Illustration: Maria Bruni
"The doctor really opens it up to everyone, asking what they want to know, what health news they've heard but don't quite understand, what they're curious about," says 25-year-old Hannah Kish, of Euclid, Ohio, who went to her first group appointment during high school for an annual wellness visit and has attended two more in the past year. "At my most recent checkup, another patient wanted to know if mammograms were being recommended for women under 40. I hadn't even thought to ask about that, so I was glad she did." It's exactly this sort of information sharing and camaraderie that's attracting doctors to a more-the-merrier approach.
Not all patients are candidates for shared appointments (certain issues, such as an undiagnosed condition that may require extensive tests, might be poorly served in a group setting), but SMAs seem especially useful for those with chronic conditions. Sentayehu Kassa, MD, who offers SMAs for people with diabetes, hypertension, and high cholesterol at a clinic in Dallas, finds that her group patients tend to be more compliant with her instructions than those who see her one-on-one. "I'll ask my diabetic group if they know anyone who's lost a limb from the disease, and they'll say, 'My uncle' or 'My sister,'" Kassa says. "That drives home the importance of keeping blood sugar levels in check and maintaining a healthy diet. It's no longer just a doctor preaching to them—it's real people sharing their stories."
Research bears out the effectiveness of the peer support model: A study in the journal Diabetes Care reported that when some 800 type 2 diabetics were assigned to either group or individual care, those who went to SMAs had lower LDL (bad) cholesterol, blood pressure, and body mass index after four years. "Chronic health conditions come with a great deal of fear, and there's real power in knowing you're not alone," says Reid Blackwelder, MD, president of the AAFP. "You can hear how other people have overcome hurdles you may face."
Of course, skeptics might suspect that SMAs are really just a way for doctors to increase their income. By lumping multiple people into one time slot, doctors can indeed take in considerably more money, with patients coughing up the same co-pay they would if seen privately. According to one study in Group Practice Journal, physicians conducting shared appointments were able to see an average of 41 patients in nearly six hours—25 more than they could see one-on-one. Yet Blackwelder maintains that shared appointments aren't a way to game the system. "They require meticulous planning and allow patients to have more time with a doctor," he says. "The positive outcomes are significant and can make them worth it for both the patients and the practice." And with the Affordable Care Act set to cover 30 million previously uninsured Americans by 2021, SMAs may be exactly what's needed to avoid logjams in waiting rooms. "With decreasing reimbursement and rising overhead costs, group visits may improve a patient's access to care without leaving her feeling shortchanged or rushed through the process," says Doorly.
Alicia Eddy, who had basal cell carcinoma before attending an SMA at Massachusetts' Harvard Vanguard Medical Associates in 2011 with other skin cancer patients, says she only wishes she had heard about the option sooner. "If something like this had been offered when I was younger, I think I would have been more informed and made changes to my skin care earlier," says Eddy, 49. "As much as you can read information packets, nothing beats talking to other people."
Next: What to expect at a shared medical appointment
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