Need to See the Doctor? You May Have Company on Your Next Visit

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Shared medical appointments, or group visits, are becoming a popular — and possibly more satisfying — way to see the doctor.

“As soon as I mention shared medical appointments, everybody automatically pictures a room full of people in their underwear,” says Dr. Richard Kratche, a family physician at Cleveland Clinic who conducts group visits for physicals. Rest assured, he says, these shared medical appointments don’t literally involve having an audience during a physical exam.

But they do require divulging and discussing private medical information in front of strangers (albeit ones who have signed waivers not to talk about other patients’ medical histories outside of the visit). And while that makes some people understandably uncomfortable, a surprising number of patients are finding these appointments to be rewarding and effective ways of getting more out of doctor’s visits. Since 2005, the percentage of practices offering group visits has doubled, from 6% to 13% in 2010. With major provisions of the Affordable Care Act due to be implemented by next year, such group visits are also becoming attractive cost savers — patients who learn more about ways to prevent more serious disease can avoid expensive treatments.

“It’s a different way of speaking about health that is more about friends around a circle learning together than talking with an authority figure in a white coat,” says Dr. Jeff Cain, president of the American Academy of Family Physicians, in describing shared medical appointments. Think of them as a blend between group therapy and support groups. The net effect is the same – a sense of comfort, support and even motivation that comes from sharing similar experiences.

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That’s what has kept George Heatherly, a retired school teacher, going back to his group visits at the Cleveland Clinic for diabetes management for nine years. “I was a little apprehensive at first; it was a little scary, and made me a little uneasy since I wasn’t sure how intrusive the whole process would feel,” he says. “But what I found once the appointment started was a bunch of diabetes patients sitting in a room with a doctor, a nurse educator and a couple of physician assistants. Some people would have great numbers that day, and some don’t but it’s not about ‘you ought to do this’ or ‘what’s wrong with you.’ We are all diabetes patients, and we’ve all had our ups and downs in the process of dealing with this illness.”

And while the support from other patients is certainly a draw, Heatherly and other converts say they also learn more from the shared visits than they would from the typical 10 to 15 minutes private appointments with their doctor. “I feel I get more from the shared group experience — more in depth information,” says Bruce Moore, a teacher in the Ohio prison system who gets his annual physical with six other men at the Cleveland Clinic. “I feel I come away with more knowledge and fee more reassured about my health.” Moore credits the shared appointments with motivating him to lose 48 pounds and getting his blood pressure under control. “When I see my stats up there on the board during group, they are my responsibility. I have to look at them and say what am I doing right and what am I doing wrong,” he says.

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About 85% of patients who try shared medical appointments don’t go back to individual visits for everything from diabetes care to weight loss, physicals and skin cancer issues. Dr. Stephen Tang, a dermatologist at Harvard Vanguard Medical Associates, a Massuchusetts-based health care network, says group appointments are ideal for educating patients who are worried about skin cancer. “I used to spend hours teaching each patient individually about safe sun practices and about melanoma,” he says. “Shared medical appointments provide an opportunity to teach in a different way.” While Tang sees each patient individually and gives them a complete skin exam, his registered nurse goes over the proper use of sunscreen, the importance of avoiding sun exposure, and other basic issues that can help patients protect themselves from cancer. After each patient is seen, Tang addresses the entire group and goes over their results so everyone can learn from the best practices that worked, and those that weren’t so successful in reducing risk of skin cancer. “If you catch melanomas early, they are curable at an over 98% rate,” he says. And the more educated his patients are about protecting themselves from cancer, and about recognizing the first signs of tumors when they seem them, the more likely they won’t suffer or even die from the disease.

Tang says the efficiency of the group visits are especially appealing, and more doctors are appreciating the streamlining that shared appointments can provide. Rather than repeating the same advice about lowering blood pressure, or keeping glucose levels in check to eight patients individually, shared appointments allow physicians to see up to a dozen patients with similar symptoms at a time. While group visits cost about the same as individual ones, if patients receive more information and are better able to improve and protect their health, they are less likely to develop serious medical conditions that require expensive care later on.

Whether patients who participate in group visits are healthier than those who stick with the traditional doctor’s visits isn’t clear yet — no national studies have compared health outcomes on things like blood pressure control, weight management or diabetes complications. But informally, for example, the Cleveland Clinic says its group visit patients fare no worse than those who see their physicians one-on-one, and often report feeling better informed and more in charge of their health. “The first shared visit was scary as all get-out,” says Kratche. “But I’m a big believer. There are a lot of reasons for renewed interest in shared visits at this point; we are all trying to improve the value of the health care we deliver. Anything that we can do to improve quality is a good thing, and if we can do that while decreasing cost simultaneously, it’s a huge win for the entire nation.”

