Tuesday, February 17, 2009

Shared Medical Appointments (2) - A Clinical and Ethical Innovation

In December I wrote about how Harvard Vanguard Medical Associates, the group practice I was part of for 32 years, is implementing shared medical visits. Today National Public Radio had a story about shared visits that is well worth listening to.

Gary Watson recently called the office of Dr. Charlie Tracy, his primary care physician. He wanted to get in to talk about his sleep apnea and some muscle pains. Mr. Watson reports "They said, 'Wait a minute, can you get here at two-o-clock this afternoon?' 'Why?' I said suspiciously. And they said, 'We're going to have one of these groups with Dr. Tracy.'"

In the NPR story we hear Dr. Tracy talking to Joanne, whose varicose veins are giving her more trouble. He looks at the veins in her calf and uses the opportunity as a "teachable moment" to discuss varicose veins with the group. Dr. Tracy does two group visits a week. He says he likes them because his patients don't feel so isolated by their illnesses in a group setting.

But he says there are limitations - "Sometimes you can't quite go into the depth that you'd like to. Some patients may be a little shy and not bring out the things they want to." But overall Tracy feels that what patients gain from the group outweighs what they might lose. "And they get to spend 90 minutes. Where else can you spend 90 minutes with your doctor? So I think for most patients it's as good and, many times, better."

But why am I writing about shared visits in a blog about ethics?

It's because I think the innovation is relevant to the question of how values change. I've felt for a long time that our national approach to health system ethics is too atomistic - focused almost exclusively on individuals with minimal attention to the needs of the wider population. I've advocated for a more communitarian ethic in writings and talks, but speeches and articles don't accomplish much, even when given by people with more eloquence than I can muster.

Shared visits let people - patients and physicians - kick the tires of a more communitarian approach. Gary Watson told NPR that even though he came to talk about his muscle pains and sleep apnea, he also learned about the shingles vaccine, how a few glasses of wine each night can raise blood pressure, and other health tips that made the ninety-minute visit a good use of his time. He says he'd come again. "I think there's a shared energy in the room...everyone seems to be open to receiving help as well as helping other people."

We all experience illness and we're all going to die. We should be thinking about health care, the resources we devote to health, and our approaches to healing, in terms of the needs of populations as well as the needs of individuals. Shared visits, which research shows to work well, provide one way to expand our moral horizons.

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