Participants and Procedure
Data for the current analysis were from a larger study designed to investigate healthcare issues in Durham County, NC. The study was partially based on the Kaiser Family Foundation’s survey on race, ethnicity and the healthcare system. The sampling strategy was designed with two goals in mind: to obtain respondents representative of residents of Durham
County and to obtain approximately equal numbers of whites, blacks and Latinos. Greater Durham County has about 234,000 residents, with a per-capita income of just over $30,000. The median age is 32. Approximately 52% of residents are female; 51% are white, 40% are black and 8% are Hispanic.

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MEASURES

The dependent variables were health concern across four domains. Participants were asked, “How concerned are you that your health will be hurt because of: a) your diet, b) an inability to exercise, c) an inability to follow doctor’s recommendations and d) a disease?” Response options included not concerned at all (coded as 1), not too concerned (2), somewhat concerned (3) and very concerned (4).

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Previous research has uncovered racial differences in health-promoting behaviors such as cancer screening, exercise, diet and doctor visits. This research suggests that blacks and Latinos are less likely than their white counterparts to adhere to these behaviors. Several system-level factors are thought to contribute to these disparities, including but not limited to lack of access or insurance, income, language barriers and provider behavior. Individual differences in psychological variables such as perceived risk likely play an important role as well.

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This study found a 30.4% prevalence of patients accompanied by other people, which agrees with prior research. Results also confirmed specific groups (dyads) noted in prior studies (ie, child accompanied by parent, parent accompanied by child) and identified new dyads for future research, particularly adults accompanied by siblings.
The positive influence of accompanying people on patient-doctor interactions supports the value of family members participating in family medicine visits and the importance of involving families in the care of patients. McDaniel et al emphasize the importance of developing positive working alliances with both patients and family members. When a new patient joins the practice, they recommend meeting with family members early on, particularly if the patient has a chronic illness.

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Descriptive analyses
The eight participating physicians completed 800 questionnaires over 2 weeks in July 1995. In the total sample (N=800), 60.4% of patients were female, and 19.4% were younger than 20 years, 38% between 21 and 40, 18.3% between 41 and 60, and 24.3% older than 61. Patients had acute (56.7%) and chronic (43.3%) problems.
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Approximately one third (30.4%) of patients were accompanied during their visits. Children and patients older than 75 were most frequently accompanied (Table 1); the proportions in these two groups were significantly larger than for all other age groups X^2 = 274.53, df/=5, P<.001). Accompanied patients were similarly distributed by sex, but were more likely to have acute problems than unaccompanied patients (Table 2). Children’s presenting problems were rarely chronic (23.2%); seniors’ concerns were primarily chronic (64.4%).

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How does the presence of an accompanying person influence a patient-doctor interaction in family practice? Information on interviewing couples or families with problems is readily available in the social science and family medicine literature. While earlier research has documented the importance of patient-doctor communication on patient satisfaction, symptom resolution, reduction of concern, and physiologic outcomes, very little research has examined the influence of people who accompany patients on everyday visits to the doctor. The few studies that have been conducted focus on the elderly or children and cancer patients.

The elderly population has been studied primarily in the context of internal medicine consultations. Children’s visits often provide the “ticket of entry” for parents to attend to their own medical needs. Pantell et al found that physicians’ interactions with parents and with children were different and concluded that children were not active participants in their own medical care. Accompanying people have been found to assume various roles that can facilitate or impede encounters and support or detract from patient-doctor relationships.

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When patients are faced with the difficulties of disclosure, family physicians have a pivotal role. The data reported here extend previous work by Geddes on what factors (eg, attitude, sex) are important when lesbian or bisexual patients choose their physicians. Over and above this information, however, this study shows that lesbian and bisexual women must constantly monitor the effects of coming out to their health care providers. A family physician’s reaction to disclosure can profoundly affect the quality of health care in the short term and, in the long term, the trajectory of health care.

Participants themselves provided concrete examples of, and suggestions for removal of, barriers to health care. In this way, these data contribute an empirical base to our understanding of the ramifications of lesbian and bisexual invisibility in the Canadian health care system. These ramifications have been discussed more in theory than in actual fact.

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