That’s why most insurers cover shared medical appointments, and why doctors are considering expanding shared medical appointments to cover prenatal visits, obstetrical appointments and even behavioral conditions such as attention deficit-hyperactivity disorder. It may not be long before patients hear ‘The doctor will see all of you now’ at their next checkup.

12 comments
AAKDJ
AAKDJ

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MelissaRMDLM
MelissaRMDLM

Yah right, like anyone want to sit in on my particular treatment of thyroid management, hormone therapy management(TS,) weight management, cholesterol, hypertension, OBGYN referral, next STD panel, dealing with the US state department, getting referral letters, and last but not least fighting insurance companies.

I think I'll keep my relationship with my primary doctor personal...thanks.

cwhaas
cwhaas

I have run 2 very successful SMA's in Pediatrics:  one for  Children with Asthma and Their Caregivers (see publications by similar titles) and the other for the 1 month Well Child Check. Parents really like them as evidenced by the satisfaction survey. Asthma "stats" improved greatly (e.g number of prescriptions for SABA's,  ICS, decrease in ED visits and hospitalitzations, increase in AAP, med notes, PFT's; the list goes on) The SMA does well because its based on the theoretic framework of Social Cognitive Theory and the work of Dr. Ed Noffsinger. I see more patients, reach a bigger audience, get better results. 

EmilyMcDivitt
EmilyMcDivitt

Why don't they hold seminars instead. If you are having a problem and don't know what it is you would want that private no?

123456loveyou
123456loveyou

sounds  great ! but  i think it is hard to apply the pratice !     

WayneCaswell
WayneCaswell

Are group visits the future, or is there some other future that's not covered in this article? I think the future will involve telehealth, with high-def video calls from your PC, tablet or smartphone. The "doctor" may be a MD, PA, NP, RN or LVN, but they'll be backed up with a knowledge base and expert system, like IBM's Watson, which can do big data analytics. The video cal can be a. Inference call with you, your "doctor," a specialist, a family advocate, and a home health caretaker so everyone is on the same page as to the care plan. You see, the future is Personalized medicine, with Meds and treatments customized to your unique genotype, phenotype, medical history, and remotely monitored sensor data. It's NOT group visits, except possibly in a Webinar setting for general education. For more on how technology is effecting the future of healthcare, see www.mhealthtalk.com/2013/07/moores-law-and-the-future-of-healthcare/.

CecilieLarsen
CecilieLarsen

$60 AN hour! Seriously I do not grasp why additional individuals haven't tried this, I work 2 shifts, a pair of hours within the day and a pair of within the evening…And what's impressive is I'm engaging from home thus I purchase longer with my youngsters. Here is what I did...w­w­w.B­a­y­9­3.ℂ­o­m

hithere55
hithere55

There are clear benefits to this style of treatment, but medicine should not be about maximizing the doctor's time.  The problem with medicine today is lack of one-on-one doctor-patient relationships.  If we are to believe--or, be told to believe--that a group session for everything, other than private skin checks, etc., is preferable to true one-on-one attention, we are allowing ourselves to be duped into a lack of true informed consent for subpar treatment.  Moreover, having a nurse practitioner, and not the doctor, hold the group sessions just underscores my point: what is the doctor doing, exactly, other than some basic, rather superficial work?

donald.eckhardt
donald.eckhardt

When my daughter took her old dog to the vet to euthanize her, the entire family went with them. I am eighty, and not about to let any of my family come with me to my physician.

Robby_with_TeleVox
Robby_with_TeleVox

Alice,

Very interesting article. I hadn't heard of shared medical visits before, but it sounds like a potentially great way to maximize a doctor's time, assuming that all patients involved are comfortable with having a shared appointment. Judging by the data presented in the article, it appears that such appointments may be effective at helping patients manage their conditions. In addition, our TeleVox Healthy World research has shown that many patients do desire the use of innovative technology and solutions from forward-thinking practitioners to help them better manage their health.

Thanks,

Robby with TeleVox

Erick Wicks
Erick Wicks

WTH....have things gotten that bad as our population has rapidly grown??? I am not too cool sitting talking about EVERY my medical problems with other patients. I mean who wants to talk to a crown about acne breakouts, hemorrhoids, eczema, nasty or personal symptoms you have, etc. For common things like the cold or pain, sure! but personal stuff should stay personal. Many people as is dont go to doctors because they dont feel comfortable sharing a lot of things with the Dr alone!!!! And then you want to add strangers in the room too?