December 1, 2008 Shared medical appointments help provide better care Play video

(Ally Donnelly, NECN) - We’ve all been there. Sitting in a doctor's office waiting for the precious few minutes you will actually spend with your MD. But what if you banded together with a bunch of other patients and all booked your appointments at the same time -- with the same doctor? It’s actually happening all over the country. They're called shared medical appointments and the man who came up with the model is right here in Massachusetts.

It seems more like a support group -- and, in a way, it is --- but, technically, it's a shared medical appointment or SMA.

Ed Noffsinger/Harvard Vanguard: A thinking man's way to get better care, to comprehensively meet your mind's as well as body's needs.

Ed Noffsinger is the psychologist widely credited with creating the major models for the fairly-new SMAs. He was going through a major health crisis of his own 20 years ago.

Ed: I had the very finest doctors you could ever want -- and yet -- the system was somehow broken.

He was spending countless hours in waiting rooms --- and, once he got to the doctor -- the one on one time was quick, often rushed....

Ed: I just ended up thinking, there has to be a better way.

He has brought that "better way" to the Massachusetts-based Harvard Vanguard Medical Associates.

This day about a dozen patients sit in a semicircle in a second floor conference room of the Chelmsford offices.

The patients are as different as their needs

To an 80-something retiree complaining of chest pain.

Harvard Vanguard offers SMAs at a number of sites in a range of disciplines -- Ob/Gyn, cardiology, geriatrics -- but by the end of next year plan to expand to over two dozen specialties. The men and women *this* day are all patients of Dr. Gretchen Gaida in internal medicine.

The way an SMA works is patients who would have had individual doctor's appointments opt for the group setting instead. They come in and share their issues with a behaviorist who writes it all on a white board and keeps the session moving with sharing and advice.

In turn, patients are each brought to a partitioned area...

Their vitals are checked and they're given any shots they might need. They then return to the group which is under way with Dr. Gaida.

49-year-old Michael Bracken came in to follow up on blood work and a wooshing sound in his ears. A one on one could have run 10 minutes, but he stayed for the entire 90-minute group session.

Bracken, patient: Even though Dr. Gaida wasn't talking with me directly, I was able to gain a lot of information indirectly. An hour and a half -- it's invaluable as far as I'm concerned.

Beecher, patient My first reaction was a happy surprise at how comfortable I was being there.

Christine Beecher is a 68-year-old retiree from Billerica. She says even though she lives in the same town, even uses the same pharmacy as some of the other patients, she wasn't concerned about anyone gossiping about her health issues.

Noffsinger: Think about psychiatry groups. They've been going on for decades and there's not problems there and they very seldom sign confidentiality release.

Grouping patients for prenatal or cancer issues seems intuitive, but why bring together folks with such disparate issues as get presented in internal medicine?

Though only a few patients were in for their cholesterol, Gaida gave them all a tutorial on their numbers.

Michael, patient: I'm just watching, I'm cutting carbs down, more vegetables.

Even though Gaida is helping Annette, Beecher was having arm pain and realized, that like Annette, it was likely the extra time she had been spending on the computer.

Christine, patient: I had a symptom analyzed without my even asking about it and a solution given.

The medical staff here say the group visits help *them* as well. They say they're able to be much more efficient, improving quality, access -- and allowing them much more time for direct patient contact.

Dr. Gaida: I think it's a lot closer personal relationship or doctor-patient relationship.

Gaida says in an aging population, she often spends her day shuttling from exam room to exam room saying the same thing to a blur of patients. In the *group setting she has an assistant to chart her notes, allowing for better focus than individual appointments.

Gaida: I'm often scanning the chart and trying to do multi tasking for example looking at last mammogram while they're telling me about their shoulder pain.

Noffsinger says with doctors seeing more patients at one time for routine care, it creates extra capacity in the overall system for patients needing urgent care. With near universal health care in Massachusetts --- and perhaps soon the nation -- more patients flood into the system. Amid physician and nurse shortages, Noffsinger hopes the group setting can make health care more affordable and inclusive.

Noffsinger: Reach out to the under served, patients that are slipping through the cracks, the uninsured, the urban poor...

As for Bracken, he'll be back.

Bracken: I already made an appt for a follow up with the same type of session.

Because he says, despite patients flanking him on all sides -- he felt like the most important person in the room.