Scenes From the 21-st Century Doctor's Office
Group appointments give patients better access to physicians
Tuesday, March 9, 2010
On a recent weekday morning, 15 expectant mothers are gathered in a circle in a large room at a Washington hospital for a collective third trimester checkup.
A midwife is off to one side taking measurements of Marilis Quijada's abdomen and using a Doppler monitor to listen to her baby's heartbeat. She notes the results in Quijada's chart, and as another patient steps forward to be measured -- they each get a turn, and each has an individual chart -- Quijada returns to the circle, where a nurse is leading a conversation on how to recognize the onset of labor.
The women have been booking shared appointments since early pregnancy and are happy, they say, to give up the privacy of a one-on-one visit for the benefits of a group session: more face time collectively with the doctor or midwife and the learning experience of sharing time with other pregnant women.
Caring for multiple patients simultaneously has gotten a new boost as the nation urgently searches for sustainable models of health care. The group visit was cited as one of 10 trends to take seriously by the Future of Family Medicine Project, a national effort headed by the American Academy of Family Physicians looking for ways to improve the delivery of health care for both patients and their doctors.
The important question, of course, is how group appointments measure up. The answer seems to be: surprisingly well.
Colleen Kivlahan of Herndon, a family physician who has been conducting group visits for years, points to research carried out in Chicago, where she practiced earlier. Two groups of patients were compared: One received traditional care, and one attended group appointments. It was no contest, she says. "The 'group visit' folk . . . blew them away in terms of self-management, knowledge, behavior change, dietary and exercise change," as well as in improvements in blood sugar control and cholesterol levels, she said. (These findings were presented at a chronic disease conference but have not yet been published.)
Kivlahan is adamant that group appointments should not be mistaken for some sort of support group or hygiene class. "They're getting comprehensive care in that setting," she said, which includes thorough medical examinations and referrals for lab tests and follow-up with specialists. It's full-fledged medical care.
But, of course, it does require some sacrifice of privacy, which some people handle more easily than others, Kivlahan says. "Patients know that they're going to have their heart and lungs listened to in that setting" -- that is, in front of everybody else in the group, whose members all have the same diagnosis. "Patients actually get used to taking their socks off and having everyone's feet checked simultaneously," she said, referring to a common check for people with diabetes. Patients who need a little more privacy with the doctor are offered a few minutes away from the group.
Providence Hospital in Northeast Washington, where Quijada goes for her group visits, also reports good results. Debra Keith, a nurse-midwife and director of the hospital's Center for Life OB-GYN clinic, says that since group appointments for pregnant women were initiated, the clinic has seen the rate of premature births drop and breast-feeding rates go up.
Quijada, 22, who already has one child, says she prefers the group model to the traditional path she followed for that first birth. Beyond the shorter wait times, she says, she loves the connection she is forming with the other women and feels more on top of what's going on during this pregnancy.
Before the program started in 2007, patients "were facing wait times of two to three hours," Keith recalls. "The physicians and midwives were totally stressed out with the backup because it was like a factory of going in and out of rooms and seeing patients and trying to hurry up."
Now, says Keith, "you can see 10 or 12 women in two hours and give them such good care that they walk away saying, 'I just got the best of it.' "