Two for one special

[Anne]

Do you dislike when spouses come to medical appointments when only one of them has an appointment? Or just when both have appointments, and you have to focus on both (and both have to do all the pre-doctor stuff simultaneously)?

Sometimes spouses are annoying, sometimes helpful. I agree when younger spouses always come together for routine stuff it’s kind of a red flag. But at least it gives you some info: e.g. patient is in a co-dependent relationship, patient has good family support, patient’s spouse is a major stressor, patient is more/less likely to be compliant with treatment/lifestyle changes based on the noted interaction.

If you really hate it, I guess you could make a no spouse in the exam room rule, but that will probably alienate some people. If you don’t care about that, go ahead. Or you could focus on solutions for the things that really bother you—how can you prevent the rooming delay? Can you make sure if there’s a twofer that they know they must come 15-20 minutes early if they want to be roomed together?

I like to sit the spouse in a position in the room where he/she (in my setting, usually she) is not right beside the patient, and then I am at my computer facing the patient with the spouse in the corner. So they are privy to everything going on and can speak up but I am asking questions directly to the patient. If they keep interrupting or speaking for the patient, I say to the patient “I want to hear your point of view”. It’s not perfect but I feel it goes better than when they are sitting side by side, and answer like they are one unit with a designated spokesperson.

[Tim]

Do you dislike when spouses come to medical appointments when only one of them has an appointment? Or just when both have appointments, and you have to focus on both (and both have to do all the pre-doctor stuff simultaneously)?

Sometimes spouses are annoying, sometimes helpful. I agree when younger spouses always come together for routine stuff it’s kind of a red flag. But at least it gives you some info: e.g. patient is in a co-dependent relationship, patient has good family support, patient’s spouse is a major stressor, patient is more/less likely to be compliant with treatment/lifestyle changes based on the noted interaction.

If you really hate it, I guess you could make a no spouse in the exam room rule, but that will probably alienate some people. If you don’t care about that, go ahead. Or you could focus on solutions for the things that really bother you—how can you prevent the rooming delay? Can you make sure if there’s a twofer that they know they must come 15-20 minutes early if they want to be roomed together?

I like to sit the spouse in a position in the room where he/she (in my setting, usually she) is not right beside the patient, and then I am at my computer facing the patient with the spouse in the corner. So they are privy to everything going on and can speak up but I am asking questions directly to the patient. If they keep interrupting or speaking for the patient, I say to the patient “I want to hear your point of view”. It’s not perfect but I feel it goes better than when they are sitting side by side, and answer like they are one unit with a designated spokesperson.

This is a great compromise. So many times a patient can either minimize or exaggerate and you have an additional resource that you can use to pull out of the patient accurate responses. MIL in the ER tried telling the attending she was feeling better and wanted to go home. A freaking fractured hip in a 94 year old. She always tells a doctor that "everything is fine". That is why an appointment was made, there is a problem that she needs a medical opinion. Park the tail end in the corner and use it as you see fit. I doubt seriously if you would allow 5 kids as Cord was suggesting. Great solution. Sometimes the 3 reasons fall back to 2. The other can help simply by reminding that the last problem needs attention. Your experience is showing through. Works with parents too.

[Lordosis]

Do you dislike when spouses come to medical appointments when only one of them has an appointment? Or just when both have appointments, and you have to focus on both (and both have to do all the pre-doctor stuff simultaneously)?

Sometimes spouses are annoying, sometimes helpful. I agree when younger spouses always come together for routine stuff it’s kind of a red flag. But at least it gives you some info: e.g. patient is in a co-dependent relationship, patient has good family support, patient’s spouse is a major stressor, patient is more/less likely to be compliant with treatment/lifestyle changes based on the noted interaction.

If you really hate it, I guess you could make a no spouse in the exam room rule, but that will probably alienate some people. If you don’t care about that, go ahead. Or you could focus on solutions for the things that really bother you—how can you prevent the rooming delay? Can you make sure if there’s a twofer that they know they must come 15-20 minutes early if they want to be roomed together?

I like to sit the spouse in a position in the room where he/she (in my setting, usually she) is not right beside the patient, and then I am at my computer facing the patient with the spouse in the corner. So they are privy to everything going on and can speak up but I am asking questions directly to the patient. If they keep interrupting or speaking for the patient, I say to the patient “I want to hear your point of view”. It’s not perfect but I feel it goes better than when they are sitting side by side, and answer like they are one unit with a designated spokesperson.

If only one person has the appointment then I have no issues. Usually any supplemental people are there for helpful reasons. What I find annoying is when there is two people there for two different appointments. A lot of times one consumes most of the time leaving very little to address the others. And in my experience it is not usually the more complicated medical one that does this.

[Bev]

I dislike going into appointments with other people. However, I used to go to all appointments with my mother because of hearing concerns and dementia. It was necessary, but I could tell that it was annoying to the doctor because I asked a lot of questions.

I do think most men avoid doctors and omit pertinent information.

Lordosis is obviously young and should ask his parents what they think about "two-fer" appointments.

