Have you ever wondered what it would be like to sit in on a doctors appointment with a patient with a similar illness to yours? Wouldn’t it be interesting to listen in to see how they approach discussions with their (your) doctor, whether they’ve got the same concerns and side effects as you’re experiencing?
Can you actually imagine it happening though? Sharing your appointment with another patient may seem unlikely in todays health care environment where the assumption always has been that patient privacy is sacrosanct. But this commonly held assumption may be wrong…
In this months’ Harvard Business Review a novel approach to appointment scheduling which allows appointment sharing between patients. Not just one other patient – up to 11 other patients to share a single appointment. Patient satisfaction with the system is about 98%. So how does it work?
Dr. Amy Tucker is a cardiologist at the University of Virginia Health System where they have originated the concept (known as Club Red). At the clinic, patients are given a choice between a one on one appointment with their specialist, and a 90 minute shared appointment where they are seen by their doctor in a group. The patients don’t sit in a waiting room either. They all gather in a meeting room where they will complete some paperwork, have a few basic measurements taken and chat informally with other patients. The doctor then goes through the patients one at a time, addressing their concerns, orders tests, discusses progress and sets further treatment plans for each patient. Any physical examinations are done privately by the doctor outside the group.
These discussions all take place openly within the group. Although the consultation is private within the group (patients sign a confidentiality agreement), it is not private in the traditional sense.
According to the clinics’ website, many patients think of the shared appointment as a seminar or class because of the wealth of information they obtain and the length of time spent at an appointment. The patient advantages of a shared medical appointment are that patients get to spend more time with their physician, no waiting room time, faster access to their doctor, and having the help and support of other patients who have similar health issues. They also leave with more information and answers to questions they never even though to ask themselves.
The advantages to the doctors are clear; In 90 minutes, they can see 10-12 patients rather than the usual 3 to 5, providing obvious efficiencies in terms of physician time. Whereas one might assume that the process lessened the patient connection with their clinician, the article suggests that ‘counterintuitively, Club Red members develop a stronger connection with the doctor, largely because they observe his or her expertise and empathy in dealing with patients’. Although I’d like to see some published information on this process, it does seem to challenge a number of commonly held assumptions – something we need to do more of in healthcare.
Whereas I’m unsure as the applicability of this process to my own specialty, I’d love to know what patients (and colleagues think). How would you feel about sharing your clinic appointment with a group of other patients with a similar disease? Would you feel comfortable talking about your own health care problems with other patients present?
Here’s Sharon Jones and Marcia Johnson, two shared appointment participants describing who it all works….
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That really sounds more like a seminar and facilitated support group than a doctor’s appointment. The way the video describes things, I can see that it might be beneficial. Not sure that I’d want to participate on an ongoing basis, though. It’s the kind of thing that I might try once or twice before making a committment to.
Regardless of whether or not people in the group signed confidentiality agreements, I would never trust that people wouldn’t accidentally reveal something they shouldn’t, so would be very selective in what I’d say in the group.
Thanks for your input Warm Socks.. It seems that patients have the option of dipping in an out or changing their minds. I would share your concerns about the confidentiality issue but I guess those who attend will self select because privacy is less of an issue. The patient populations / disease states would have to be chosen carefully for this reason, Have a look at Brian McGowans reply below for further discussion.
Personally, I’d loath it.
I was treated for breast cancer a few years ago and it was a real effort to navigate past and beyond all the various groups that people thought I’d suddenly just love to spend my time with people with whom all I had in common was a shared illness. Horrendous thought. Yoga sessions, support groups, relaxation groups, various complimentary therapies/quackeries etc etc. Thanks, but not a snowballs chance in hell.
The very last thing I’d want to do is spend time listening to the minutiae of other people’s illnesses, whether the same as mine or not. It is the very definition of tedium.
That said, these various groups and activities seemed to be enthusiastically attended by loads of people, so I may be an outlier.
I find this idea to be very compelling. We talk constantly about patients connecting with other patients through social channels. Why not connecting IRL with other local patients under the care of the same provider team? Sharing experiences, etc. Consider that one patient may be better at articulating a question about a shared experience than another patient. All patients in the room would be the beneficiary of that enhanced interaction.
I would sign up for this instantly if I had a chronic condition.
Here is some background I provide on small group therapy in Chapter 4 of #socialQI:
“By some accounts, Joseph Hersey Pratt is credited with the first
use of small groups in a therapeutic manner when in 1905 he began
treating patients suffering from severe tuberculosis.3 By the time he
published his findings in 1953 he claimed to have treated more than
3,000 patients. Pratt referred to his small group sessions as classes in
“thought control, emotional re-education, and persuasion.” His weekly
sessions began with education, to teach his patients to best care for
themselves and their illness, and he included several behavioral techniques
such as keeping diaries and publicly tracking and recording
weight gain. Over time he began to realize that the group process itself
had a therapeutic effect. Pratt wrote of his experiences that, “The class
meeting is a pleasant social hour for the members . . . a spirit of camaraderie
develops”; to challenge the members of the group, “ . . . the greatest
gains in weight are posted conspicuously . . . the member who remains
outdoors the longest is recognized”; and finally, “the favorable cases
that are making rapid progress toward recovery infuse a spirit of hope
in all . . . .” His lessons later evolved into the core therapeutic principles
of peer-to-peer healthcare.
Cohesiveness: Allows members to feel a sense of safety, acceptance,
and validation.
