Group doctor visits
Pilot program underway may give patients more time with physicians
SAN DIEGO, Cali. – You know the drill; you wait and wait to see your doctor only to be rushed along once you actually get in the exam room. But what if there was a better way?
Patients at University of California at San Diego are testing a new way to see their doctor, with a 90-minute group visit.
"For me, this is about giving patients a choice, giving patients access to me as a physician," explained Alexander Kuo, director of hepatology, UC San Diego Health System.
Kuo calls one patient at a time to the front of the room for an exam. The rest of the group watches, listens, and asks questions.
"They're looking for just more resources, more information, and more help in dealing with their illness," Kuo said.
The group meets every four to six weeks in addition to their private appointments. The pilot program offers patients better access to their doctors and each other.
"They have a lot of shared knowledge and they can teach each other from their shared experiences," Kuo said.
A recent study showed physicians are seeing less of their patients. Doctors in training spent just eight minutes a day with each patient, that's only about 12 percent of their time, but they spent almost half of their days in front of a computer screen.
Christy Dickson-Johnston suffered acute liver failure last year. She decided to try a group visit. She says having the support of her doctor and the other patients helped her cope.
"You're not alone. It's so wonderful. You're sitting there, and you go, ‘Oh, I feel that too,'" she said.
It's a new idea that could change the way you see your doctor.
Typically, between five and seven patients attend Kuo's group visits. They can also bring a guest. At this time, UC San Diego offers the group appointments to patients with diabetes, liver disease, and HIV.
Some places offer group visits instead of private appointments, but Kuo emphasizes that his group visits are in addition to regular exams. There is no extra charge, just the regular copay.
More than 100 million patients in the United States suffer from chronic conditions, like HIV, diabetes, or cirrhosis. These diseases require constant management by patients, but access to doctors, such as hepatologists, can be hindered by long waits for appointments. Researchers at UC San Diego Health System and across the country have launched a program to increase access to medical experts and comprehensive patient education through shared medical appointments. While a typical individual appointment lasts 15 to 30 minutes, a shared appointment is 90 minutes long. Inside a group medical appointment, five, ten, to 15 patients gather in a conference room for their medical visit. (Source: health.ucsd.edu/news/features/Pages/2012-12-10-shared-medical-appointments.aspx and http://my.clevelandclinic.org/patients-visitors/prepare-appointment/shared-medical-appointments.aspx)
INSIDE A SHARED MEDICAL APPOINTMENT: Their doctor attends the session accompanied by a nurse and a documentation expert who will record all medical observations and prescription changes. Every patient is required to sign a legal form to protect each other's privacy so that personal information is not shared outside the appointment. "When I started with shared medical appointments, I really wanted to focus on patients with advanced liver disease. These are patients with cirrhosis who are either on the waiting list for transplant or are considering being placed on the list," Alexander Kuo, director of hepatology at UC San Diego Health System, was quoted as saying. He says he found that these patients had a lack of information on the complexities of transplantation. The standard 20-minute, individual exam wasn't enough. Dr. Kuo's shared medical appointments usually consist of both men and women typically in their mid-50s or 60s. Caregivers are also encouraged to attend and contribute to the information shared. "Patients are fully clothed. Limited physical exams are performed in the group setting, this might include listening to breathing, palpating the abdomen and examining the legs for swelling. If the patients need a more extensive exam, one can be done afterwards in a regular exam room," Dr. Kuo explained. Kuo estimates that 80 to 90 percent of patients in his current medical practice are eligible for shared medical appointments. (Source: health.ucsd.edu/news/features/Pages/2012-12-10-shared-medical-appointments.aspx)
GAINING CONTROL: Steven Edelman, at UC San Diego Health System, leads shared medical appointments for patients with diabetes. Diabetes is a disease that requires constant attention. With shared medical appointments, Dr. Edelman believes he can educate and motivate patients to take a more proactive role in managing their disease. He organizes his patients in groups of ten by type 1 and type 2 separately, as well as by gender. "For our patients with Type 1 diabetes, technology is often a topic of discussion. The patients compare and contrast devices for insulin pumps and continuous glucose monitoring. Some patients in the room should actually be using a monitoring device. Even though I have diabetes myself and use a device, I often cannot talk patients into using one. But when they hear advice from their peers, many change their minds," Dr. Edelman was quoted as saying. Dr. Amy Sitapati, MD, interim medical director of the UC San Diego Owen Clinic says that in treating patients with HIV or AIDS, the shared medical appointment is a model that helps give patients a medical home, which is a requirement of the California HIV/AIDS Research Program. "Patient-centered medical homes are being adopted as a care delivery model. With shared medical appointments, we have found something that is effective, especially in light of the Affordable Care Act," Dr. Sitapati was quoted as saying. (Source: health.ucsd.edu/news/features/Pages/2012-12-10-shared-medical-appointments.aspx)
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