expectations do they associate with their website? Methods Built on a detailed analysis of the relevant German and international literature, hypotheses were developed which were empirically checked in the further course of the work.
Results physicians participated and valid questionnaires were included in the analysis. The study revealed the following results: The age and sex distribution as well as the distribution of medical specialties in the examined group correspond to the expectations. Many of the websites have been online less than one year. The following hypotheses could only partly be confirmed by the results of the survey: Physicians from different specialties deal with their own website differently.
Conclusion At present, the importance of the Internet for recruiting new patients is still small, but we anticipate it will continue to expand in the future. Keywords: Established physicians, Internet, advertising, survey, marketing of health services, private sector, Germany, public relations, practice management. A number of hypotheses were been concluded from the theoretical background information: Physicians with an "open-minded" attitude towards IT and Internet attach a higher importance to the own website than those who are less "open-minded.
The questionnaire consists of the following thematic groups of questions: the physician himself, his motives and attitudes the website, its age, size etc. Results physicians participated, and valid questionnaires were included in the analysis and furnished the following results, represented by the corresponding tables: To a large extent, the age Table 2 and the sex Table 1 distribution in the examined group corresponded to the expectations from the general information on medical Internet users. Table 1 Sex Distribution. Open in a separate window.
Table 2 Age Distribution. Table 3 Medical specialty. Table 14 Participation in Medical Professional Politics. Table 6 Time in Practice. Table 12 Website Presence. Discussion The hypotheses could only partly be confirmed by the results of the survey: Physicians of different specialties deal with their own website differently. Table 10 Internet Familiarity Scale. Table 9 Use of Internet. Table 5 Size of Practice. Table 4 Type of Practice. Conclusion In conclusion, it appears that the importance of the Internet for the recruitment of new patients is still small, but it will continue to expand in the future.
Footnotes Conflicts of Interest: None declared. References 1. Arztrecht in Niedersachsen. Martensen RL. Physician Advertising. Schulte K. Morrice AAG.
Medical History. Jarass HD. The key is Dminor, an important Mozartian key for drama, and Beethoven's 'Tempest' tonality. The tessitura of the voice part might be termed 'cruelly high', but Schubert was certainly not deliberately punishing his singer, he simply lacked experience in vocal writing. The music has the air of being conceived in the style of an instrumental sonata for violin perhaps with words added later.
Because he does not have the guiding example of Zumsteeg in front of him, Schubert is very cavalier with the poem. Right at the beginning, for example, he substitutes the emphatically explosive 'brauset' for 'braust', and repeats whichever phrases and words that appeal to him, willy-nilly. The poem's opening line inspires a small anthology of Sturm und Drang pianistic devices. As soon as the maiden is mentioned in the second line the composer writes the word dolce, and the music changes into D major.
The effectiveness of this essentially Schubertian fingerprint is undermined, however, by the setting of the words on a D major arpeggio which soars up to a high tessitura, suggesting a Valkyrie rather than a vulnerable maiden. This is immediately followed by tempestuous water imagery the poem's third line , the pianist's fingers working up a storm in short choppy scales, encompassing a fifth, which pound the shore and ear mercilessly.
The word 'seufzt' 'sighs' brings another change of mood: hectic quavers are replaced by much longer notes in the vocal line. Underneath the singer's semibreves and minims the piano invokes pathos with pleading intervals and 'meaningful' scales. Mention of tears in the last line freezes the action into crotchets enlivened by piquant chromaticisms. Schiller places this strophe in inverted commas.
Although the music cultivates an air of self-conscious pathos, and the rum-ti-tum accompaniment occasions a smile, these things are still to be found in countless Italian operatic arias up to the time of Verdi, and beyond. The astonishing thing is that this 'southern' style has already been somehow assimilated by the composer as early as , and that it has seeped so successfully into his musical consciousness. Once again the free repetitions of 'gestorben' together with an inherent sob built into the music seem unworthy of the proprieties associated with the German song, but what we are hearing here, surely, are the birth-pangs of the lied, even if that birth takes place not in the opera house itself, but in a nearby side-street.
The fluidity and, above all, the uninhibited emotion of the vocal line in D minor, poised above, and meshing with, those incessantly rolling sextuplets in the accompaniment, seem strangely familiar.
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Here is a note of Mediterranean passion not to be found in Zumsteeg or Reichardt, and not even in Mozart in quite the same way. I am in no doubt that we are hearing the beginnings of music for another woman in extremis who also appeals to the Virgin for help and who was to achieve immortal existence only three years later- Goethe's Gretchen and the heroine of Gretchen am Spinnrade and Gretchens Bitte. It is not as long a journey from 'Das Herz ist gestorben' Schiller to 'Mein Herz ist schwer' Goethe as one may think; and how appropriate it would be should Schubert have sown the seeds of his first great Goethe song in the heart of his first Schiller setting.
This aria uses the strophe's first three lines; the remainder of the verse is set to a 'Recitative in tempo' which is awkward. With such a disregard for logic, Schubert, at this stage of his life at least, seems to have been an operatic natural. As in Hagars Klage a moment of genuine inspiration is followed by a musical disappointment.
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The composer chooses to repeat the strophe's third and fourth lines in an allegretto tempo, together with a modulation into F major. This is once again in an ungrateful tessitura, doubled note-for-note by the piano. After having treated the singer's line in the Grave section with great skill, we return to what appear to be violin studies.
This shape seems not to have been understood by Schubert who elided the second and third strophes and paid no attention to potentially the most dramatic moment, the opening of the Virgin's statement. Only a change of tempo to Andante shows that a crucial new section of the poem is beginning mid-bar; and then the nondescript doubling of the vocal line by the piano seems particularly inept and anonymous. The reason for this is that the clue that the Virgin is speaking is given only in the last line of the strophe at 'Ich, die Himmlische'.
It seems likely that the young composer was not quite clear about what was happening. Until these words he seems to have been unaware that he was writing music for the Madonna herself to sing. And he had probably not yet learned the crucial lesson of reading ahead and making the poem's thorough acquaintance before setting it.
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Just before that point there is a double bar line and, interestingly enough, a modulation into C major, the key of so much of Schubert's later religious music. The Virgin, introduced four lines later than she should have been, is no blushing flower; her outpourings are largely marked forte and inhabit the stratosphere. What is more, Schubert continues her aria into the next strophe there is no gap at all in the music instead of returning to the maid who has been chastened and instructed by the heavenly intervention of verse 3.
It is perhaps the only occasion that Schubert seems to have got himself into a complete muddle over the dramatization of a poem. The music for the fourth strophe, with its undulating triplet accompaniment in the left hand, was no doubt meant to have had a radiant and comforting tone. Instead Schubert composed possibly the most difficult-to-sing page in his whole vocal output.