Patients and healthcare professionals can both benefit from group consultations, explains Dr Chris Mimnagh.
Right now, your model of consultations, either as a patient or as a member of the NHS, is probably based on the idea that one clinician and one patient take part in the consultation at the same time. So, I’d be willing to bet that the idea of sharing an appointment with other people seems frightening.
But just wait a moment. There are circumstances in our lives when we are happy to work in groups to solve problems, share understandings and listen to interesting ideas of expert speakers. Granted, these opportunities are usually not in medical consultations, but an increasing number of clinicians across the UK are implementing shared medical appointments as a means of improving efficiency, creating self-care networks and becoming more effective as clinicians.
I appreciate these are big claims to make, but shared medical appointments have a good body of evidence, predominantly from Australia and America, and increasingly from the UK, which suggests that patients with a common need, together with a clinical expert and a clinical facilitator, experience a positive outcome and productive experience when placed together for an hour.
In my own practice in 2014, we started out on the journey to deliver a new model of general practice. As part of that model, we use shared medical appointments for particular patient groups, ranging from breast cancer survivorship to patients with raised cardiovascular risks, including heart failure.
Obviously, not every patient is suitable for an interactive consultation with multiple patients present, but our experience suggests that individuals who do participate gain significantly in terms of peer support and understanding.
It’s a very simple concept really. We all know that when involved in a conversation, half the time we are thinking of what to say next to keep the conversation going. In a group situation, you have the opportunity to listen in to somebody else’s conversation and will probably hear the same messages and questions you have, raised by other people.
Part of the shared medical appointment methodology is to ask patients what questions they would like to have answered and to prioritise them for the clinical expert. This usually takes place before the clinical expert arrives, as this allows people to agree on the importance of the questions, as well as serving as a bonding exercise between patients.
It has long been suggested that patients remember only four things from consultations, and although it is too early to say, I suspect patients leaving a group of shared medical appointment, leaflets in hand, will remember significantly more.
By now, if you are an optimist, you’re probably thinking: “But what about confidentiality?”, and “How do you handle examination?” If you are a pessimist, you probably have already consigned the idea to the rapidly growing it’ll-never-work-here pile.
Confidentiality is an issue and all patients are asked to sign a confidentiality agreement – a hard learned lesson when one of our group members sat down with strangers for the first time and asked: “Will this cure my erectile dysfunction?”
We first began our shared medical appointments over 12 months ago, with the support of SMA UK Contact Group. Clear guidelines and rules are available for the roles of facilitator, clinical expert and data recorder, and we have engaged specialists in oncology, cardiology and heart failure. We have learned that these appointments are a useful tool as well as a means of increasing productivity.
We have been fortunate in having good support from our local specialist clinical services, with particularly strong support from one local cardiologist, Dr Jay Wright, who described the shared medical appointment he completed in 35 minutes as possibly the most productive moments of his clinical life. There was no telling the patient: “Go and see your GP to get medication”, there was no telling the patient: “I’ll send a letter to your doctor”, there was no waiting around for the next patient to come in.
There is far more to discuss and expand upon in this fascinating development of consultation method – doubtless we will have to seek out UK-based evidence, stand scrutiny from critics and the usual criticism from those choosing to deny change.
Dr Chris Mimnagh is a part-time GP partner in Liverpool and head of clinical innovation liaison and deployment at The Innovation Agency, the academic health science network for the north-west coast. To find out more about group consultations, please contact email@example.com @ChrisMimnagh
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