Need a Doc Now? Sure, If You Don't Mind Sharing

This article is more than 12 years old.

Most of us know the frustration of having to wait weeks to get a doctor's appointment, and then waiting again when you finally get there but your doctor is rushed and running late. Well, imagine if there were no more waits for a doctor, and your appointment could last a leisurely 90 minutes. Turns out that's actually happening, but there's a catch: You have to be willing to share your appointment with a group of other people.
Gary Watson of Natick recently called the office of his primary care physician, Dr. Charlie Tracy. He wanted to get in to talk about his sleep apnea and some muscle pains.
GARY WATSON: "They said, 'Wait a minute, can you get here at two-o-clock this afternoon?' 'Why?' I said suspiciously. And they said, 'We're going to have one of these groups with Dr. Tracy.' "
"These groups" are officially called shared medical appointments. A few hours later, he's in a room with eight other patients for about an hour and a half. Most of them have different symptoms and health concerns.
NURSE: "I want you to really feel free to open up and share with each other. We have some cold drinks, hot drinks..."
A nurse helps Dr. Tracy. There's also a medical assistant who takes patients one by one to a private exam room to check their vitals. No one has to get undressed in front of the group. There's also a helper who takes notes as Dr. Tracy calls on each patient.

DR. TRACY: "Joanne, you're first. Why don't you just tell folks why you are here today?"
JOANNE: "I'm here because my varicose veins are worse since I had surgery seven weeks ago."
Dr. Tracy kneels in front of Joanne and rolls up one of her pant legs. Then he tells the other patients to take a look.
DR TRACY: "Now, can everybody see what we're looking at here? Can you see where it's just kind of blueish here? Everybody see that?"
This is what Dr. Tracy calls his "chalk talk." He sees a chance for a teachable moment that can benefit all the patients, even if they don't have the same health issue at this point.
DR TRACY: "The things that will help reduce varicose veins are what? Exercise training. What else? What about diet? What should you avoid in your diet?
PATIENT: "Salt."
DR. TRACY: "No salt, and then, of course, weight."
Some health networks are promoting these shared medical appointments because they reduce wait times and backlogs, and let doctors spend more time with patients, even if not one-on-one. Participants can also learn from the questions and comments. That's why patients are asked to stay the whole time.
Gary Watson says even though he came to talk about his muscle pains and sleep apnea, he also learned about the shingles vaccine, how a few glasses of wine each night can raise blood pressure, and other health tips that made the ninety-minute visit a good use of his time. He says he'd come again.
WATSON: "I think that there's a shared energy in the room, that everyone seems to be open to receiving help as well as helping other people."
Watson acknowledges he had doubts at first about going to a shared appointment at Harvard Vanguard Medical Associates in Wellesley. Skeptics point out that doctors can profit from the group approach because most insurers pay the same for a shared appointment as they do when they see patients individually. And most doctors can see double the number of patients in a group than they can one-on-one.
ED NOFFSINGER: "Sadly, when people first hear about this they often say, 'Oh, it's cattle car medicine. It's a way for the doctors to gouge patients for more money and spend more time on the golf course or whatever.' It's anything but."
That's Dr. Ed Noffsinger. He's helping Harvard Vanguard design its group visits. The health network now offers 22 shared appointments each week at its offices across eastern Massachusetts. They're voluntary, they cost the usual co-pay, and patients sign a privacy form promising not to discuss other patients later.
Noffsinger says the group format can create a sense of unity among patients.
NOFFSINGER: "They didn't want to share their problems with their friends and loved ones and bring them down. Well, speaking with other patients that are in the same boat of being a patient — they would be more understanding."
Pam Pleasants of Milton feels that camaraderie. She's also at Dr. Tracy's group visit in Wellesley. She says it's reassuring to see she's not the only one battling high cholesterol and middle-age weight gain.
PAM PLEASANTS: "Meeting with Dr. Tracy one-on-one, you get his full and undivided attention. I didn't feel that it was divided attention here, but I think there was also the support of the group. And I guess it was the affirmation, as well, like, don't beat up on yourself so much, which is easy to do."
Dr. Tracy does two group visits a week. He says he likes them because his patients don't feel so isolated by their illnesses in a group setting. But he says there are limitations.
DR. TRACY: "Sometimes you can't quite with a single patient go into the depth that you'd like to. Some patients may be a little shy and not bring out the things they want to."
Although he points out that either doctors or patients can schedule one-on-one follow-ups. Dr. Tracy says what patients gain from the group outweighs what they might lose.
DR. TRACY: "And they get to spend 90 minutes. Hey! Where else can you spend 90 minutes, right, with your doctor? So I think for most patients it's as good and, many times, better."
Harvard Vanguard wants to offer fifty shared appointments weekly by the end of the year. The Lahey Clinic runs group visits for men once a week. And although Partners Healthcare discontinued its group sessions due to lack of interest after experimenting with them a decade ago, it now says they'd be worth trying again.
Still, many patients say there are some health issues they'd only talk to their doctor about in private — marital troubles, substance abuse, sexual problems. Again, patient Pam Pleasants:
PLEASANTS: "One of the nurses reminded me, says, 'You haven't had a breast exam in a while.' Needless to say that would be a one-one-one appointment."
But for other health issues that involve keeping your clothes on, Harvard Vanguard says shared appointments are a useful tool. So if you're willing to sacrifice some privacy, the doctor can see you now.

Martha Bebinger Twitter Reporter
Martha Bebinger covers health care and other general assignments for WBUR.




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