Written by Jennifer Nelson for Next Avenue
Typically, you see your doctor in brief 15-minute appointments that go by in a flash. There’s barely enough time to chat about your primary concerns, let alone things like diet, exercise and lifestyle issues. But what if you could spend 60 to 90 minutes with the doctor, along with other patients who have the same illness? Meet the shared medical appointment.
Psychologist Edward B. Noffsinger came up with a model for group appointments after he became seriously ill between 1988 and 1992. He decided patients should have more time with the doctor, not less.
A shared medical appointment is typically a 90-minute session where six to 12 patients are seen in a group. The doctor or other health worker talks to each one in turn, and other patients there may weigh in. All are united by a common condition or goal, like diabetes, weight management or wellness.
For instance, in a diabetes management visit, the physician starts with the first patient, discusses his or her diabetes, goes over that patient’s latest lab values, determines medication or refill needs and hits on certain concepts about managing diabetes that could be valuable to the rest of the group.
As the doctor makes her way around the room, she elaborates and expands on some concepts while skipping ones already brought up. In between patient care, a facilitator may demonstrate how to use a device or discuss the importance of a flu vaccine, said Dr. Marianne Sumego, specialist in pediatrics and internal medicine and medical director of shared medical appointments at the Cleveland Clinic.
Anything that involves the physical examination of the patient is done privately. “One of the things people have a fear of is that 12 people go in and disrobe together. That doesn’t happen,” said Scott Wallace, an associate professor and expert on incorporating the group medical appointment at Dell Medical School at the University of Texas at Austin.
The Cleveland Clinic incorporated shared medical appointments formally in 2010. Today, it offers shared appointments for more than 150 conditions, including kidney disease, coronary artery disease, chronic pain, addiction, pregnancy-related back pain and more.
“We focus on prevention for a lot of conditions, maintenance for a lot other conditions, and even some conditions where the focus is at the discharge level — reducing the chance that someone gets readmitted and what to do in order to not be hospitalized again,” Sumego said.
In a group appointment, patients chat about how their medications are working (or not), whether they need to adjust their diet and exercise plan, their blood work results, how they’re managing their illness and more. The doctor may ask a patient where he’s eating out or learn that she’s a schoolteacher who has a lot of stress. Such discussions can elicit crucial facts that can help other patients cope better with their illnesses.
“In a shared appointment, those factors come out much more frequently and there’s time to address how you might manage them,” said Sumego.
Some clinics with shared appointments join the newly diagnosed with those who’ve had a condition longer. Groups may stay together for repeat appointments or have different participants each time.
Group office visits started about a decade ago, and in recent years the number of patients and facilities taking advantage of them has grown.
“They initially started more around the efficiency issue than around the effectiveness issue,” said Wallace. Much to everyone’s surprise, they turned out to be both efficient for doctors and effective for patients, he noted.
Those sharing the appointment almost form a community, even if it only lasts as long as that particular appointment. Patients learn a great deal more about their medical circumstances because they hear many other perspectives and condition-specific issues and get insights into them.
“One problem with chronic disease is that it’s isolating. When people are diagnosed with a chronic disease, they typically feel excised from the broader community,” said Wallace. You may not feel comfortable talking about your condition socially, but in this context it’s welcome.
A group setting can also help patients feel freer to discuss topics they might not get to broach one-on-one with their doctor. Everyone with the same illness can share how they work in exercise or scale back on sweets, for example.
“I think the value comes from both the clinician and the shared medical experience of others,” said Wallace. Patient knowledge is often more important than the clinician’s knowledge when it comes to managing the day-to-day of chronic conditions. Doctors serve as both a host for patient knowledge and a repository of traditional medical information, Wallace said.
One group Wallace sat in on discussed frying chicken without skin to help cut fat from the diet. “There’s not a lot of physicians out there who talk about frying chicken during the office visit,” he said. A woman in another group shared how she “accidentally” ate a donut, something not part of her diet plan. While the “accidentally” part got all-around chuckles, it then morphed into a discussion of not always being perfect in managing illness.
To find a shared medical appointment, ask if your clinic or medical facility offers them. Patients may have to sign a confidentiality agreement that states, like Las Vegas, what’s shared in a group appointment stays in a group appointment. And of course, one-on-one visits are still the norm for exams and other acute health care issues.
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