Group Doctor Visits Gain Ground

WANT to spend more quality time with your doctor? Maybe you should try joining a group.

Paradoxical as that may sound, it works remarkably well for Bill Swain, 69, who began going to shared medical appointments several years ago after his doctor suggested the idea. Now he attends quarterly sessions for eight to 15 people that usually last 90 minutes.

A digital white board lists group members’ vital signs, such as blood pressure and weight. Mr. Swain, who doesn’t like falling behind his peers, especially likes the accountability and the extra medical attention.

“Yearly physicals can mean sliding too far back,” said Mr. Swain, who is retired and lives in Ellensburg, Wash. “I had a lump on my neck a few months ago. It turned out to be nothing, but I might have put it off until my physical. This way, I have the physician’s ear four times per year.”

Shared medical appointments are still relatively rare, but they are slipping into a system rife with 15-minute doctor visits, nearly doubling in popularity in the last 10 years, according to the American Academy of Family Physicians. And they are being seen as one weapon for fighting fast-rising diseases like diabetes, which threaten to overburden the health care system.

Several studies show that group visits are particularly effective at keeping chronic illnesses in check. Typically, recent lab results are discussed and patients can schedule individual time with doctors if they need it. Nurses are also on hand to refill prescriptions or take vital signs.

Some experts see shared medical appointments as one antidote to the increasingly rushed typical medical visit, which doesn’t provide enough time to discuss chronic illnesses or overall wellness care. An aging population will intensify the need for new solutions in coming years, experts say.

The idea of structured group visits is generally considered the brainchild not of a physician but of Edward Noffsinger, now a semiretired California psychologist. Though he had a life-threatening illness, Dr. Noffsinger said, he had difficulty getting an appointment to see his doctor, and even when he did, visits were too rushed.

“I wanted to give people more time with their doctors,” he said. “And then there’s the opportunity to share with other patients. People feel responsible to others, but not their doctor.”

These days, the medical treadmill keeps going faster and faster, he said. “The problem is getting worse, not better,” he said. “But when you’re sick, you want good care and support.”

Byron Haney, a family physician and Mr. Swain’s doctor, sees group visits as a powerful prescription. Patients are able to take over more of their own care, while he acts as a facilitator. “It’s so outside the box,” Dr. Haney said. But the results, he added, are startling, such as greater patient satisfaction and sustained weight loss.

“People leave knowing that recovery is possible and that they’re not alone,” Dr. Haney said. He sees shared appointments as a powerful community medicine tool to more effectively meet future needs.

Dr. Haney also uses shared medical appointments to help prevent diabetes, one of the country’s fastest growing diseases. “I’ve never had a prediabetic convert to diabetic in a group setting,” he said.

Shared medical appointments are being used elsewhere, too. Joslin Diabetes Center, based in Boston, offers the Weight Achievement and Intensive Treatment program, a 12-week program and group intervention for diabetics that helps control weight and manage the disease.

During the program, nearly 500 people have lost an average of 20 pounds each, according to Osama Hamdy, medical director of the Obesity Clinical Program at Joslin, and an assistant professor of medicine at Harvard Medical School. Moreover, Dr. Hamdy said, many have managed to maintain their weight loss and reduce their use of medication.

“People in groups do much better than individually,” Dr. Hamdy said. “They find wonderful friendships and motivate each other.”

Mike Herlihy, a 69-year-old diabetic, turned to the Joslin program several years ago after having trouble losing weight on his own.

“The program completely changed everything,” he said. By the end of 2010, he had lost 70 pounds, and he has managed to keep most of the weight off. Changing his lifestyle was the hardest part, Mr. Herlihy said. But the Joslin program, and the team there, helped him.

“Behavior change is the toughest thing to do,” he said. “But this is a holistic approach.”

Mr. Herlihy says he continues to exercise one hour a day, regularly checks his sugar levels and even carries a scale to weigh in when he travels. “I learned discipline, like eating slower or having only half a sandwich,” he said. “I feel pretty good, and that’s reinforcing, too.”

Nevertheless, shared medical appointments are not a panacea.

The group visits don’t work for everyone, said Edward Shahady, a family physician and medical director of the Diabetes Master Clinician Program at the Florida Academy of Family Physicians Foundation in Jacksonville, Fla. Some patients find that it’s not their style, said Dr. Shahady, who has been offering shared medical appointments since 2003.

And Dr. Carole Lieberman, a psychiatrist in Beverly Hills, Calif., bristles at the whole idea of shared medical appointments.

“Medicine is deteriorating in many ways,” she said. “It’s all about saving money. And group visits are the next outrage.”

Dr. Lieberman argues that spending time with one’s doctor helps build rapport. “And seniors are getting the worst of a downward spiral in health care,” she said.

But many patients thrive under the regimen, Dr. Shahady said, and studies suggest that group visits are generally beneficial. Older patients like the socialization offered by groups, he added. And though they might be shy to share at the beginning, many quickly start talking, even about such intimate matters as sexual dysfunction.

The renowned Cleveland Clinic, which introduced group visits over a decade ago, has been folding more shared appointments into its schedule. The clinic now offers many varieties, including ones for diabetes, high blood pressure, wellness and Parkinson’s disease.

To attend these group visits, patients typically sign confidentiality agreements, which give them more privacy.

Dr. Marianne Sumego, an internist and director of shared medical appointments at the Cleveland Clinic, acknowledges that group visits are not right for some people.

“This is patient-centered,” Dr. Sumego said. The visits provide more timely prevention and treatment in many cases, while other patients do better with one-on-one sessions with their doctor, she said. “With an aging population, I need to think outside the box.”

Mr. Swain in Washington is pleased with his results. Cheered on by his peers, he has given up chocolate ice cream and sugar in his coffee. “They encourage me to take the best care of myself,” he said.

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