The third person in the room: Frequency, role, and influence of companions during primary care medical encounters
- OBJECTIVE: We wanted to characterize patient accompaniment to medical encounters and to explore the rationale and influence of the companion on the primary care medical encounter.
- STUDY DESIGN: This was a descriptive study.
- POPULATION: Academic general internal medicine physicians, patients, and patient companions participated.
- OUTCOMES MEASURED: We measured the frequency of waiting and examination room companions, the reasons for accompaniment, the influence on the encounter, and the overall helpfulness of the companion as assessed by patients and companions. We also determined the physician’s assessment of the companion’s influence, helpfulness, and behavior during the encounter.
- RESULTS: Companions were in the examination room for 16% of visits; 93% were family members. The rationales for waiting and examination room companions were to help with transportation, provide emotional support, and provide company. Examination room companions helped communicate concerns to the physician, remember the physician’s advice, make decisions, and communicate their own concerns to the physician. Patients believed that examination room companions influenced 75% of medical encounters, mainly by improving communication between physician and patient. Physicians agreed that examination room companions favorably influenced physician and patient understanding (60% and 46% of encounters, respectively). Patients indicated that waiting and examination room companions were very helpful for 71% and 83% of visits, respectively.
- CONCLUSIONS: Companions frequently accompany patients to their primary care medical encounters. They are often family members, and they assume important roles in enhancing patient and physician understanding.
Unique to our study was the specific assessment of companion influence on various aspects of the medical encounter from the perspectives of the companion, patient, and physician. As expected, examination room companions had significant influence on aspects of communication. Examination room companions were generally considered helpful by patients and physicians. Physicians may use the companion and patient as barometers of the visit’s accomplished goals. Hence, the time spent listening to a companion provide information about a patient’s medical problems might be balanced by the provision of less emotional support to the patient, especially if the companion is providing that support. The physician may offer an explanation until confident that either party (patient or companion) has a complete understanding. As demonstrated by the results, physicians, patients, and companions thought that patient understanding was increased in approximately 50% of encounters by a companion’s presence, and companions overwhelmingly were considered very helpful by patients.
Our study was limited to 1 urban, academic, general internal medicine practice and may not be generalizable to other settings. The method of assessing medical and social complexities was simple, and the very presence of an examination room companion may have biased physicians to rate these patients as having more complex problems than unaccompanied patients. Also, the longer period of the second part of the study necessary to enroll 200 patient–companion pairs, compared with the companion frequency data of the first part of the study, suggested that we did not enroll “consecutive” patient–companion pairs. This may be explained by the exclusion of patient–companion pairs when either party was not literate in English. Also, the logistics of obtaining consent and administering post visit questionnaires by a single research assistant interfered with the attempt to enroll all patient–companion pairs. Convenience enrollment of unaccompanied patients may have been biased. The effect of the companion on the medical encounter was not verified by objective measures such as timing visit length. Further, patients, companions, and physicians rated the effect of the companion’s presence immediately after the encounter; the full effect of the companion’s presence might require more time to emerge.
Companions frequently accompany patients to their ambulatory general medicine visits. The companion is usually a family member who is present at the request of the patient. Companions assume important roles and are overwhelmingly considered helpful by patients. Nonetheless, some of the behaviors that contribute to an effective physician–patient relationship might be diluted by the presence of a companion. Future directions of study include (1) assessing the effect of the companion on the physician–patient relationship, including specific aspects of communication and behavior, and (2) determining whether companion involvement influences health outcomes or resource use.
· Acknowledgments ·
We thank Marcia Blake, MA, for her statistical expertise; Jean Kutner, MD, MSPH, for her assistance with data analysis and statistical expertise; and Robert Dellavalle, MD, PhD, for his editorial assistance.
