This model, around since the mid-1990s, is now getting more attention. In a shared medical appointment, eight to 10 patients with a common denominator—a chronic condition such as diabetes, or elderly adults in need of a road map to aging well—see the doctor together for a long visit, often 90 minutes. Joining the session in some cases are a nurse, a behaviorist, and a documenter, each working to help the appointment run smoothly.
For visits that require a physical exam, each patient sees the physician in private room while the facilitator leads the group. With exams complete, the group reconvenes for a physician-led discussion. Through this approach, not only do patients interact more with the doctor, but they also learn from each other in an open, safe setting. Even though the physician sees more patients, he or she doesn't feel rushed due to the extended length of the visit.
"Working harder and doing more isn't the best answer," Sumego says. With shared medical appointments, "we're utilizing a concept that is basically more effective; it leverages resources, and we're offering it to our patients so that they have a high-quality visit." The key to making this work requires selecting the right high-impact specialty, working with a physician leader and team passionate about that specialty, and designing the group visit with both its physician and patient population in mind.
Group appointments take root
Back in 1988, Edward B. Noffsinger, PhD, received the scary diagnosis of pulmonary hypertension, "potentially lethal cardiopulmonary condition" as he describes it. For the two-and-a-half decades prior, he'd been director of oncology counseling and chronic illness services at Kaiser Permanente, so he knew how this country's healthcare delivery system worked. Yet as a patient, he was underwhelmed by his treatment. "I had the best doctors really anyone could hope to have, but I found that medical care as it was being delivered just wasn't satisfactory," he says. "It was very frustrating for the patient, for the doctor, the waits were very long to get in, the visits too rushed. The poor doctors, they looked worse than you felt."