title: Effects of family presence on the content and dynamics of the clinical encounter among diabetic patients.
abstract: OBJECTIVE
  Primary care visits often include a family member or friend. The purpose of this study was to determine the effect of the presence of a family member on the visit content and dynamics among diabetic patients in Family Medicine settings.
  
  
  METHODS
  Encounters of patients with type 2 diabetes from 20 primary care clinics were audio-recorded and transcribed. Encounters were coded using the Davis Observation Codes, classifying content into 20 different categories at 15-second intervals. A random sample of 30 patients with family members was selected; 30 encounters in which no family was present were then matched to the randomly selected patients so that they would be similar group-wise in A1C level, length of visit, level of distress and discussion of non-patient family problems for analysis using orbital decomposition, an analytic technique based on symbolic dynamics in which categorical time series data are used to identify amount of complexity present and recurrent patterns of strings.
  
  
  RESULTS
  Visits were more linear if family members were present. When family members were present, 90-second strings of preventive services and evaluation/feedback were observed while 90 seconds of exercise discussion occurred when they were absent. Visits without family members tended to include more chatting, compliance discussion and nutrition counselling, while those with family members included more patient questions and evaluation/feedback. Finally, the sequence of history-to-planning-to-evaluation was observed when family were absent, but evaluation-to-planning-to-history when family were present.
  
  
  CONCLUSIONS
  The presence of a family member was associated with increased linearity and recurrent patterns that focused more on evaluation/feedback, preventive services, and patient questions, and less on chatting, exercise, compliance and nutrition in diabetic encounters.
authors.affiliation: University of Texas Health Science Center, San Antonio, Texas, USA.
authors.forename: David
authors.initials: D
authors.lastname: Katerndahl
authors.forename: Michael
authors.initials: M
authors.lastname: Parchman
mesh_terms: D000368:Aged; D003376:Counseling; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D005190:Family; D005195:Family Relations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D010349:Patient Compliance; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000458:organization & administration*; D013315:Stress, Psychological / Q000453:epidemiology; D013997:Time Factors
keywords: clinical encounter; diabetes; doctor-patient relationship; family practice; non-linear dynamics; systems science