How Physicians View Caregivers: Simmel in the Examination Room

Abstract

The presence of caregivers in medical encounters changes the doctor-patient relationship. Although there is extensive literature on how caregivers affect medical encounters, there is little research on how physicians view such caregivers. We explore that issue by conducting structured, in-depth interviews with eighteen pediatricians and eighteen geriatricians. The interviews were recorded and transcribed, content analysis was performed, and conceptual codes were developed based on material in the interviews. Findings support Simmel's theory about the changes occurring when dyads become triads. Adding caregivers to medical encounters leads to a loss of intimacy between patients and physicians, decreased patient participation, and the formation of coalitions between physicians and caregivers. We conclude by urging medical schools to sensitize physicians to how caregivers affect medical encounters.

Patients’ perceptions of visit companions’ helpfulness during Japanese geriatric medical visits

“…Several previous studies have suggested that the presence of a companion could result in a loss of intimacy or jeopardize patient privacy [20,21]. The disclosure of sensitive issues, including those that might relate to the caregiver, can be especially problematic [22]. We found no evidence in this study to suggest that this is true.…”

Client–caregiver–nurse coalition formation in decision‐making situations during home visits

“…1994). Also, nurses’ perceptions of triadic interactions could be examined, as done by Barone et al. (1999) in their study with physicians.…”

“…Physician–caregiver against patient coalitions formed when physicians wanted information. Barone et al. (1999) did not report other types of coalition formation.…”

“…1991, Greene et al. 1994, Barone et al. 1999) and the nature of coalition formation and types of decisions made in coalitions of physicians, older patients and relatives (Coe & Prendergast 1985) have been conducted.…”

Do EPs change their clinical behaviour in the hallway or when a companion is present? A cross-sectional survey

“…Our findings of alterations in provider–patient communication based on triadic encounters is corroborated by geriatric studies. Barone and Greene found that the presence of caregivers can inhibit the candour of geriatric patients, preventing them from speaking openly about sensitive issues 13. Furthermore, Ishikawa and colleagues14 found physicians and patients spoke significantly less when there was a companion present 14.…”