La relation à trois dans la consultation avec un patient âgé

Very old age and dependency increase the recurrence of third party presence during medical consultations. Such presence, however well-intentioned, is far from being neutral and has a range of repercussions on the examination (as regards communication, psychological dynamics or possible coalitions). It compels practitioners to engage in a second relationship with the third person, which affects their primary relationship with the patient. An exploratory study has been conducted in order to better define how physicians organize their consultation when a third person accompanies an elderly patient; how they perceive that third party presence and what impact it has on self-censorship during the medical encounter. Thirty-one general practitioners responded to a questionnaire. The results are the following: accompanied elderly patients were seldom examined without the presence of the third person. In general, practitioners did not perceive the presence of a third person as disturbing to the relationship and thus they were rarely the ones to request a face to face examination. Lack of time, an often cited argument, was not the determining factor for triadic consultation. Self-censorship in such presence is high and involves matters closely related to the patients' health (e.g. personal hygiene, alcohol, abuse). These results would justify some accommodation in the framework of the consultation, in order to have separate time-slots for the elderly patient and the third person respectively. Such accommodation is not easy to organize and practitioners could (should) be better trained in that regard.