September 4, 2013

Format of Shared Medical Appointments Important

This blog by Dr. Fisher really had me scratching my head and then I needed to read the link he provided. Dr. Richard Kratche, a family physician at Cleveland Clinic who conducts group visits for physicals seems quite happy with the results. Now I admit this would not make me happy and even if waivers of confidentiality were signed, who is to say that people won't talk about what they heard. Gossip is common and people like to embellish when they can.

Some people are comfortable with this arrangement, while others shudder at the thought. Now granted, I am familiar with a different type of shared medical appointments (SMAs). A couple of doctors in two western rural states have peer mentors for diabetes education. One doctor has four peer mentors and the second has two peer mentors. The doctor with four peer mentors has two for type 1 diabetes and two for type 2 diabetes. Both doctors have patients that travel up to 100 miles one way and they want to make the best use of their time. Both doctors are family physicians and have patients on oral medications and insulin. The second doctor does refer the more complicated patients to the first doctor and they make things work between them.

In their SMAs, they use the peer mentors for gathering information and meter readings and then the doctor first takes any combination patients (husband/wife, parent/child), covers the lab results with them, and covers their meter printouts. Then each moves to single patients (not that they are single), and covers their lab results and meter printouts. All the time, the peer mentors are conducting education with those waiting to see the doctor or have seen the doctor. Both doctors have educated the peer mentors they have involved in the education.

I have been involved with both doctors either at the start of their training their own peer mentors, or after a few sessions when the peer mentors wanted to ask me questions. We do this by video conferencing and often after hours. I have substituted with one doctor when one of his mentors was in the hospital and this worked out quite well with video conferencing. Depending on the time of year, even if one mentor cannot be present, they have been able to use the video setup to take part.

This has been working very well for the two doctors I work with in Kansas, but that may end this year because they have hooked up with the U. of Kansas and their telemedicine group for more education across more diseases, diabetes being one of them. This happens, but several of the patients have asked if I will still answer emails and send copies to their doctor when I answer them. The husband and wife doctor team talked to me about this and they are talking to the patients, so this has not been resolved yet.

Therefore, apparently SMAs come in many varieties and ways of dealing with patients. I admit I do not wish my lab results made public unless I chose to let someone know outside the SMA. Even when I blog about people's results that are part of our support group, I am very hesitant to do so, but a couple have said use the numbers since I use made up names. Even George commented that he said his A1c in front of us and no one criticized him for what it was. That is the way we are George. And, the situation you were in, we knew you had nothing to compare to and we knew that you will learn.

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