| A growing proportion of medical interviews are between physicians and elderly patients who are accompanied by another person (triads). This transcript-based study analyzed communication patterns of information-giving and seeking of these triads. Of 88 audio recordings of older-patient medical encounters, 36 had accompanying persons, and were analyzed descriptively. Sixteen unaccompanied patient-physician encounters (dyads) were matched to 16 triads on patient characteristics of age within 5 years, race, gender, clinic status, and severity of illness to isolate the effect of third persons on physician-patient interaction and length of the encounter.;After transcription and timing, coding provided measurements that identified the proportion of participation for all persons in the pre-physical, physical examination, and post-physical portions of the encounter. A measure, called "physician orientation," quantified physician attention to patients and to third persons. Content areas suggested by geriatric assessment guidelines were used to compare dyads and triads.;The patients had a mean age of 75, were 69% male, and 67% African American. Over half were first time clinic users; 61% were rated by the physician as moderately or extremely ill. Accompanying persons were predominately female (86%) and family members (83%). Specific physician orientation to patients changed during the encounter, comprising 68% of physician initiations in the pre-physical, 74% during the physical examination and 51% post-physical. Third persons responded to 8% of questions directed to the patient. The combined information-seeking by both patients and accompanying persons accounted for only 4% of the total information exchange with patients asking an average of 4.3 questions and third persons 3.4.;Comparison of triadic to dyadic encounters showed that there were no significant differences in length of the encounter, or in any measure of information exchange when the contributions of patient and third persons were combined. Since unaccompanied patient's contributions are equivalent to the combined contributions of patients and third persons, the presence of the third party is associated with decreased patient participation in the medical interview. Reported memory problems were discussed significantly more often in triads. Other differences suggest that patients' problems related to functional independence are more likely to be discussed in triads. |
