Shields Cleveland G, Epstein Ronald M, Fiscella Kevin, Franks Peter, McCann Robert, McCormick Kevin, Mallinger Julie B
University of Rochester Medical Center, Department of Family Medicine, Rochester Center to Improve Communication in Health Care, Rochester, NY 14620-2830, USA.
J Am Board Fam Pract. 2005 Sep-Oct;18(5):344-54. doi: 10.3122/jabfm.18.5.344.
To conduct a pilot study to examine physician patient interaction when elderly patients are accompanied during a medical visit.
This was a study in which 30 patients were randomly assigned to be accompanied (13) or unaccompanied (17) during a regular medical visit to their physician. Visits were tape recorded, transcribed, and coded with the Measure of Patient-Centered Communication (MPCC) and with the Rochester Participatory Decision-Making Scale (RPAD).
We found no differences between the number of words spoken in accompanied versus unaccompanied visits, comparing patients alone with patients and companions combined. Physicians spoke longer without interruption in accompanied encounters (39.9 vs 78.6 words per speech turn). There were no differences in the level of MPCC or in the level of participatory decision making between the 2 types of visits. In accompanied visits, patients introduced most of the concerns and physicians discussed concerns with patients more than with companions.
Previously reported differences in accompanied versus unaccompanied visits may reflect patients' preferences for being accompanied, the role they wish their companion to play, and the patients' health status. Being accompanied by a family member or friend does not result in less attention being paid to patients' concerns.
开展一项试点研究，以考察老年患者在就医时有陪同人员在场时医患之间的互动情况。
本研究中，30名患者在定期看诊时被随机分配为有陪同人员（13人）或无陪同人员（17人）。就诊过程进行录音、转录，并使用以患者为中心的沟通量表（MPCC）和罗切斯特参与式决策量表（RPAD）进行编码。
将单独就诊的患者与有陪同人员的患者进行比较，我们发现有陪同人员和无陪同人员就诊时所说的单词数量没有差异。在有陪同人员在场的问诊中，医生不间断讲话的时间更长（每次讲话轮次分别为39.9个单词和78.6个单词）。两种类型的就诊在MPCC水平或参与式决策水平上没有差异。在有陪同人员的就诊中，患者提出了大部分问题，并且医生与患者讨论问题的时间多于与陪同人员讨论的时间。
先前报道的有陪同人员和无陪同人员就诊之间的差异可能反映了患者对有人陪同的偏好、他们希望陪同人员所扮演的角色以及患者的健康状况。由家庭成员或朋友陪同并不会导致对患者问题的关注减少。
