A physician seeing the husband and wife together

As a medical provider, while seeing a husband and wife, or a couple, regardless of gender, one comes across several situations that  may be considered difficult to handle and that require a good deal of tact and confidentiality.

This is the case with seeing a husband and wife or (couple), together, for an examination. Ultimately, it depends on the rapport that the couple shares. If they are fine with being in the same examining room, you need not worry. However, it might be a good idea to ask permission to examine them together; especially if the examination might be embarrassing, or confidential information needs to be gained. While evaluating the body language that is on display with regard to this encounter, the provider can then proceed with the visit and take the lead.

Two is not always better than one

From the point of view of revenue, the doctor might end up spending more time with these patients, as there are two people in the room and many questions can be presented. This may change the focus of the conversation as well as the exam. A physician-patient relationship is extremely delicate and might be broken if there is too much of stress involved in this scenario. If the physician sees both the husband and wife together, there is a likelihood that one of them might not get due attention. Both the doctor-patient and the husband-wife possess relational privileges and these need to be respected.

Permission granted

The physician should also consider the legal aspects and repercussions when considering examination of both patients at the same time, in the same room. There are some cultures in which the wife might not be open to speak to the doctor while in the presence of her husband, or she might be completely overshadowed by the husband. In such instances the doctor might not be able to do justice to both patients. The doctor might not be able to assess the situation correctly and therefore not obtain all the pertinent data.

Stay focused on the mission

Although there are several pros linked to the husband and wife being seen together by the physician, there are several cons attached to this scenario. The doctor needs to be judicious. If, at any point, he feels that the visit is not moving in the right direction, he/she then must modify the visit. He may do this by making an appointment to see one of the patients at another time, or suggest that he see them separately.  As a reminder, it is always appropriate to ask one of the patients to remain in the waiting room, while the provider examines the other patient.

From the point of view of the CPT codes, the provider can record separate office visits, one for each patient, since the visit for both of the patients is considered to be separate and completely different. Remember to document the encounter appropriately.

Adam Alpers is a primary care physician and blogs at Medical Billing & Coding for Physicians.

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  • rezmed09

    It is usually a lot more endearing and fun.

  • http://www.fancyscrubs.com FancyScrubs

    Very tricky…staying focused is a must. Having an extra ear is good and someone to write things down too. Less confusion when a patient leaves if someone else documents instructions.

  • http://fertilityfile.com IVF-MD

    Just as in anything in medicine, there is no one universal answer to this question. By virtue of my specialty (infertility treatment) almost all our cases involve a husband and wife as a team.

    With regards to having the husband in the room during the ultrasounds and other procedures, it’s best to give a choice. Some couples absolutely 100% want the husband to be there and an integral part of every visit. Other couples decide to have the husband in the waiting room (or even completely out of the office either at home or at work) during the wife’s medical care. Sometimes, this is a decision on a wife not wanting her husband to see her in a medical setting. Sometimes, this is the squeamish husband’s decision not wanting to be present.

    People have a choice and the most respectful physicians try as best as possible to ask patients what would make them happiest.

  • Emrith Jacobson

    How do you deal with a case when the husband is post craniotomy and the wife is literally his walking memory? She also holds his JPOA and is his advocate. He needs her, tells the doctor this, and then the doctor asks questions of the post craniotomy male when the female has the answers and the male is hugely embarrassed that he cannot remember the answers himself. Add this to the fact that both are long term chronic pain patients who were dumped by their PCP/IM doctor for illegal reasons on the PCP/IM’s side, and that same past doctor is plainly doctoring the records. Only the wife has the wit and wherewithal to obtain the pharmacy’s records, proving the dumping doctor is in fact, lying. I’d be very interested in your views on this sad situation, possibly condemning them both to siezures, and the husband is already having tonic-clonic @ a rate of 5 to 7 a week, but now without his pain meds, he could have much more serious ones. This is extremely unethical. How would you handle this situation? Sincerely E.J.