Lenny Morrison of Ellensburg, Washington, started taking medication to treat high cholesterol in 1992. Almost two decades later, his cholesterol was still high and his weight was ballooning, while his blood pressure and blood sugar levels had also started to creep up.
“I was probably my heaviest and most out of shape,” says Morrison, who at 5 foot, 5 inches, weighed about 175 pounds. It was around that time, five years ago, when his primary care provider, family physician Dr. Byron Haney, who is in private practice in Ellensburg, suggested he try shared medical appointments.
A typical doctor’s visit might last 15 to 20 minutes and involve one patient and one doctor. Shared appointments, on the other hand, often last around 90 minutes, and it’s not uncommon for 10 patients to see the doctor during that same appointment — though the number varies — for anything from management of a chronic disease, like diabetes or asthma, to routine primary care.
[See: 10 Lessons From Empowered Patients.]
According to the American Academy of Family Physicians, an estimated 10 percent of family doctors offered shared medical visits in 2015; that’s up from 5 percent in 2005. Across other medical specialties, it’s not clear exactly what proportion offer shared medical visits, but experts say it seems an increasing number of health providers are conducting group visits. A concept widely credited to psychologist Edward Noffsinger, these have been adapted for the medical setting (where the term shared medical appointments has taken hold) over the past couple decades.
During that time, patients like Morrison have begun to realize the benefits of this emerging alternative to the traditional care model. “You’re in a room with people that have [similar] problems, so you get to hear about what they’ve gone through and think about what you can do to improve,” he says. Morrison sees Haney in this group setting every three months, along with a half dozen or so other patients — including some who are prediabetic or diabetic. Patients share experiences, and vital numbers, from fasting blood sugar to cholesterol levels, are checked in the office. Those are posted during the visit, so all patients can see the progress (or backsliding) they’ve made. Morrison says it helps that his peers are real — no perfect patients — and that they can all learn from one another.
Shared medical appointments differ from models like support groups or even group therapy. Namely, health providers who conduct the group visits provide hands-on care, such as blood pressure checks or listening to a patient’s heart, and perform the functions they would during one-on-one visits like writing prescriptions for medication refills. More intimate evaluations — like if a patient needs to disrobe — would still be done in private, one-on-one, says Haney, who is a professor of medicine at Pacific Northwest University of Health Sciences in Yakima, Washington, where he teaches medical students about shared medical visits.
The combination of doctor education and learning from peers has helped Morrison make substantial lifestyle changes — including how he eats and informing a passion he developed in recent years for working out. He’s even become a personal trainer. Ultimately, that allowed him to reduce his cholesterol levels so he could come off medication, and Morrison says he’s now in the best shape he’s ever been in, weighing about 150 pounds. “I have gotten … my life back,” he says, and he shares his experiences with other patients during group visits.
Patients like the extended format of shared medical appointments, and they’re often hearing information in response to questions they forgot to ask — or didn’t think to ask — that can benefit their care or self-management of a condition, says Dr. Marianne Sumego, an internist and pediatrician, and director of shared medical appointments at Cleveland Clinic.
[See: HIPAA: Protecting Your Health Information.]
Shared medical appointments were first offered at Cleveland Clinic in 1999, and now more than 100 providers facilitate group visits for everything from diabetes management to pediatric care and treatment of osteoporosis. Visits are focused on addressing issues where a certain amount of patient education is required and self-management is needed to control a disease.
Patients who participate in shared medical appointments typically sign paperwork in advance acknowledging they’ll be sharing health information not only with a doctor but in front of other patients, while also stating that they plan to keep discussions within the group.
However, Jamie Court, president of the not-for-profit Consumer Watchdog, still sees potential problems with the format. “For the patient, there are privacy issues, confidentiality issues, and patients will often feel more comfortable saying something in a one-on-one, physician-to-patient meeting, than they will in a group,” he asserts. “So there may be key parts of a diagnosis that aren’t reached if patients have to rely exclusively on group visits and don’t ever get one-on-one time with the doctor.”
Doctors who offer shared medical visits emphasize that patients are free to share as much or little information as they like, and that one-on-one visits are additionally arranged, where needed, like when a patient brings up a more involved medical concern during a group visit. Proponents of group visits also say privacy concerns are overstated and that most patients who opt to go to group visits find the peer community more helpful than intrusive.
But while the vast majority of doctor’s visits are still one-on-one, Court worries that patients may feel compelled to go to group visits by health providers or HMOs focused on the bottom-line — such as if it’s very difficult to schedule a one-on-one appointment with a doctor and more convenient to schedule a group visit instead. “I’m just concerned it’s another cost-cutting tactic by hospitals and medical groups to save money at the expense of patient care, and I think the jury’s out on whether the group medical visit is based on the best science, or the best budgeting,” he says.
Haney says shared medical appointments absolutely reduce the cost of care, while also improving the quality of care and the patient experience. Though he encourages his patients to try shared medical appointments, he says he isn’t aware of patients being pressured, or compelled, in any way to choose group visits over one-on-one visits.
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
Experts say patients who are weighing whether a group visit might be the right fit should approach it on a trial basis. “These are optional visits,” Sumego emphasizes. She reiterates that the vast majority of patient-doctor visits at Cleveland Clinic are one-on-one. But, she adds, shared medical appointments are certainly a model of care that can improve outcomes. “It’s really meant to support and supplement what the patient’s already receiving and doing in order to manage their condition.”
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Group Visit: Why Shared Medical Appointments Are Gaining in Popularity originally appeared on usnews.com