Universality: The recognition of shared experiences and feelings
among group members serves to remove a group member’s
sense of isolation, validate their experiences, and raise
self-esteem.
Altruism: The experience of being able to give something to
another person can lift the member’s self-esteem and help
develop more adaptive coping styles and interpersonal skills.
Encouragement: A member can be inspired and encouraged
by another member who has overcome the problems with
which they are still struggling.
Development of socializing techniques: Provide a safe and
supportive environment for members to take risks and eventually
improve their interpersonal skills
Imitative behavior: By observing and imitating the leader
and other group members, members can develop and improve
their interpersonal skills
Information sharing: Members report that it is helpful to
learn factual information from other members in the group.
Interpersonal learning: Members achieve a greater level of
self-awareness through the process of interacting with others
in the group and through feedback.
Since the time of Pratt there have countless examples of social-based
models for driving health and wellness. Of these, two have been
heralded as the classic examples: Alcoholics Anonymous and Weight
Watchers. I will add a third more recent example to round out the discussion:
Pastor Rick Warren’s “The Daniel Plan.” Then, we will look at
an entirely different way to understand the social influence on health…”
Clearly, I am eager to learn more about this model, both from a healthcare quality impact perspective AND from a healthcare policy perspective.
Thanks for sharing!
Brian
Thanks Brian. A really enjoying SocialQI and would thoroughly recommend it to patients or healthcare professionals interested in the power of social networks (in real life and online) to improve health outcomes.
My own feeling on this is that it won’t be for everybody. The preventative health setting (womens’ cardiac health for Club Red) seems to work best. Trying to do it for complex diseases such as rheumatoid / lupus (where detailed physical exam usually needed) or where severity varies enormously might be tricky.
Interesting feedback from lots of people here though.
Great concept Ronan. As “WarmSocks” has already pointed out, it sounds like a facilitated support group which is already done in many other healthcare professions especially dietetics, nursing and exercise therapy (in the form of classes or seminars). The only difference here is that it is being tried and tested by specialist physicians as the facilitators and we are calling it a group appointment as opposed to a seminar or support group.
In Australia, you would need specific government funding models for medical specialists to consider offering such a service where the doctor is the facilitator for the entire session.
Overall, I can see it being an excellent service to provide for a particular patient profile paired with an open minded physician.
Ronan, thanks for writing and sharing another thought provoking article. I think that whilst most of us would probably hate the thought of sharing our initial appointment with a specialist, the idea that some interactions could be enhanced by using a group setting is a really good one. It reminded me of the days when my father used to work in a village clinic in rural North India. Most of the medical clinics were held in open rooms with little privacy and often with 10 or more strangers in the room. I suppose there are some cultures where privacy is not as tightly guarded as others.
I’m sure that some people have questions they wouldn’t dare ask their doctor and they would really benefit from seeing how others approach the consultation. I’m also sure that many of us doctors would have to do some work on our communication skills to manage the more difficult group situations. I also agree that this approach wouldn’t be best suited to patients with complex problems – from the doctor’s perspective the approach has to be individually tailored and a lot of concentration is required to deal with all the issues. In my experience, frequent interruptions in a complex interview makes it more difficult to remember to deal with the important issues.
In theory, as a patient, I like the idea but have some concerns as to how it would work. I have very agressive, treatment resistant RA and the frustration I have had with support groups is that I have not really found anyone else like me. My Rheumatologist tells me I am unlikely to find anyone around here like me as I have the dubious honour of being his most challenging patient. I know its not necessary to have identical cases to offer support to each other but I would indeed find it somewhat reassuring to find someone else with a similar case. My question here is if we are all so different and our cases can vary so much from mild disease that responds well to medication through to severe unrelenting disease that requires regular IV pulse therapy and frequent admission to hospital (like myself)…would we all be in the same group and if so how would this work or even be beneficial. I can see people with milder disease feeling anxious that they may progress to this more severe level of the disease…and indeed there may be some envy or resentment felt by those at the other end of the scale. Ultimately though I think I would be prepared to give it and go and see how it went. Just wondering.
I can hardly imagine this medical appointment setting in Southern Europe countries….Here, the med appointment is considered personal and private… Doctors would need to learn new skills for handling and leading a multiple patients appointment and also have an incentive to do it.
On the other hand, there are some benefits to it, as mentioned with the previous commenters, but I see it as a good practice for diseases involving a change in lifestyle e.g. diabetes, hypercholesterolemia. The physician has common advice and instructions for almost all patients and patients could benefit from sharing experiences with the disease with other members of the group.
I do not see how it could be implemented in serious, complicated diseases as cancer. In this case, the physician has a lot of work on an one-to-one basis with the patient, and the patient comes to the appointment with a lot of questions. Besides, it would be too stressful for patients at various stages of the disease to hear symptoms and adverse events of other patients..
Personally I’ve gained much from being in other patients company over the years, and why I remain committed to continued patient education programmes. I agree with many of the comments above, especially what Brian covered. I also agree that there are some aspects that would need to looked into more prior to group set-up – e.g. the need for strong facilitation to ensure benefit for group partipants (balanced discussion & able to respond to personalities who may try & dominate discussions and those who want to share shock/horror stories); along with patients expectations/needs in such a process (maybe to look at ‘grouping’? – maybe age; those newly diagnosed; those who have been dealing with the disease for longer [e.g. RA: other secondary diseases & also effects of 'pre-biologics age' - joint damage issues/need for replacements and management strategies in & around these impacts].