OBJECTIVE:We wanted to characterize patient accompaniment to medical encounters and to explore the rationale and influence of the companion on the primary care medical encounter.STUDY DESIGN:This was a descriptive study.POPULATION:Academic general internal medicine physicians, patients, and patient companions participated.OUTCOMES MEASURED:We measured the frequency of waiting and examination room companions, the reasons for accompaniment, the influence on the encounter, and the overall helpfulness of the companion as assessed by patients and companions. We also determined the physicianamprsquos assessment of the companionamprsquos influence, helpfulness, and behavior during the encounter.RESULTS:Companions were in the examination room for 16% of visits; 93% were family members. The rationales for waiting and examination room companions were to help with transportation, provide emotional support, and provide company. Examination room companions helped communicate concerns to the physician, remember the physicianamprsquos advice, make decisions, and communicate their own concerns to the physician. Patients believed that examination room companions influenced 75% of medical encounters, mainly by improving communication between physician and patient. Physicians agreed that examination room companions favorably influenced physician and patient understanding (60% and 46% of encounters, respectively). Patients indicated that waiting and examination room companions were very helpful for 71% and 83% of visits, respectively.CONCLUSIONS:Companions frequently accompany patients to their primary care medical encounters. They are often family members, and they assume important roles in enhancing patient and physician understanding.

PURPOSE: Ambulatory case Presentations occur typically in conference rooms, and attending physicians often have little contact with patients. The purpose of this study was to examine the effects of two different ambulatory case presentation formats that involve attending physicians more directly.SUBJECTS AND METHODS: We conducted two randomized controlled trials in a community-based ambulatory internal medicine clinic. Participants comprised 393 adult patients, 40 house officers, and 14 attending physicians. In the first trial, patient encounters were assigned randomly to either exclusive house officer-attending physician conference room discussion or to house officer-at tending physician conference room discussion plus attending physician-patient interaction. In the second trial, patient encounters were assigned randomly to either exclusive house officer-at tending physician conference room discussion or to exclusive house officer-at tending physician discussion in the examining room with the patient present. Patient satisfaction; attending physician contributions to teaching, diagnosis, and therapy; and house officer comfort and autonomy were assessed.RESULTS: Patient visit satisfaction and house officer assessment of attending physician teaching, diagnosis, and therapy were similar in the control and intervention groups of both trials. Patients involved in examination room discussions thought they were more comfortable with the discussion (mean +/- SD, 4.3 +/- 0.9 vs. 3.4 +/- 0.9 on a one- to five-point Likert scale, P <0.001) and more often indicated a preference to listen to the discussion in the future than did the control group (86% [71/83] vs. 63% [52/83], P <0.001). Some house officers (11% [9/83]) but no attending physicians (0/83, P <0.001) were made uncomfortable by examination room presentations, and some house officers (11% [9/83]) thought that examination room presentations diminished their autonomy.CONCLUSION: Patients perceive that ambulatory examination room presentations are beneficial, whereas some house officers perceive that examination room presentations are associated with discomfort and diminished autonomy. (C)2002 by Excerpta Medica, Inc.

BACKGROUNDTime management in ambulatory patient visits is increasingly critical. Do patients who perceive a longer visit with internists report increased satisfaction?METHODSProspective survey of 1486 consecutively encountered ambulatory visits to 16 primary care physicians (PCPs) in an academic primary care clinic. Patients were queried regarding demographics, health status, perception of time spent before and after ambulatory visits, whether the physician appeared rushed, and visit satisfaction. Physicians were queried regarding time spent, estimated patient satisfaction, and whether they felt rushed.RESULTSIn 69% of 1486 consecutive visits, patient previsit expectation of visit duration was 20 minutes or less. Patient and PCP postvisit estimates of time spent significantly exceeded patient previsit time expectation. Patients who estimated that they spent more time than expected with the PCP were significantly more satisfied with the visit. When patient postvisit estimate of time spent was less than the previsit expectation, visit satisfaction was significantly lower independent of time spent. Patient worry about health and lower self-perceived health status were significantly associated with patient expectation for longer visits. Primary care physicians felt rushed in 10% of encounters. Although PCPs estimated patient satisfaction was significantly lower when they felt rushed, patient satisfaction was identical when PCPs did and did not feel rushed. Patients indicated that PCPs appeared rushed in 3% of encounters, but this perception did not affect patient satisfaction.CONCLUSIONPerceived ambulatory visit duration and meeting or exceeding patient expectation of time needed to be spent with the physician are determinants of patient satisfaction in an ambulatory internal medicine practice.

OBJECTIVETo test the hypothesis that there is substantial use of a practitioner of alternative/complementary medicine by patients traditionally considered to be underserved.DESIGNCross-sectional, self-administered survey study.SETTINGSThree university hospital-affiliated general ambulatory clinics serving patients of different socioeconomic status and racial origin.SUBJECTSFive hundred and thirty-six (93% of those attending) consecutive clinic attendees.OUTCOME MEASURESPast use and desired future use of one or more practitioners of five modalities of alternative/complementary medicine and willingness to pay for these modalities out-of-pocket.RESULTSPast usage and desired future usage of one or more practitioners of alternative/complementary medicine was comparable at the three clinic sites despite wide differences in socioeconomic status and willingness/ability to pay out-of-pocket for these services. Multivariable analyses revealed lower self-rated health status and female gender (both p < 0.006) but not income, race, age or education as independent, significant predictors of use of a practitioner of alternative/complementary medicine.CONCLUSIONUsage of alternative/complementary medicine is not confined to any well-circumscribed socioeconomic group and is common in patients often considered to be underserved. Self-assessed lower health status is significantly and independently associated with use of a practitioner of alternative/complementary care.