[Lordosis]

I dislike going into appointments with other people. However, I used to go to all appointments with my mother because of hearing concerns and dementia. It was necessary, but I could tell that it was annoying to the doctor because I asked a lot of questions.

I do think most men avoid doctors and omit pertinent information.

Lordosis is obviously young and should ask his parents what they think about "two-fer" appointments.

My parents are divorced but never went to appointments with each other.

Both remarried and still do not do it.

Same with my in-laws. And same with most middle aged to "young elderly" couple I know

[Fugue]

I see both points of view. I get a lot of doubles in my practice, and even triples. One parent and two kids, for example. I had a family of five who all scheduled appointments and no showed the first time around. That was a pleasant conversation.

i’d say in my experience it’s 50-50. Many times the spouse gets in the way. Many times it goes smoothly and lets me be more efficient. But lordosis point is well taken, often times the extra spouse can be a hindrance to efficiency and some practices do have rules that no doubles are allowed, unless it is for specific reasons (dementia, etc). At the height of Covid we did not allow any extra family members into the room unless they were needed to help the patient dress, remember things, etc.

my biggest issue is not the double itself. It’s that often times they show up at the second appointment time, not the first. I am a softy and generally do not come down hard on these cases. But I do have colleagues who will force the first patient to reschedule because they missed their appointment time, which is reasonable in my opinion.

[Lordosis]

I see both points of view. I get a lot of doubles in my practice, and even triples. One parent and two kids, for example. I had a family of five who all scheduled appointments and no showed the first time around. That was a pleasant conversation.

i’d say in my experience it’s 50-50. Many times the spouse gets in the way. Many times it goes smoothly and lets me be more efficient. But lordosis point is well taken, often times the extra spouse can be a hindrance to efficiency and some practices do have rules that no doubles are allowed, unless it is for specific reasons (dementia, etc). At the height of Covid we did not allow any extra family members into the room unless they were needed to help the patient dress, remember things, etc.

my biggest issue is not the double itself. It’s that often times they show up at the second appointment time, not the first. I am a softy and generally do not come down hard on these cases. But I do have colleagues who will force the first patient to reschedule because they missed their appointment time, which is reasonable in my opinion.

Yes that happens as well. I take it case by case. Depends how busy they day is and if the patient has done it before, how much time I think it will take etc.

Good point about the double no show. That is a real kick in the productivity.

[wideopenspaces]

If only one person has the appointment then I have no issues. Usually any supplemental people are there for helpful reasons. What I find annoying is when there is two people there for two different appointments. A lot of times one consumes most of the time leaving very little to address the others. And in my experience it is not usually the more complicated medical one that does this.

Can you just room them separately? Like have the nurse do vitals on person one, you come in and person 2 gets taken out for rooming and vitals a few minutes in to the first person's appointment? You can just say your schedule does not allow to room and vital 2 patients at once.

I know this probably won't work for most specialties but I have a rule that I don't see any 2 members of the same family. I have rarely made an exception, it's always become an issue and inevitably I've had to transfer one of the people to another doctor.

I do allow patients to bring in partners, children, parents, etc but if it becomes clear this is pathological, then we start doing at least part of the appointment alone with the patient. But for me it's just fodder for our sessions, not just a temporary problem to work around.

[Lordosis]

Can you just room them separately? Like have the nurse do vitals on person one, you come in and person 2 gets taken out for rooming and vitals a few minutes in to the first person's appointment? You can just say your schedule does not allow to room and vital 2 patients at once.

I know this probably won't work for most specialties but I have a rule that I don't see any 2 members of the same family. I have rarely made an exception, it's always become an issue and inevitably I've had to transfer one of the people to another doctor.

I do allow patients to bring in partners, children, parents, etc but if it becomes clear this is pathological, then we start doing at least part of the appointment alone with the patient. But for me it's just fodder for our sessions, not just a temporary problem to work around.

This is what we try to do. For people that do schedule back-to-back appointments we try to room the first one and have me get started with them while the nurse gets the second ready. But it doesn't always work.

[familydocPA]

At least they both scheduled appointments with you. Invariably if only one family member has an appointment, the other will have "just a quick question, doc"

[NumberWhizMD]

I typically try to room one first and get in to see them while the other is being roomed. Most of my couples who show up together are older, but I have a few younger couples as well. I've known most of them long enough that I try to not let it bother me any more. I also understand the relationship dynamics a lot better the longer I have known them, so I know how to manage it better.

I do get more annoyed when one is scheduled and the other isn't, but still has questions for me. If clinical, I'll usually tell them they'll need to schedule an appointment, in a tactful way. I don't usually get any pushback on this.

I have had to ask people before to let the patient speak. Usually asking once is enough. And with my teens, I always ask the parent to leave at the end for my additional sensitive questions. Only once was I questioned on this.

[Rando]

I have two nurses so usually just we just check the couple in separately, then see them together if they want. Generally not an issue unless one has dementia, then you need to check them in together in order to get a good history.