Sometimes Three Isn’t A Crowd: Group Appointments with Doctors

You’ve heard of group therapy for mental health issues, how about physical conditions?

By Michelle Andrews, Kaiser Health News

(Courtesy: Kaiser Health News)

(Courtesy: Kaiser Health News)

When visiting the doctor, there may be strength in numbers.

A growing number of doctors have begun holding group appointments — seeing up to a dozen patients with similar medical concerns all at once. Advocates of the approach say such visits allow doctors to treat more patients, spend more time with them (even if not one-on-one), increase appointment availability and improve health outcomes.

Some of the most successful shared appointments bring together patients with the same chronic condition, such as diabetes or heart disease. For example, in a diabetes group visit, a doctor might ask everyone to remove their shoes so he can examine their feet for sores or signs of infection, among other things. A typical session lasts up to two hours. In addition to answering questions and examining patients, the doctor often leads a discussion, often assisted by a nurse.

“We tell people, ‘You don’t have to say anything,’ But give them 10 minutes, and they’re talking about their sex lives.”

Insurance typically covers a group appointment just as it would an individual appointment — no change in the co-pay amount. Insurers generally focus on the level of care provided rather than where it’s provided or how many people are in the room, says Edward Noffsinger, who consults about group visits. (His website is even called groupvisits.com.)

Some patients say there are advantages to the group setting. “Patients like the diversity of issues discussed,” Noffsinger says. “And they like getting 2 hours with their doctor.”

Patients sign an agreement promising not to disclose what they discuss at the meeting. Although some patients are initially hesitant about the approach, doctors say their shyness generally evaporates quickly.

“We tell people, ‘You don’t have to say anything,’ ” says Edward Shahady, with the Florida Academy of Family Physicians Foundation in Jacksonville. “But give them 10 minutes, and they’re talking about their sex lives.” Shahady trains medical residents and doctors to conduct group visits with diabetes patients.

Though group appointments may allow doctors to increase the number of patients they see and thereby boost their income, many doctors are uncomfortable with the concept, experts say, because they’re used to taking a more authoritative approach with patients rather than facilitating a discussion with them.

According to the American Academy of Family Physicians, 12.7 percent of family physicians conducted group visits in 2010, up from 5.7 percent in 2005.

Doctors say patients may learn more from each other than they do from physicians. “Patients really want to hear what others patients are experiencing, ” Shahady says.

Jake Padilla of Westminster, Colo., participated in his first group visit more than a decade ago, shortly after he had heart bypass surgery.

Padilla, now 67, continued to attend group appointments geared to primary-care patients’ concerns for years after that at the Kaiser Permanente outpatient clinic near his home. He usually went once a month or so, and the members of the group constantly changed.

One woman who attended the group was 102 years old, he remembers. Fellow patients wanted to know how she managed to live that long. One of her secrets, she said, was deep breathing. Padilla has since used that advice when his blood pressure gets out of control.

But group visits aren’t for everyone. Padilla’s wife, Tedi, went to one meeting with him and never went back.

“She said she didn’t have time to sit there and listen to all those patients,” he says.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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