Could Shared Medical Appointments Be in Your Future?
More and more patients are giving up a little privacy for big help with health problems
In some ways, nothing could be more private than an appointment with a doctor. And yet shared medical appointments (SMAs) are becoming, if not all the rage, then certainly more and more common in the United States and in England, Scotland and Australia.
Marianne Sumego, MD, Director of SMAs at Cleveland Clinic in Cleveland, defines SMAs as appointments where 10 to 12 patients are seen at the same time for the same condition. “For wellness appointments, we see six to seven patients,” says internist and pediatrician Sumego, who has been overseeing such appointments at Cleveland Clinic for more than 15 years.
The concept was developed in the late 1990s by psychologist Edward B. Noffsinger. Since then he has implemented the model for more than 500 health care providers.
A streamlined process
In practice, a SMA works like this: A patient is checked in just as she might be for an individual appointment. She is taken to an exam room by a medical assistant who reviews her chart and addresses refills, vital signs like blood pressure and heartrate and any concerns. “Unless the appointment involves a private exam, which is done before the SMA starts, the patient is then taken into a shared medical room where a facilitator” — and the other patients — “greet her,” says Sumego.
The facilitator asks each participant to sign a waiver acknowledging that the group meeting is a medical appointment requiring that any shared information remain private. “We also use first names only so that there are minimal ways that any person can be identified,” says Sumego. “We want patients to feel that the appointment is safe and private.”
The facilitator moves from patient to patient, identifying updates and concerns and gathering patient history. “Some details are written on a board so that patients can see common questions,” says Sumego.
Enter the doctor
When the doctor arrives, both she and the facilitator begin addressing each individual, talking about her condition and treatment plan. “So, if there are 10 patients in the room, it’s as if each patient experiences 10 visits,” says Sumego. “Each person the doctor talks with has something different or in common with the other patients.”
That’s when the sharing begins: The doctor begins addressing common questions and common needs. “Often treatment plans and information can be applied to everyone there,” says Sumego. For instance, if the session is for people with diabetes, everyone may wonder how to get through the holidays with all the sugary carbs thrown their way. “So the doctor may be able to explain things like counting carbohydrates,” says Sumego. ”It’s an opportunity to get more information. By removing the redundancy of each separate appointment, the doctor has more time to go into depth.”
Each shared medical appointment takes 90 minutes, says Sumego. Individual visits usually last 15 to 30 minutes.
Eight-five percent of patients return for second shared medical appointments, says Sumego. “Our surveys after each SMA reveal that patients love the extra time, the additional questions they get answered and that they walk away with more information than they get from individual appointments.”
The doctors like the process also, she says. “They feel they give more information to the patients and so the patients are better able to manage. And the SMAs are fun, informal and relaxing — a nice break in their day.”
The efficiency of the process also saves everyone money. Doctors see more patients in less time while getting to spend more time offering information to all. Patients with individual appointments might have to schedule another appointment, say, with a dietitian or a nurse. But SMA patients may get the information they need from the group appointment, making that second appointment unnecessary, says Sumego. SMAs are covered by insurance.
Best conditions for SMAs
Sumego suggests that almost any condition has an aspect that would lend itself to shared medical appointments. “We think about education needs. And SMAs are also useful for conditions where peer support is important, such as weight management.”
Cleveland Clinic offers 77 SMAs, focusing on everything from osteoporosis to heel pain, from asthma to wellness visits.
Sumego suggests that people interested in SMAs go to the Cleveland Clinic website for information. “Then when they see their doctor, they can ask if she offers something like that. SMAs are optional. But I suggest that if patients try one, they will be surprised. A lot of people are hesitant but when they get in one then they don’t want to leave.”