Entry into the health care system: the family's decision-making process.

Background And Objectives: Prior work has demonstrated the importance of family members in deciding whether or not to consult a physician. This study investigated how such decisions are made and what dimensions are important in the decision-making process.

Methods: Thirty middle-class couples each role-played four hypothetical illness situations. Verbatim transcripts were analyzed according to a negotiation paradigm.

Results: If the decision was to wait rather than to consult a physician, the decision was more likely to have been initiated by the person designated as experiencing the signs and symptoms. Conversely, if the decision was to consult a physician, the decision was more likely to have been initiated by the spouse. Subjective views of the meaning, duration, and effect of the signs and symptoms were important dimensions in deciding whether or not to call the physician.

Conclusion: We suggest that family practice residents be taught to inquire about family members' roles in the patient's decision to seek health care. This would demonstrate in a concrete way, beginning with the initial steps in the doctor-patient interview, the family physician's commitment to the context of the family.