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Ladies and Gentlemen, the Doctor Will See You Now


WebMD Health News
Reviewed by Merle Diamond, MD

July 31, 2000 -- Call it a possible cure for the all-too-brief doctor visit: the shared medical appointment, also called a DISMA, DIGMA, or CHCC -- acronyms that could spell a new trend in managed care. They all boil down to a single concept: sharing your doctor's appointment with others. Not the kind of appointment in which everyone strips to their skivvies and says "ah," but the group discussion variety -- with optional one-on-one time -- so that patients can share information and above all else, share more time with the doctor.

"I think it's the future of medicine," says Ed Noffsinger, PhD, father of the DIGMA (Drop-In Group Medical Appointment). "What this means is, once a week they're welcome to drop in and see their own doctor [in a group setting]." Noffsinger, a consultant and director of clinical access improvement for the Palo Alto Medical Foundation in California, says group appointments give patients two things they want most: better access to medical care and more time with their doctors.

What the DIGMAs don't give is privacy. But surprisingly, Noffsinger and others say that doesn't seem to be a problem. "It's remarkable," says Mark Attermeier, MD, who runs DISMAs (Drop-In Shared Medical Appointments) at a clinic in Eau Claire, Wisc. "We have patients talking about sexual dysfunction, erectile dysfunction, prostate problems, menopause. Contrary to what you might think, it feels like a safe place. Regular people talk about that stuff. It's the stuff of life."

It's also the stuff of embarrassment, for some, and that's why proponents readily admit group appointments aren't for everyone -- nor should they be. By one estimate, about 40% of patients will refuse to attend a group appointment. But in addition, some patients just shouldn't. These would include patients with sudden illnesses, or those coming in for long medical appointments -- such as physical exams, Noffsinger says. The best candidates: those with chronic illnesses who have day-to-day concerns about managing their disease.

That's essentially the group invited to participate in CHCCs (Cooperative Health Care Clinics) at Kaiser Permanente in Denver. In addition, they tend to be elderly. John Scott, MD, who pioneered the Kaiser groups, says he has found evidence the groups have the capacity to satisfy just about everyone. "We ran [a] study for a year," Scott tells WebMD. "It showed patient satisfaction was through the roof. The docs loved it. The quality of care was better ... and the cost was dramatically lower." Scott says that a two-year study is now ready for submission to a medical journal: "It was even more dramatic, with decreased hospitalizations, decreased emergency room visits, decreased referrals, and decreased nursing home admissions."

No matter what they're called, group medical appointments usually share a certain structure. There's a socialization period, followed by an educational component. A question and answer session might follow, along with a check of vital signs. Patients can then get new prescriptions from the doctor, referrals, and perhaps minor tests done. And if necessary, they can have short, one-on-one, private consultations. Length of time for a group session varies, with Scott's running about two and a half hours.

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