Patients Aplenty

Canada ranks last out of eleven countries when it comes to quick access to a family doctor. That's according to a study released in January of this year by the Organization of Economic Cooperation and Development (OECD). A relatively new and controversial solution is helping doctors to see more patients faster.

The solution is called a group or shared medical visit. In a typical group medical visit, all fifteen or more patients sign in at the same time and share an appointment that lasts an hour and a half.  The patients are grouped by they conditions they have in common.  Each member of the group might have all or a combination of diabetes, high blood pressure and elevated cholesterol.  Or, each member might have arthritis or chronic pain.  Or, it might be a group medical visit for women who are pregnant.  

If you do the arithmetic, the time saved can be enormous.  At a miserly ten minutes a patient, fifteen patients seeing the doctor one on one will take up two and a half hours of the doctor's time and up to three hours getting in and out of the examining room.  A group visit that runs ninety minutes saves sixty to ninety minutes.

There's growing evidence that the care patients receive in groups is every bit as good as what they receive one on one.  A study published last fall in the Canadian Medical Association Journal found that patients seen in groups had improved control of their diabetes. Other studies have found that group medical visits may help kids with asthma manage their symptoms better.  A study published in June in the journal Neurology looked at nearly three hundred patients in which the neurologist saw patients in groups of up to eight.  Compared to patients who saw the neurologist one on one, the people who had group visits had better quality of life.

Far from providing an inferior level of care, there's evidence that group visits are better than a one on one appointment. For one thing, group visits are more efficient.  Instead of having to tell fifteen patients about the side effects of the cholesterol-lowering drug Lipitor, you only have to say it once. Another benefit is peer support.  If a patient tells the group they're having difficulty learning how to inject insulin, there's a good chance that someone in the group has faced the same difficulty and can offer helpful suggestions.  You don't get that in a one on one visit to the doctor.  

Another reason is peer pressure. At a group visit, everyone gets their blood pressure and blood sugar checked and written on a white board.  The fact that everyone sees the results gives extra incentive for patients to take better care of their diabetes and high blood pressure.  And when you reach your targets, you get applause and high fives from the group.

Still, there are issues that need to be addressed.  Maintaining patient privacy is a fundamental concern - especially if the group visit is in a small town where patients know each other.  Doctors who have group medical visits need to instruct patients that what's said at a group visit should never be revealed to anyone else.  If a patient at a group visit has something personal to discuss with the doctor, they can duck into a separate room to have a private conversation. It's not either-or.  Patients who have group visits also have the option of having one on one visit as needed.

The practice has really taken off in BC, where hundreds of physicians look after thousands of patients through group medical visits.  In that province, they're seen as a way to cope with a critical shortage of family doctors as well as specialists. They're starting to catch on in rural parts of Ontario and other parts of Canada.  The use of group medical visits has expanded to include seniors, patients with dementia and patients with mental health conditions.  We need more studies, but so far, the results are promising.  

If you've had a group medical visit, I'd love to know your thoughts.

Dr. Brian Goldman is host of White Coat, Black, which returns with new episodes this fall. His new book - The Secret Language of Doctors - is published by HarperCollins Canada Ltd.

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