Implications of Companion Presence with or without the Patient in the Family Medicine Consultation

Research Article

J Fam Med. 2016; 3(10): 1093.

Implications of Companion Presence with or without the Patient in the Family Medicine Consultation

Turabian JL¹*, Rodriguez-Almonte FE¹, Minier- Rodriguez LE¹, Cucho-Jove R¹ and Villarin-Castro A²

¹Department of Family Medicine and Community, Health Center Santa Maria de Benquerencia, Toledo, Spain

²Head of Studies, Teaching Unit of Primary Care and Community, Primary Care Management, Toledo, Spain

*Corresponding author: José Luis Turabián, Department of Family Medicine and Community, Health Center Santa Maria de Benquerencia, Calderón de la Barca, Toledo, Spain

Received: October 17, 2016; Accepted: November 10, 2016; Published: November 14, 2016


Objective: To evaluate the clinical implications between the presence of a companion with or without the patient in the office.

Design: Analytical observational study.

Location: A family medical consultation in Toledo, Spain.

Participants: Data from patients and their companions were collected, including whether the patient was present or not.

Main Measurements: For each patient and companion, the following variables were collected, among others: age, gender, chronic illness, chief complaint, drugs, social class, request for additional tests, kinship, social status and availability of companion. Comparisons were made using chi-square test, with Yates correction or Fisher’s exact probability, Student's t-test and the Mann– Whitney test. Finally, an analysis using logistic regression was performed.

Results: Of the 106 patients included, 63% patient were with a companion, and 37% were companions without the patient being present in the office: The presence of the patient with the companion compared to visits without the patient was significantly associated with lower sick leave [6% vs. 23%; p = 0.022], were more often the wife or husband [51% vs. 27%; p = 0.05], there were fewer chronic diseases of the musculoskeletal group [21% vs. 44%, p = 0.024], and taking less drugs from this therapeutic group [10% vs. 31%; p = 0.017]. In the logistical regression analysis with the variables that showed statistical significance in the bivariate analysis, and using as the dependent variable "the patient is present in consulting room", significant differences were found in relatives (husband / wife), who has shown a O.R. of 2,701 (i.e., if the companion is the spouse of the patient, the patient's odds of presence increases 2,701 times).

Conclusions: 1) There is a high frequency of companions attending the office without patients, which has ethical implications, and can cause false positives and negatives that can have serious consequences; 2) Dismissing inconsistent relations, there is no difference between patients or companions either if the patient is present or not in the office; and 3) The likelihood that the patient is present in the consulting room is significantly only when the companion is the husband/wife of the patient.

Keywords: Companion; family; Physician–patient communications; Caregivers; Family practice; Office visits; Physician–patient relations; Professional–family relations


The specialty of family medicine emphasizes the importance of assessing the patient's health, illness and disease within the context of family and community. Providing family-oriented primary care is one of the distinguishing features of this specialty [1,2].

Another important feature of family medicine which is taken into account in the individual care, is the presence of companions with the patients [3,4]. Conventionally, physician training focuses on an encounter between two people: the patient and the physician. In practice, a third person (a companion) frequently accompanies a patient during a medical encounter [5]. A second adult – usually parents or a husband or wife – accompanying the patient to the consultation is always significant and deserves the attention of the doctor. Although many consultations occur only with the patient, others involve companions with the patient in the office [6]. Routine visits in which one or more family member is present in the medical office with the patient are frequent. Overall, it is accepted that in about 30% of consultations there is a companion with the patient, usually a family member, especially in the case of elderly patients and children, who can assume important roles in improving the understanding of both the patient and doctor [7-9].

The presence of family members creates unique opportunities and challenges for the physician while interviewing the patient during an office visit. The physician must address issues of confidentiality, privacy, and agency during consultations. Special skills are required to respectfully and efficiently involve family members, while keeping the patient at the center of the visit [10]. The major results of existing studies suggest that the presence of companions with patients in consultations is often perceived as useful, and that these companions assume a variety of roles that improve the results of the consultation and medical care [4,5,11].

