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.
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.
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.