Medicare patients should bring a companion to office visits

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 and 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 and 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.

James Haddad is a medical student who blogs at Abnormal Facies.

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  • http://www.facebook.com/people/Ardella-Eagle/840440226 Ardella Eagle

    Mr. Haddad speaks idealistically with an eye to practicality.  Unfortunately, I await the government’s input in the way of HIPAA regulations and paperwork with legal documentation from the companion showing the patient’s permission for the sharing of personal medical information. 

  • http://www.facebook.com/people/Lou-Mullen/100000454463374 Lou Mullen

    I agree, as a Palliative care nurse now looking after a dear friend at home with Cancer, All care persons that assist with ADL should take part in health care assessments, to check the client is getting the correct attention.
    However the reality is… not many Doctor’s take any notice of those attending with a client, pass the point of conversation; Who are you.
    Case conference with most MD’s and senior nurses is a myth if you are ranked lower than point of registration.

    • http://abnormalfacies.wordpress.com/ Abnormal Facies

      I agree that primary caretakers should be present for visits, but I take the argument further by including patients who are independent.  Someone who knows what questions/concerns you have before you arrive – I’ve seen many patients get flustered while trying to organize their thoughts and I think the benefits of bringing a companion extend beyond just the elderly.

  • http://twitter.com/HealthChamp Ida Schnipper

    Totally agree with use of  health advocates.  Health Champion, a private health care advocacy company offers a physician office advocacy service and an Emergency Room Advocacy Service. We send knowledgeable Nurse Advocates with our clients to physician office visits or can join enrolled clients in the ER  When we go the ER on behalf of clients we bring updated medical records. 

    The public needs to become familiar with the use of advocacy services, know that they are available and demand that the services become part of reimbursement through private and public means.

  • http://pulse.yahoo.com/_3CY2U67646G7UIAHBQVTT2UP4Y Kristy S

    Interesting article.  Especially this part here “Additionally, it helps to have someone who’s able to hold you accountable for your health – are you doing what your doctor recommended?”

    With that said how does that family member or friend that is there to hold the patient accountable for their health tell the doctor that the patient is not complying with the treatment plan knowing that the patient is going to get mad at the person with them?

    • http://abnormalfacies.wordpress.com/ Abnormal Facies

      Kristy,

      I was really thinking of the home context when I wrote that – someone in the patient’s personal life who can be there to make sure you’re doing the right thing.  But as you point out, bringing someone close can also result in you being ratted out to your physician :)

      I have an aunt who does this with her husband.  I’m sure he doesn’t like it, but what’s worse – having your spouse’s feathers ruffled for a moment or having their doctor making decisions with inaccurate information?

      Jim

      • http://pulse.yahoo.com/_3CY2U67646G7UIAHBQVTT2UP4Y Kristy S

        Jim,

        Thank you for your response.  That helps me understand better the point that you were trying to get across.