The effect of a secondary patient on the family practice visit

Background. This study describes how the provision of care to a family member other than the identified patient affects the outpatient family practice visit. Methods. Research nurses directly observed consecutive patient visits on 2 separate days in the offices of 138 practicing family physicians. Patient visits during which another family member's problem was addressed were identified. Differences in patient and visit characteristics, patient satisfaction, delivery of preventive services, and time use, measured with the Davis Observation Code, were compared for visits with and without the provision of care to a family member. Results. Care was provided to a secondary patient during 18% of observed outpatient visits. The secondary patient was present during only half of these visits. When another family member's problem was discussed, patients were more likely to report that their expectations for the visit were met. There was no difference in patient report of satisfaction with the visit, the delivery of preventive services, or the level of billing for visits at which another family member's problem was addressed. Visits during which another family member's problem was discussed were an average of 1.3 minutes longer; with less time spent chatting, providing feedback, and conducting physical examinations, and more time spent counseling, taking history, gathering family information, and delivering preventive services. Conclusions. The provision of care to a second family member is relatively common in family practice, and affects the care of the index patient in identifiable ways. This care of another family member represents an important added value of family practice.