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Overview

According to , patients report being more likely to understand and follow clinicians’ advice, discuss difficult topics, ask questions, and be more satisfied when family members or friends participate in medical visits. Clinicians also report understanding patient concerns better when family members or friends participate in medical visits.

Action

Prepare staff and clinical teams.

• Define roles of staff in welcoming family and friends, and provide appropriate training.
• Prepare the clinical team to use conflict resolution techniques in case there are disagreements between the patient and their companion.

Let patients know that family and friends are welcome.

• Have staff who make appointments let all patients know they can bring a family member or friend. For example, staff might say, "Will anyone be joining you?" or "The doctor wants you to know that you are welcome to bring a family member or friend with you, if you like."
• If you have an online appointment system, add a statement that encourages patients to bring family and friends. List the possible roles family and friends can play. For example, "A family member or friend can remind you about symptoms to report or questions to ask, provide you with support, and help you with followup tasks."
• When sending appointment reminders, reinforce that family and friends are welcome.
• At the end of a visit, have clinical team members tell patients that they’re welcome to bring family and friends to the next visit.

Make family and friends feel comfortable.

• Greet family and friends warmly, introduce yourself, and ask them to introduce themselves.
• Confirm with patients that they want the family member or friend to participate.
• Let companions know that they are part of the care team while also requesting them to let the patient speak first.
• For in-person visits: 
  • Have an extra chair near the patient so you can easily look at both of them. 
  • Offer a Note Sheet (or Note Sheet in Spanish) and pens to take notes.
• For video visits, ask them to position the camera so you can see both the patient and the family member or friend.

Engage both the patient and their family member or friend in the discussion.

• Speak directly to the patient, while including family and friends in the conversation. 
• Enlist the help of family or friends if you’re having trouble making yourself understood. Family and friends may be able to identify the source of the difficulty or suggest other phrasing. 
• Do not let family or friends dominate the conversation at the expense of patient participation. Family and friends often provide useful additions to what patients say, but the focus should remain on the patient. If a family member or friend is hijacking the agenda, gently return to the topic the patient wants to talk about.
• Do not rely on family or friends to interpret for patients who prefer a language other than English. 
  • Untrained interpreters are more likely to make clinically significant mistakes. Use qualified interpreters. Refer to Address Language Differences: Tool #9.
  • If patients prefer, they can have family or friends interpret for them. However, you should always have a qualified interpreter present to make sure no errors are made.

Ensure patients get private time.

• It is important to have private time to talk with patients confidentially about sensitive topics such as abuse, incontinence, sexual health, unhealthy substance use, mental health, or memory impairment. 
  • You could say to the companion, "I like to spend the last 5 minutes of every appointment with just my patient. Please wait in the lobby."
  • If questioned, you can respond, "This is routine in my practice. I'm sure you understand. They'll be right out."
  • Be firm—don’t make exceptions.

Track Your Progress

Monitor the impact of your effort using the following suggestions before implementing this tool and 2, 6, and 12 months later.

• Over the course of a week, have check-in staff keep track of the number patients who do and don't bring someone to the visit. Record the percentage of patients who brought someone with them.
• Over the course of a week, have check-out staff ask patients who did not bring a companion, "Did you know that you’re welcome to bring a family member or friend to visits?” Record the percentage of patients who answered "No." 

Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions. 

Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.