The confidential bond between patient and physician is one of the hallmarks of the American medical system. We demand privacy for our check-ups and procedures as well as our medical records. In fact we have a law called HIPPA or The Standards for Privacy of Individually Identifiable Health Information that regulates exactly how medical information can be used to ensure our privacy.
Most adult interaction with physicians occurs alone, or at most, with close family members. But for certain sectors of the population, there’s a small but steady swell in the direction of communal medical visits. There is a positive trade off to giving up the privacy of individual visits. Your doctor can often spend more time with you (even though it is in the company of your peers) in a shared medical appointment. Some medical organizations think this exchange is worthwhile.
Although the set-up of group visits varies by location, the American Association of Family Practitioners says that “a shared medical appointment (also known as a group visit) is when multiple patients are seen as a group for follow-up or routine care. These visits are voluntary for patients and provide a secure but interactive setting in which patients have improved access to their physicians, the benefit of counseling with additional members of a health care team (for example, a behaviorist, nutritionist, or health educator), and can share experiences and advice with one another.”
Some think this could be a wave of the future to increase patient compliance with treatment recommendations and reduce medical costs for chronic diseases. Can the loss of a little bit of confidentiality be assuaged by greater access to your physician and the support of others in the same situation?
The Joslin has been testing this hypothesis by holding shared medical appointments with unrelated patients in its Latino Diabetes Initiative (LDI) since 2006. All LDI patients are invited to participate in the group model. (Participation is voluntary) And from the positive response of both patients and physicians it’s not going away any time soon.
At LDI, the groups consist of 6 to 12 patients and the doctor spends about 90 minutes with the group. Patients come in a half-hour before the scheduled time to have their vitals and laboratory work completed. During the session, all patients’ current treatment regimens and lab values are posted on a white board for the group to see. The physician running the group will speak with each patient individually during the course of the session, but also address common themes arising from that day’s patient issues.
Everyone hears each other’s questions and has an opportunity to provide comments and suggestions.
As an example of the power of the community, Andreina Millan-Ferro, LDI’s Patient Education and Clinical Outcome Coordinator, relates the experience of one patient who needed insulin to control her diabetes but refused. No matter how many times the physician met with the patient individually she would not budge from her stance. At some point in her association with the practice, she decided to attend a group session. Each of the group members except her was taking insulin. She had the highest A1C of the group. By the end of the meeting, the patient had decided to try insulin and the physician hadn’t said a word.
In addition to the clinical aspect of the visit, most group sessions have an educational component facilitated by an allied health professional. The topic can either be pre-selected—for example, foot care may be discussed on the third Monday of the month—or the subject matter can be drawn from the issues brought forward during the clinical portion of the appointment.
According to the AAFP website, group medical visits have the potential to:
- Instill hope in patients by allowing them to see examples of success in managing a health issue.
- Add universality by disconfirming the uniqueness felt by patients regarding their conditions and/or health issues.
- Impart information and allay patient anxiety.
- Encourage an unselfish regard for the welfare of others.
- Promote imitative behavior and allow for positive role modeling among patient peers.
- Offer interpersonal and cognitive learning within the group setting.
- Provide group cohesiveness where peers can offer support among themselves.
Not all patients or medical practices are right for group care, but the paradigm seems to work well for patients with stable chronic disease requiring total mind/body care, and diabetes certainly fits that definition.
Group medical visits have been tried with other patients with diabetes outside the Latino population with success, but the concept still very much an odd man out. So far there hasn’t been cross over into the main clinic at the Joslin, but who knows? Perhaps individual care will someday be the exception.
Would you attend a group medical visit if you were given the chance?