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Back in May, I attended my first group physical exam at the Harvard Vanguard medical center in Watertown. It was a routine annual physical exam with my doctor – and five other women.
I signed up out of curiosity and also because I bought in, somewhat, to the premise. I understand that there’s a push in health care to contain costs. Group appointments are touted as a useful trend. And I’m a sucker for community and shared experience.
My shared medical appointment lasted from 5:30-7pm on a Thursday night. My vital signs were taken in a private room, and my doctor came in for a ten-minute physical exam. She ticked through my concerns and asked me to bring them up with the group – the shared portion of the appointment.
I returned to the waiting room, where a nutritionist was holding court. She’d charted all our lab results on a whiteboard in the center of the room – red and white blood cell counts; cholesterol; glucose and Vitamin D. She lectured us all to eat more vegetables.
Then the doctor returned for our group discussion.
There were 6 women in total, ranging from their late twenties to late thirties. Some had no children; some had several. Some had allergies; some had high cholesterol; some had irregular periods or poor eating habits. Most issues were highly specific – knee pain, chronic conditions. In each case, the common priority – to live a healthy, painless life – manifested itself in very different ways. The one near-universal trait was Vitamin D deficiency.
The doctor interviewed us each in turn, while the others listened in. One woman had polycystic ovarian syndrome, and was upset with the effects of the medication she was taking. One woman described, sheepishly, eating fast food five nights a week. Two women chimed in on the issue of taking birth control pills. A medical assistant took notes on a computer in the corner. Everyone was polite and kind, but there wasn't much to say to someone else’s problems.
With five minutes left on the clock, I was the last of the interviews. The doctor urged brevity. I brought up a few personal issues, but was asked to make follow-up appointments to fully address my concerns. And that was it.
I ended up making two appointments in the following weeks – with a nurse practitioner – to get the prescriptions and referrals I meant to get during my physical.
At 90 minutes, the shared exam clocked far longer than a typical physical appointment. Over half of the time was spent discussing health issues that didn’t pertain to me. And if the point was to save medical costs by hustling six of us through an annual exam together, the follow-up appointments I made – with full co-pays, billed to my insurance as separate appointments – probably negated that time/money benefit for both sides.
There may yet be a future for shared physical exams; with skyrocketing health care costs and a nationwide doctor shortage, we might not have a choice. And there could be improvements – patients could be binned into groups with more health issues in common, and maybe in those group discussions, most of the conversation would apply to everyone.
But I think I’m going to sit this one out for as long as possible. A better experience would require a lot more groundwork, discrimination, and planning for every appointment. And if the question on the table is “Can we contain healthcare costs without compromising quality?” – the answer, in this case, was no – not now, not yet, not without some up-front investment.
This program aired on August 12, 2011. The audio for this program is not available.
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