Comparisons between accompanied and unaccompanied patients are presented in Table 1. The fact that faculty physicians had a greater proportion of accompanied patients who received and completed surveys is likely due to the necessity of English literacy for inclusion into the survey study. At this practice site, patients cared for by residents are more likely to be non-English speaking and have a companion for the purpose of translation. Examination room companions were often the spouse or partner (55%), parents (17%), or less frequently roommate or friend (7%), whereas waiting room companions were commonly a spouse or partner (46%) or roommate or friend (24%). Overall, family members accounted for 93% of examination room companions and 76% of waiting room companions. Examination room companions were more likely to be female than waiting room companions (65% vs 51%, P = .05). Patients who were older, less well educated, and whose cases had greater medical or social complexity were more likely to have a companion in the examination room.
Patients’ and companions’ assessments of the reasons for accompaniment and the companions’ influence on communication and resource use are shown in Table 2. The patients’ and companions’ stated reasons for companion accompaniment were in good agreement with the kappa statistic ranging from 0.41 for “help with insurance forms” to 0.61 for “help remember the physician’s advice.” Patients’ and companions’ agreement regarding the influence of the companion on the medical visit was less than 0.4, suggesting marginal agreement for tests ordered (κ = .29), prescribed treatment (κ = .36), and length of visit (κ = .33). There was good agreement for number of referrals (κ = .45) and for physician and patient understanding (κ = .62 and .60, respectively).
Table 3 displays the physicians’ reports of the examination room companion’s influence on the medical encounter. Table 4 shows the physicians’ reports of the behavior of the examination room companions.
Patients regarded examination and waiting room companions as “very helpful” for 84% and 71% of visits, respectively, and as “very unhelpful” for 1% of visits. Of the 121 patients who came alone to their medical visits, 7% indicated that they considered bringing a companion to their visits and 16% thought a companion’s presence would have been helpful.
Physicians regarded examination room companions as “somewhat to very helpful” for 66% of visits. When physicians did not have contact with a companion, they indicated that contact would have been helpful for 16% of patient encounters.
Multivariable analyses explored the effects of independent variables on the decision to bring a companion into the examination room. A physician rating of a case of having greater medical and social complexity was the only variable associated with companion accompaniment to the examination room vs not having a companion (OR, 1.7; 95% CI, 1.4–2.1). Patient characteristics and patients’ reported reasons for accompaniment were factors influencing accompaniment into the examination room vs the waiting room. A need for help with communicating concerns to the physician (OR, 7.8; 95% CI, 2.4–25.6), help with remembering the physician’s advice and instructions (OR, 7.1; 95% CI, 2.0–25.3), and greater medical and social complexity of cases (OR, 1.5; 95% CI, 1.1–2.0) were associated with being accompanied to the examination room over just the waiting room. In contrast, needing help with transportation was negatively associated with having a companion in the examination room vs the waiting room (OR, 0.2; 95% CI, 0.1–0.5).
DISCUSSION
Companions frequently accompany adult patients and participate in ambulatory medical encounters. We found that companions accompanied 29% of patients and were present in the examination room for 16% of outpatient medical encounters. Examination room companions often were present to aid communication with the physician and to help the patient remember instructions. Physicians, patients, and companions believed that physician and patient understanding often were favorably affected by the presence of a companion. A companion’s presence in the examination room had beneficial effects on patient and physician understanding and very rarely had a negative effect. These findings reflect the results of previous studies in which approximately 33% of patients were accompanied to family medicine and geriatric encounters and 66% of these companions were present in the examination room.1,7-10,12,13 The only variable associated with accompaniment into the examination room vs presenting to one’s appointment alone was a physician rating of greater medical and social complexity. This finding also corroborates the findings of other studies.7,14,15
Some research has suggested a negative effect of a third person during the medical encounter. For example, older patients in triadic encounters raise fewer topics, are less assertive, and participate less in humor and joint decision making.6 Other research has failed to find a benefit in health outcomes with the presence of a companion, and unaccompanied patients rated themselves as having greater understanding of their medical problems and greater faith that their physicians were doing everything possible for them than patients accompanied to their visits.15 Still others have found that physicians provide more information and time but less emotional support to accompanied patients.7