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.

Given that physicians reported that accompanying people had a positive influence, we conclude that problems of triangulation were not apparent. The concept of triangulation, which emanates from the family therapy literature, occurs when a third person is drawn into a two-person system to deflect or diffuse conflict or anxiety. The nature of the everyday encounters described in this study might have made them exempt from such emotional responses, or the data collection method might not have been sensitive to such a complex process.
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This study found a high prevalence of accompanying people with children and with the elderly. Similar to the findings of Pantell et al, the role of parents accompanying children was that of advocate. In contrast to findings in earlier work, this study found that only rarely were parents “unbooked patients” or using the child as their “ticket of entry” into the doctor’s office for medical care.

The finding that one third of patients older than 75 were accompanied on their visits to doctors has important clinical implications. While prior research has documented the negative influence of accompanying people during encounters with elderly patients, our findings revealed that accompanying people were often advocates and that overall interactions were reported as positive. This might reflect physicians’ relationships with both patients and family members, taking into account the needs and concerns of both parties. It might also be that accompanying people provide important information about patients’ problems and management, which facilitates doctors’ care. flomax canada

Unique to this study was the identification of three other dyads: patients accompanied by spouses, parents accompanied by children, and elderly patients accompanied by elderly siblings. Patient-spouse dyads fell primarily into two groups: women patients between the ages of 21 and 40 accompanied by their partners and seniors accompanied by spouses. Younger women, we speculate, are being accompanied by their partners during prenatal and postnatal visits, and this could reflect the increasing involvement of men in their partners’ pregnancies and postnatal care. As for the elderly couples, with the ever-increasing number of seniors in our population, many will be accompanied by their partners due to cognitive or physical limitations.
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The most troublesome dyad was parent accompanied by child (ren). As the number of children present during an office visit increased, the encounter was more often described as neutral or at worst negative. This problem has not been identified before in the literature and suggests a need for better child care options in doctors’ offices. Women with complex problems might be reluctant to raise concerns if disruptive children are present (eg, disclosure about violence).

A dyad not dominant in our study was elderly patient accompanied by adult child. This is contrary to findings in the literature that highlight the important caregiving role played by adult children in their parents’ health care. Also notable was the number of elderly female patients accompanied by elderly female siblings. These two dyads require further exploration to gather additional data to support the positive interaction reported for the elderly sibling dyad and to investigate the reported absence of the adult-child caregiver role. viagra canadian

limitations
While this study included only eight practices, the physician sample included both urban and rural, academic and community-based, recently graduated and experienced, male and female physicians. Another limitation was the sole use of physicians’ assessment of the role and influence of accompanying people on patient-doctor interactions. Future studies could include other sources of data (ie, patients’ perceptions) and use qualitative methods. Also, patients’ ethnicity was not documented, limiting generalizabili¬ty of the findings to culturally diverse patients in need of interpreters.
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Conclusion
This study documented a substantial prevalence of patients accompanied by other people and explored doctors’ perspectives on the influence of accompanying people on patient-doctor encounters. Future studies need to include patients’ and accompanying peoples’ perspectives. Qualitative methods might be the most effective way to examine  these important viewpoints. Qualitative methods might also provide opportunities for further exploring dynamic interchanges in the dyads and in the subsequent triad that evolves in doctor-patient-accompanying person interactions.