Doctors Should Be Prescribing A Third Wheel

Posted on August 19, 2011


When a patient shows up for a doctor’s appointment with a companion, I often find myself studying (and later, interacting with) them as much as I do the patient.  Most times, a quick review of body language is all I need to make an assessment – is this person looking out for the interests of the patient?  Are they here begrudgingly, or out of concern?  Are they indifferent, or attentive?

The daughters of two patients I recently saw as outpatients illustrate the companion archetypes I hold in my mind.  One fell asleep while playing with the cell phone in her lap as we explained to her mother that she may have a life-threatening condition requiring immediate treatment and hospitalization.  The other walked in with a pen & a legal pad, and proceeded to record everything discussed about her mother’s health (she even recorded her vital signs that morning) – at a routine follow-up appointment.

It’s typical to see elderly patients accompanied by their children when they can’t be relied upon to understand & retain instructions delivered by their physicians, but I’m also a fan of younger, more independent patients bringing a companion or advocate.  We could all benefit from an extra pair of ears in the room, as well as someone who may ask questions or raise concerns we haven’t ourselves thought of.  Additionally, it helps to have someone who’s able to hold you accountable for your health – are you doing what your doctor recommended?

In terms of compliance, we speak of perceived severity and self-efficacy as proxies for patients’ likelihood of adhering to their plan of care.  However, crucial to (and perhaps more important than) achieving these conditions is an understanding on the part of the patient.  In my opinion, there is no better way to realize this than to have a companion – a family member, caretaker, or a friend – present at each doctor’s visit.

It has been estimated that between 30-60% of patients 60 an older are non-adherent to their medication prescriptions, and the incidence of non-compliance increases with the number of medications prescribed.  For the elderly in America, polypharmacy is the rule, not the exception, with studies citing averages of 7 or 8 medications.  When compounded with declining cognition and independence (sometimes a result of medications themselves), as well as the level of health literacy most people have to begin with, it’s a wonder we achieve a measurable level of compliance at all.

Research has also shown that Medicare beneficiaries who bring a companion are more satisfied with their health care providers than unaccompanied patients.  For this and the reasons above, it would make me happy to see more of an effort on the part of public health organizations and individual physicians to campaign for companions to be present at all visits to the doctor’s office – especially for, but not restricted to, the elderly.

Posted in: Health, Medicine