Gunny Alford, a 63-year-old with advanced liver disease, took a seat as his doctor listened to his heart as part of a regular checkup.
As the UC San Diego physician explained lab results and asked about Alford's recent symptoms, several other patients and their family members looked on, paying close attention.
A liver transplant specialist, Alexander Kuo, explained to the group that Alford had cirrhosis of the liver from years of drinking but was doing well and would be an excellent candidate for a transplant.
"Your blood works looks good," Kuo told Alford. "This is beautiful."
A growing number of physicians around the nation are turning the traditional medical visit inside out, making what were once one-on-one, private appointments a group experience.
Shared medical appointments are becoming more widespread as physicians look for more efficient and effective ways to treat increasing numbers of patients with chronic diseases. The visits could increase significantly under the nation's healthcare overhaul when millions more Americans gain insurance coverage and need to access doctors. Multi-patient appointments are especially valuable in areas with physician shortages, proponents say.
Group appointments are being offered through UC San Diego to patients with diabetes, HIV and liver disease. Obesity and diabetes patients at the L.A. County-run Martin Luther King outpatient and specialty health clinic also have the option of attending group visits, and similar programs are being rolled out in Massachusetts, North Carolina and Ohio.
Proponents say the model allows patients to get appointments faster and spend more time with doctors. Physicians like not having to repeat themselves several times a day to people with the same ailments. Research shows that for certain patients, group visits can reinforce healthy behaviors and reduce emergency room visits.
"I can tell them until I am blue in the face what they have to do," Kuo said. "The peer pressure of the group does the trick."
But the practice is raising concerns about privacy, as doctors share patients' confidential and intimate medical details with group members. "It is a recipe for disaster," said attorney Rabeh M.A. Soofi, who handles privacy cases. "It is just a matter of time before there is going to be an increase in litigation involving group physician visits."
At most shared appointments, patients and their family members are required to sign confidentiality agreements, promising not to talk about other patients outside the room.
Edward Noffsinger, a Northern California psychologist who helped pioneer group appointments, said they won't work for everyone. But with a growing physician shortage, they offer an alternative for doctors and clinics facing patient backlogs and busy schedules.
At the Martin Luther King clinic, endocrinologist Theodore Friedman leads a two-hour group appointment for obese patients. The sessions are a mix of a social gathering, support group, health education class and personal medical discussion.
During a recent appointment, Friedman asked two dozen patients seated in a conference room why they were there. Several wanted to lose weight. Friedman, speaking with the help of a Spanish translator, stressed the dangers of being overweight, including heart disease, diabetes and high blood pressure.
Then he shed his lab coat and started an exercise video. "Everyone who can, stand up," he said. "And don't watch me. I have no rhythm." Following Friedman's lead, other clinic staff joined patients in several minutes of stretching, bouncing side to side and breaking a sweat.
The patients also watched a demonstration on cooking a healthy stew and listened to a presentation about the harmful effects of too much fast food. Meanwhile, Friedman made his way around the room to chat with each patient, checking their lab work and evaluating their medications.
"We've got to get you better," he told one woman with diabetes after reviewing her chart. He asked her to schedule a personal appointment and assured her that they could get her disease under control with medication, diet and exercise.
Several of the same patients were back for a group session the next month. One reported eating more vegetables; another started walking more. A third cut out fast food.
The group applauded when Maricela Guajardo said she lost 15 pounds by giving up soda and tortillas. "It helps making a commitment to others," Guajardo said afterward.
That's one key advantage of group appointments, Friedman said. In addition to seeing the doctor, patients regularly interact with dietitians, orthopedists, social workers and one another. And they learn from questions others raise and how others are managing their disease.
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