Unfortunately, a brief 15-minute consultation barely holds enough time to address a patient’s primary concern, let alone to discuss other problems.
To address this deficiency in healthcare, psychologist Edward B. Noffsinger developed the idea of shared medical appointments (SMAs) in the 1990s.
The model was founded by his own experience – having become seriously ill between 1988 and 1992 – after which he decided that he, as a patient, would like to have immediate access to his doctor, more time for discussions with his physician, and to receive support and information from other patients who suffered similar health conditions.
Allowing patients to learn from one anotherUnlike a typical doctor’s visit, a shared appointment often lasts around 90 minutes, and typically involves a group of roughly ten patients who are united by a common health condition such as diabetes or hypertension, or by a similar patient outcome goal such as weight loss or smoking cessation.
During a group visit, the physician discusses each patient’s latest health condition, runs through latest lab results and determines a management plan, during which others participate and weigh in on advice or concepts that may be useful to them in managing their disease.
The focal points of SMAs are meant to enhance patient education and management of a disease, where patients are encouraged to discuss on a variety of issues such as their medications, blood results, as well as methods that they have adopted to cope with their illness – essentially forming a support group, but with hands-on care by healthcare professionals.
“One problem with chronic disease is that it’s isolating. When people are diagnosed with a chronic disease, they typically feel excised from the broader community,” said Scott Wallace, associate professor from Dell medical School at the University of Texas.
“You may not feel comfortable talking about your condition socially, but in this context it’s welcome.”
According to the American Academy of Family Physicians (AAFP), the SMA model allows patients better access to their physicians and allied health professionals, and has been proven as a method effective in enhancing patient’s self-care and improving patient outcomes.
“We focus on prevention for a lot of conditions, maintenance for a lot other conditions, and even some conditions where the focus is at the discharge level — reducing the chance that someone gets readmitted and what to do in order to not be hospitalised again,” said the medical director of SMAs at Cleveland Clinic, Dr Marianne Sumego.
Protecting patient confidentiality in group visitsBy this paragraph however, most healthcare professionals would have already measured the potential repercussions of adopting such an approach in healthcare practice, mainly concerning patient confidentiality – an ethical duty upheld by healthcare providers to safeguard trust in patient-doctor relationships and to protect patient privacy.
“For the patient, there are privacy issues, confidentiality issues, and patients will often feel more comfortable saying something in a one-on-one, physician-to-patient meeting, than they will in a group,” said Jamie Court, president of a not-for-profit Consumer Watchdog.
“So there may be key parts of a diagnosis that aren’t reached if patients have to rely exclusively on group visits and don’t ever get one-on-one time with the doctor.”
Constructively, confidentiality of patient information is not absolute, and can be disclosed with patient consent. However, while participation in SMAs is purely voluntary, it is essential that patients thoroughly understand the reasons for and consequences of disclosing private information regarding their health.
Likewise, to protect participants of the group visit, patients sign a confidentiality agreement, and should therefore be educated of the legal and ethical consequences should they fail to comply.
SMAs as an adjunct to traditional consultationsHealthcare professionals are well aware that the medical practice is not one-size-fits-all – even if patients have the same illness – and the practice of medicine is moving to become tailored for individuals, such as the approach in personalised medicine which is founded on the patient’s genetic makeup.
Similarly, some may hold strong conviction that patient education should be personalised, and that group visits may not provide a suitable environment to engage in one-to-one learning.
According to Wallace however, patients’ experiences regarding day-to-day management of chronic conditions may actually be more valuable to other patients than a clinician’s clinical knowledge.
“I think the value comes from both the clinician and the shared medical experience of others,” said Wallace, adding that doctors serve to facilitate patient knowledge while providing evidence-based medical information.
Group medical visits are optional and extra one-on-one visits with doctors are often arranged for patients, adds Sumego.
“It’s really meant to support and supplement what the patient’s already receiving and doing in order to manage their condition,” she said. MIMS
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