Abstract:

Ongoing discourse from 40 transcribed medical visits involving an elderly patient, family caregiver, & physician reflects uncertainties about the capabilities & responsibilities of each person in this triad. Interactive behaviours that support patient self-care capabilities & those that support dependency are identified & described, & patterns of interaction related to the patients' cognitive or sensory impairments are explored. The presence of a family member at an older patient's medical visit - in combination with the authoritarian traditions of medical care, assumptions about frailty & aging, & true impairment - appear to trigger behaviors that marginalize the patient & support dependent self-care. Behaviours that support independent self-care are less evident. An awareness of this tendency may enable physicians, family members, & patients to break the cycle of increasing dependence & support instead the patient's adult independent status in the clinic setting.