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Monday, December 1, 2008

His nine patients already were seated: Shared medical appointments

When Dr. Eugene Lindsay arrived to see his 4:30 appointment on a recent Thursday, his nine patients already were seated on folding chairs arranged in a semicircle around a table of snacks. For the next 90 minutes, he examined them, one by one, discussing their personal medical details out loud.

Dr. Lindsay, a cardiologist and CEO of Harvard Vanguard Medical Associates, now sees patients only in such groups, called "shared medical appointments."

"It was fabulous," said Nicholas Poly, an 80-year-old retired engineer. "I have problems similar to what other people have. I get to hear their questions too, and that's good."

Walter Kelly, on the other hand, attended two group visits, and then said he would rather see Dr. Lindsay individually if that were an option. Walter, age 89, had begun seeing Dr. Lindsay five years ago, after he got a pacemaker for his heart murmur.

The groups attempt to increase the satisfaction of patients and doctors by allowing more time in the visit, at the expense of privacy and modesty.

For the group appointment to work, additional staff and privacy and confidentiality policies are needed. A medical assistant takes vital signs and gives immunizations privately, in a nearby room. A nurse wrote patients' questions on a white board in the conference room used for the visit. Patients can talk to the doctor privately if they have questions they don't want discussed publicly, e.g., about sexual problems.

My hunch is that, as in group therapy in the behavioral health world, much of the clinical success of a group depends on the similarity of patients in the group.

Advice to people with delayed individual medical appointments: Ask your doctor about shared medical appointments.

Read a very different group visit story.

Thanks to Liz Kowalczyk for the source story in yesterday's Boston Globe.

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