Physician perspectives on the elderly patient-family caregiver-physician encounter.
BACKGROUND
Eldercare often necessitates the presence of a family caregiver at the senior's visit to a doctor's office. Studies indicate that some caregivers are not satisfied with these encounters or with their outcomes. An understanding of the dynamics of these complex interactions is required.


OBJECTIVE
To explore family physicians' attitudes to interfacing with family caregivers of the elderly, to identify factors within the family doctor-elderly patient-caregiver encounters in the office setting that might be problematic for physicians, to ascertain factors that might contribute to doctors' behaviors and concerns, and to propose possible solutions for optimizing the outcomes of these visits.


METHODS
A questionnaire for self-administration was mailed to 200 family physicians in Montreal, Canada who are affiliated with two community secondary care and one tertiary care hospital and involved in geriatric office practice. The survey focused on family physician attitudes, concerns and observations on the interactions among themselves, elderly patients and their family caregivers during office visits.


RESULTS
A total of 142 completed questionnaires were returned with a 71% response rate. Most family doctors felt that it was their responsibility to respond to caregiver concerns (90.6%) and that they were generally meeting their needs (94.2%). In contrast, 81% found this activity stressful and that as few as three such encounters per day were sufficient to generate stress. Causes of stress included: a) concern regarding misdiagnosis, b) different agendas or conflicting responses of patient and caregiver to doctors' suggestions, and c) reluctance of the elderly or the caregiver to use community resources. A common physician strategy was reliance on acquired professional experience to solving problems of the elderly or of their caregivers.


CONCLUSIONS
Despite the stress involved, physicians are interested in assisting caregivers in the management of the elderly. Many doctors lack adequate knowledge about or confidence in community resources. Clinicians may require enhanced skills in conflict resolution necessary to achieve optimal outcomes.
Yaffe
Mark J
MJ
Department of Family Medicine, St. Mary's Hospital, McGill University Faculty of Medicine, Montreal, Canada. mark.yaffe@mcgill.ca
Klvana
Jacqueline
J
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D017028:Caregivers; D003153:Community Health Services / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D009819:Office Visits; D010817:Physician-Patient Relations; D010821:Physicians, Family; D013315:Stress, Psychological / Q000209:etiology; D011795:Surveys and Questionnaires