- The Washington Times - Tuesday, March 18, 2003

Mary Cormier doesn't worry about squeezing all her medical questions into one rushed doctor's appointment. The 78-year-old Springfield woman is part of a relatively new trend in health care, in which patients meet their doctors in a group setting that lasts far longer than the average appointment.
Group medical appointments, which typically run 90 minutes, give patients like Mrs. Cormier the flexibility to spend quality time with their physicians.
The appointments are emerging as an alternative to today's fast-paced medical visits, in which doctors barely have time to exchange pleasantries and come up with a diagnosis. The meetings vary in length and focus some are for senior citizens, while others concern younger patients who share similar conditions, such as obesity.
These meetings have yet to grab a sizable foothold in the modern medicinal scene. A quick survey of several District hospitals finds no doctors offering such appointments in the city. Kaiser Permanente of the Mid-Atlantic States offers group medical appointments to older patients in Northern Virginia.
One Texas doctor says she believes she runs the only practice in her state to offer group settings.
Group medical appointments aren't meant to replace traditional, one-on-one meetings, but to supplement them.
The Kaiser Permanente meetings, open to men and women, are held once a month and include lectures on the latest medical news.
Mrs. Cormier says she finds the meetings' guest speakers educational but says she learns even more from her fellow patients.
"There's a lot of give-and-take," she says.
She felt close enough to her fellow group members that during a session dealing with trauma and survival, she shared the pain of losing her 29-year old son 15 years ago.
"These people are like your friends," she says.
Dr. Paul McClain, a geriatrician who leads the group appointments in Kaiser Permanente's Fair Oaks Medical Center, says patients routinely take it upon themselves to educate each other.
"Two or three people share the same illness, and you'd be surprised how much they teach each other," he says. Patients can swap tips about diet, medication and alternative medicines that have helped them with their conditions.
Dr. McClain says his once-a-month sessions begin with a small team of medical professionals, including nurses, taking the blood pressure and other vital signs of his patients.
Patients must sign a confidentiality clause because some information about their cases could be heard by others. For more sensitive material, group-appointment doctors often set aside time at the end of the meeting for brief private consultations.
These appointments are voluntary, and some patients may have conditions such as dementia that could preclude them from a group setting.
Dr. Thomas Weida, a family physician with Hershey Medical Center at Penn State College of Medicine in Pennsylvania, says group medical appointments are still far from the norm. An American Academy of Family Physicians board member, he says he meets doctors at national meetings who are curious about the group sessions and how to start them.
He says initial research suggests these appointments can have positive health benefits. Dr. Weida cites a study of diabetic patients in group medical care that found they enjoyed a 32 percent reduction in total cholesterol and 7 percent reduction in total medical costs.
"The patients themselves become a support group. It's a very powerful dynamic," he says.
Kathy Brenneman, director of geriatric medicine at Providence Hospital in Northeast, says the group-appointments concept also could be an effective way to spread medical information to a greater number of patients.
"In managed care, time is so short. It may in some ways be better time spent to reach more people," Dr. Brenneman says before adding, "How many times per day do I say the same things to people?"
Group medical appointments, like every other part of modern medicine, aren't free. Insurance offers varying coverage options. Patients under Kaiser Permanente plans have their visit fees covered. Others may not be as fortunate.
Because the practice is relatively new, insurance companies often don't have the proper codes to correspond to these appointments, making reimbursement difficult. Some doctors can file for insurance coverage by billing based on the type of care administered during the group meeting. Patients should check with their health coverage's compliance division to see how it deals with such appointments.
Dr. Kim McMillin, a family practitioner with the Baylor Health Care System in Garland, Texas, hadn't heard of group medical appointments until a few years ago. Now her practice is about to mark its first full year offering once-a-week sessions.
She says the groups attract patients in part because of people's innate curiosity.
"How many people love 'ER'"? she asks. "The human side of us causes us to be interested in the health care of others."
She predicts the appointments will become more common, which could be a boon for doctors nationwide. She says the appointments can result not only in better-informed patients, but also in fewer individual appointments, something that clogs the daily planners of many a doctor's practice.
Dr. Edward B. Noffsinger, director of Clinical Access Improvement at Palo Alto Medical Foundation in California, created a variation on the group concept in 1996 after he learned the frustrations of being a patient himself.
Dr. Noffsinger suffered through a severe cardiopulmonary condition in the late 1980s. Even though he says he had the "best doctors in the world," he found "traditional medical care wasn't working for me."
On the day of an appointment, he would sit, nearly nude, in his doctor's office for long periods of time until his doctor arrived. The consultation would last all of 10 minutes, leaving Dr. Noffsinger with more questions than answers about his condition.
When his health worsened, the one thing he wished for was more time with his doctor to help explain the complexities of his case.
Eventually, his health returned. He used his memories from that experience to help create Drop in Group Medical Appointments, or DIGMA, in which patients knew they had an open invitation once a week to visit with their doctors in a group setting.
Part of a group appointment's appeal, he says, is that patients are more candid about their health in the social settings.
One patient casually said during a group gathering that she gulped down nitroglycerin tablets before going out dancing to prevent her heart condition from flaring up. Those tablets are meant as an emergency measure, Dr. Noffsinger says, not as a casual drug to be taken so frequently.
"It's a life-threatening lifestyle," he says of the woman's approach. "It could push her heart beyond its ability to cope."
Dr. Noffsinger may have created his local group medical appointment program, but Marlene McKenzie, program coordinator for Kaiser Permanente's group visits in Colorado, says similar visits have existed in various forms for nearly a century.
Ms. McKenzie says that in 1907, Boston doctors cared for tuberculosis patients in group settings and found that the patients did better than those treated individually.
"The mental health folks picked up on this notion early on," she says, referring to group therapy, "but it didn't catch on in the primary care environment."
Thirty such senior-centered groups are operating in Colorado.
Dr. Noffsinger says doctors may disagree about the relevance of group meetings, but he measures their success, in part, based on how many meetings draw to a close.
Typically, the last thing a patient wants to do is extend a doctor's appointment, but even after 90-plus minutes of medical care, he says, "you see the people still talking in the lobby or the parking lot."

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