However, although it is no surprise to clinicians to hear that patients often attend outpatient medical visits with a companion, for example a family member, and that this is a common phenomenon in family medicine and other medical areas, previous research on communication in medical encounters has primarily focused on dyadic interactions between the physician and patient. Consequently, even a cursory examination of the vast literature on patient–physician relationships reveals that this characteristic, and its implications for medical practice, have been sparsely studied [12,13], and very little is known about the phenomenon of the presence of a companion with the patient in the medical office.

Moreover, clinicians may also be aware that it is not uncommon the presence of a companion to be present without the patient or instead of the patient in the consultation of family medicine. But even less is known about this fact: the presence of the companion by the patient (rather than the patient). In this context, it can be assumed that: 1) the presence of a companion without the patient at the office indicates a greater severity of the patient’s biopsychosocial fragility compares to the presence of a companion with the patient, and this could have practical clinical implications; 2) the importance of the ethical and legal implications of communication with the companion when the patient is not present, and this is particularly relevant in the case of a high frequency of visits by the companion alone to the family medicine consultation; and 3) the possible bias of information obtained only from the companion in the family medicine consultation.

Thus the aim of the study was to describe the frequency and characteristics of the presence of the companion with the patient and the companion without the presence of the patient in the office of family medicine in our environment, and to assess their practical clinical implications.

Materials and Methods

An analytical observational study, which included patients of both sexes over 14 years old, was conducted (family doctors attend patients over 14 years old in Spain). The sample size calculation was performed taking as variable comparison the "number of chronic diseases of companion" Assuming a confidence level of 95%, a power of 80%, a ratio cases/controls 2: 1, and a standardized mean difference 0.6. So, it would be needed 34 cases and 68 controls [14].

The location was a family medicine office, in the Health Center Santa Maria de Benquerencia, Toledo, Spain, which has a list of 2,000 patients.

From a randomly chosen day for 15 consecutive days, from 26 November 2015 to 18 December 2015, the visited patients were included, and data from the companions with patients and from companions who were there without the presence of the patients at the office, were collected. Companion was defined as any person who accompanied the patient in the consulting room or that consult instead the patient.

Patients were included only one time. Thus, were excluded the repeated consultations of same patient, including only the first visit.

For each patient and companion the following variables were collected: presence or absence of the patient at the medical office, age, sex, chronic disease (defined as "any alteration or deviation from normal that has one or more of the following characteristics: is permanent, leaves residual impairment, is caused by a non-reversible pathological alteration, requires special training of the patient for rehabilitation, and / or can be expected to require a long period of control, observation or treatment”) [15], classified according to International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) [16], taking medication, classified according to the ATC (Anatomical Therapeutic Chemical classification code or system [17,18], amount of sick leave taken by the patient, potential familial problems in the patient context based on the genogram, social-occupancy class, according to the Registrar General's classification of occupations and social status code [19,20], chief complaint according to ICD-10, whether an analytical or imaging test was requested for the patient, whether the patient need a consultation with a specialist, the companion relationship to the patient, and the social availability of the companion in relation to the patient.

A Microsoft Excel® file was built, and the Statistical Package for the Social Sciences® (SPSS) software [21] was used. Descriptive data, which were expressed by standard measures of central tendency and dispersion, were obtained. The bivariate comparisons were performed using the chi-square test, with Yates correction when it was pertinent, for the percentages, the Student t-test for the mean, Fisher’s exact probability test and the Mann–Whitney test for comparing means in variables with nonparametric distribution. Finally, an analysis using logistical regression was performed with the "Enter" method, including the variables that showed statistical significance in the bivariate analysis

The informed consent of all patients or their guardians for using their data in research was obtained.

Results and Discussion

Figure 1 shows a flowchart of the study. During the 15 days of data collection, 445 patients were included, of whom 106 presented with a companion or the companions were there without the patient’s presence (23% total frequency or prevalence of the presence of a companion).