Shared Medical Appointments – A doctor’s perspective
It is my pleasure to share with you my experiences of running Shared Medical Appointments (SMAs), also known as group appointments. I am a rural General Practitioner, with a solo private practice in the beautiful Riverland of South Australia. My clinic allows me to practice slower medicine. Taking more time with patients and providing more information. Lifestyle Medicine is a core focus in all my consultations. Through my training in Lifestyle Medicine I have learnt about Shared Medical Appointments. I enjoy participating in and offering my patients the option of the Shared Medical Appointment experience. The concept is certainly not new. It is common place to have more than one consultation in a room with several people. Typically, it’s a family, with each person having a shared or different health concern. It is certainly not limited to families. The patients being consulted do not have to be related, I see couples and friends at the same time. Shared Medical appointments are for anyone. Anyone that appreciates a supportive environment and learning opportunities. Not only are they as effective as a regular consultation but there is evidence that patients are more likely to achieve their lifestyle goals when they address them in a positive group setting. So much of our lives are conducted in a social environment. I believe SMA’s are a natural extension of our social tendencies which occur in most aspects of our lives. This extension is a core component to why I believe SMA’s are as effective as they are.
What is an SMA?
Much like a consult in which I see parents and children or friends in the same room, I hold a consult for the group. There are different types of SMAs. A SMA can be anything and everything that isn’t urgent medical care. So obviously, not good for a heart attack or asthma attack. Some clinics run a SMA that addresses whatever the patients needed to see their doctor regarding. Those appointments will vary widely from day to day. The patients come together with their various concerns as they would do for any regular GP appointment. Each are consulted one at a time, while everyone involved learns and can provide support. A programmed SMA, has a set educational agenda in addition to supporting patients to address their needs. I have run programs for weight loss, improved mental and physical well being, as well as one for people living with Polio. I plan to expand my groups to address heart disease, diabetes, osteoarthritis as well as other conditions such as Multiple Sclerosis. SMA’s are only limited by one’s imagination.
How does an SMA work?
SMAs are much like any consultation with a doctor, with a little bit of organising at the beginning of the first consult. Typically the reception staff sorts the appointments, a facilitator runs the group and documents while the doctor attends for the ‘consultation’ aspect of the session. For my clinic, I am all of the above and I find it works well. The first consultation, medical confidentiality is discussed and an agreement to not discuss anything another person has said or done outside of the consult is signed. Of course, I am happy for my patients to spread good health information that I present. During the first consult, we all introduce ourselves and I outline the few simple rules to keep the consults running smoothly. If anything private needs to be said or examined, then the doctor and patient can leave the group room to a private consult room.
For my programmed SMAs, I have handouts, informative videos and provide strategies to implement, to assist the group to achieve their shared goals. For example, the Gutbusters program (Healthy Weight for Women and Waist Loss for Men; information available here) is about understanding how our bodies and minds work, in addition to not only learning about nutrition and physical activity but also preemptively address possible hurdles or obstacles that trip up our good intentions. I also provide The Lift Project, an excellent program created by Dr. Darren Morton. The Lift Project is available online here, and can be done in the supportive and fun SMA environment. It uses Positive Psychology, Neuroscience and Lifestyle Medicine to lift our moods and wellbeing to the best it can be. The science and research behind how we think, eat, sleep, move and much more are addressed and demonstrated in an understandable and fun way by Dr Morton’s videos. If needed, I can step out of the room to print referrals and scripts while the group watches the video lessons. These SMAs run weekly or fortnightly for a set number of sessions. Each session addresses how everyone is going and introduces new strategies, techniques and education. In addition, to watching the education videos done by experts in their field, I typically hand out further information that I have collated through my years of study. I prefer to provide handouts, particularly for important concepts, so when someone goes home, they can review it and be able to refresh their memory. Some of the programs have resources, links and downloads that are available online. Both the above mentioned programs have great workbooks that we can all work through together. I have a small ‘library’ of books that I have read through the years. I keep the valuable ones on my desk so my patients can borrow them if they would like. I have a few different recipe books for people to start having fun trying new Plant Based recipes. If they find a book they like, then they can order one of their own. Often people are pleasantly surprised how easy a Plant Based meal truly is. These programs and recipe books allow patients to move through and past their initial concerns about creating a meal that doesn’t revolve around meat. It’s great fun to see people realise that Plant Based eating doesn’t narrow down their taste options, in fact it does the exact opposite. Free of the ‘meat concept’ there are so many wonderful tasty foods and meals to enjoy.
Why book an SMA?
There are several reasons why SMAs are of benefit. I believe that nothing compares to sitting across from someone who is in the same situation as you are . They get it. Without saying a single word, they can relate to your experience. I believe there is something powerful in that, that I can’t provide as a health care provider. I can’t emphasise enough how much I find SMA’s to have a great positive atmosphere. The fellow patients pitch in with strategies they use and with support for each other. I often find myself writing down a tip or resource to share in the future. We are all learning. Everyone has something to offer. If someone expresses that they are discouraged or frustrated, others in the group speak up about how they share a similar experience and often provide good, supportive advice.
As a doctor, I can go into far more detail for an extended period of time during an SMA than I could with a one on one appointment. This eliminates the time pressure. In a typical GP consult, I would give a handout on Whole Food Plant Based nutrition. During an SMA, I can go into the details. Providing tips, resources and answering questions. There is no doubt patients benefit from this and I truly enjoy being released from the pressure to hurry up and wrap it up.
We are more likely to achieve our lifestyle goals when they are addressed in a group setting and that is worth the effort of trying something new just in itself. With more people comes more experience, more insights and information. I’ve seen friendships made. Laughter enjoyed. There is nothing like sitting across from someone who is in the same or similar situation to know it’s ‘not me, it’s all of us’.
Challenges?
The only challenge I have come across, has been recruiting men to the weight loss group. It’s a shame, as I know they will have a great time as well as get healthier. There are some people that avoid SMAs due to having participated in support groups that were negatively focused or had participants that tended to ‘just whinge’. That just hasn’t been my experience with SMAs. If anything, when someone starts talking negative, they are typically readily supported and encouraged by their fellow patients.
To be quite honest, I wouldn’t be doing something if the benefits weren’t worth the cost and efforts. Though a program like this might not be of interest to everyone, I am confident that my patients do benefit from the advantages that come with a Shared Medical Appointment. I particularly enjoy the atmosphere of the groups and they serve as reminders for me to practice what I preach in my own life. I’m sure I am mentally and physically healthier for providing the programs. There is no doubt in my mind SMAs are well worth it. They will remain a core component of my practice. I invite you to seek out the Share Medical Appointment service nearest you and give it a go. What have you got to lose? More importantly, what have you to gain?
This article was originally written for Whole Food Living and has been republished with permission. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.