The majority of my patients come to visits accompanied by a family member, friend or caregiver. This dramatically changes the dynamic of the patient-provider encounter. When a family member is present, there is no longer a monogamous patient-provider relationship, but one that resembles polygamy and all its complexities.
During these visits, I’m expected not only to address the concerns of my patient, but also the concerns that the accompanying individual has for the patient, and at times, the concerns these individuals have for themselves. Although I expected these types of encounters when I worked in pediatrics, I did not anticipate that it would be just as common in adult medicine.
There is a theory in sports that team performance correlates with the number of fans and cheerleaders present. This is one of the ideas behind the home-team advantage. Essentially, this belief is consistent with the team approach to medicine that I value.
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I fundamentally believe it is best to involve the entire family in a patient’s treatment plan whenever possible. The more individuals working together towards a common goal, the better the outcome will be. It is a great theory, but how do we get it to work in primary care?
A 15-minute time frame is difficult enough to adhere to when there is only one patient in the room, but add another person or two, and it becomes almost impossible. The solution is not to exclude family and friends who accompany the patient, but to incorporate them into the encounter efficiently.
When another person is present, it is important to acknowledge this individual by introducing yourself and determining their relationship to the patient. This will enable you to assess the individual’s level of involvement. I always strive to make sure that both the patient and the accompanying person understand the treatment plan at the end of these encounters.
As we work in primary care to create a medical home for our patients, we can’t forget that at the center of most homes is the family. We have to remember that in family medicine, we are responsible for treating the whole family.
Leigh Montejo, MSN, FNP-BC, is a National Public Health Service Corp scholar completing her service commitment as a Family Nurse Practitioner at Tampa Family Health Centers Inc. in Florida. Her areas of interest include adolescent health, health promotion and improving access to healthcare in underserved populations.
