Examining doctor-patient communication in triadic versus dyadic medical interactions in geriatric clinics in Singapore

Due to Singapore's rapidly ageing population, there will be greater demands placed on the country's healthcare system. One of the critical facets of healthcare is doctor-patient communication. Effective doctorpatient communication is linked to higher patient involvement, adherence to recommended treatment, patient satisfaction, quality of care and better health outcomes. ¹² In contrary, many complaint cases in hospitals are related to insufficient communication, ³ underscoring the need for good doctor-patient communication strategies.

Given the elderly's reduced cognitive, mental, and physical abilities, they are often accompanied by family members or others to doctor clinics.^{4 6} However, companion involvement can increase the complexities of the already challenging doctor-patient communication. ⁷⁸ While companions can provide emotional, informational, and practical support, ⁹ they may also take passive or even antagonist role, ⁶ which can negatively influence the doctor-patient communication. ¹⁰

In the United States, around 36-39% of elderly patients visit a doctor with a companion. It is not known what the rate is in Singapore, what roles companions undertake during medical consultations, and how companion involvement influence the doctor-patient communication here. The proposed study aims to fill this research gap by examining the prevalence and typologies of the dyadic (doctor-patient) and triadic (doctorpatient-companion) communication during medical encounters in geriatric clinics in Singapore. The roles of the companion and their effects will also be assessed, from the multi-perspectives of doctors, patients, and companions.

A mixed-method approach comprising two phases will be applied: 1) observation (taped conversations) of dyadic and triadic medical interactions supplemented by surveys and 2) in-depth-interviews of doctors, patients, and companions. This study will perform the first scientific investigation into the triadic versus dyadic communication with elderly patients in Singapore. The insights gained can serve as a basis for future larger studies in doctor-patient communication and have important implications for communication training in medical schools and policy development in healthcare services.

PANG Weng Sun
Professor 
GERIATRIC EDUCATION & RESEARCH INSTITUTE