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.