THE EFFECTS OF THE PRESENCE OF A 3RD-PERSON ON THE PHYSICIAN OLDER PATIENT MEDICAL INTERVIEW

Objective: To compare communication in triadic (three-person) and dyad ic (two-person) older patient medical interviews and to determine the influence of the presence of a third person on the physician-older pat ient relationship. Design: Matched sample of dyadic and triadic audiot aped outpatient medical visits. Audiotapes were coded with the Multi-d imensional Interaction Analysis (MDIA) system. Setting: Hospital-based medical primary care group practice in a major urban teaching institu tion. Participants: Patients 60 years and older who were making their first visit to study physicians. In a sample of 96 audiotaped initial medical visits, 15 encounters involved three persons. These 15 cases w ere matched with 15 dyadic interviews for gender and race of the patie nt and for gender and race of the physician. Main Outcome Measures: Co ntent, interactional processes, and specific language and communicatio n behaviors of older patients, physicians, and third persons in the me dical encounter, as measured by the MDIA system. Results: The specific content and the quality of interactional processes of physicians were not affected by the presence of a third person. However, older patien ts raised fewer topics in all content areas (medical, personal habits, psychosocial, and physician-patient relationship) in triads than in d yads. Overall, patients were less responsive (ie, the quality of their questioning, informing, and supportiveness was poorer) on patient-rai sed topics in triads than in dyads. Patients were rated as less assert ive and expressive, and there was less joint decision-making and share d laughter in triads than in dyads. Patients were frequently excluded from conversations in visits in which a third person was present. Conc lusions: The presence of a third person in the medical encounter chang es the interactional dynamics of older patient medical interviews and may influence the development of a trusting and effective physician-ol der patient relationship.