Group Visits

On Thursday, we tried something a little different. Since so many seemed to have similar complaints, I thought this lent itself nicely to doing group visits. This is something I’ve been hankerin’ to do for the last 2 years, having read the book by Noffsinger, out of Harvard, about the Shared Medical Visit. Here is a link to his book: http://www.harvardvanguard.org/about/MOST/MOSTInnovation.asp This link tells you a bit more about how the visit runs: http://www.lifestylemedicine.org/noffsinger. Basically, it is a type of group visit where 12-15 people with various complaints are seen as a group; the doctor does individual, 1 on 1 visits with each patient aloud for the group to hear, then between patients, while the doctor finishes the note, a “behaviorist” leads a 1-2 minute discussion about something that was discussed at the visit. Patients can chirp up when appropriate to lend their story or support to the patient who is being seen, and if the patient has any private matters to discuss, there is time set aside for that too.

                After getting the OK from Kathy and Susan, Britt, the medical student, and I decided she would get vitals, while I conducted the consultations. After each consult, she gave a 1-2 minute talk about something we discussed at the consultation. We had planned about ½ dozen different talks with bullet points. After each group, Britt asked the patients for feedback. It was 100% positive, and many gave us both hugs as they left the group. It was so gratifying to be able to reach this many people more deeply than we could have with just a 5-7 minute consult.

We did 5 different groups, plus we saw another 12 patients afterwards, not in a group setting. For the day, we saw about 68 patients this way. This was a bit more than I could have seen alone, and maybe a little fewer than Britt and I combined, but it allowed us some time for each of us to “catch our breath.” We both felt that the difference was negligible, and the benefits far outweighed the mild loss of productivity. We both felt refreshed and invigorated at the end of this day. There were a few moments that shined out.

The first group session, with Fidel standing behind the patient and interpreting for me.

                In the first group, we had 16 patients, including 6 kids under 11. The first 2 women were quite depressed, and I had to spend more time with each of them. I feared that was a recipe for disaster, as it may have been “contagious” and others would have similar complaints, bogging the whole group down. This wasn’t the case, though. There was one other with severe depression at the end, and she took less time than usual because she heard what was said before. This group took almost 2 hours, so the next group, we took 12. We had more volunteers than spots and had to turn some away.

Our first group was outside. Sister Susan observes, while Britt gives a 2 minute
talk on how to work with stress.

After lunch, we took another group of 10. In this group, there was a woman who kept on helping the other patients with what they were trying to say, or what I was asking them to do. I called her “la infermera” (the nurse). When it was her turn, I called her my nurse, and she loved it.

In another group, an elderly lady, while trying to find her meds in dress pockets, pulled out Kleanex, a toilet paper roll, medicine packets and other assorted knick knacks. Everyone laughed good naturedly when she said she had a whole pharmacy in her dress.

In another group, our last of the day, 4 of the people had rotator cuff injuries. After teaching isometrics to one, they all got it, with a little reinforcement. The true beauty of group visits at work.

I have to say that Britt was awesome in her job as educator. She spoke simply and hit the major points well. When she finished, I sometimes summed up and got some accord from the group. This could not have been successful without her. At the end of the week, during debriefing, she said that the feedback she and I got after each session was the most memorable part of the entire week for her. Several said that they have never had so much time with the doctor before, and received such timely education. Good job, Britt! She is currently thinking she will be doing international medicine as a significant part of her career. She is going to be an outstanding doc, and I felt privileged to work with her.

Britt doing a mini-lecture while I watch on
in one of the groups.
Picture by Mary Frazer

After our last group, we saw a few others one on one. I saw a 48 year old who looked to be around 300 pounds, and no taller than 5 foot 3 inches. She had the usual headache and stomach pain, but when I reached across to examine her belly, she had a positive Murphy’s sign, which means possible gall bladder disease. Her pain was worse with fatty foods, so we got an ultrasound which confirmed several stones in her gall bladder. When I told her the news, she refused to go to the hospital. Charlotte came by and told her what I was telling her, about the dangers of not getting it taken care of, but she still refused to go. Sister Susan, then Father Mario all worked on her, and she finally relented. She was fearful that her 14 year old daughter would not be cared for and wouldn’t go to school, as she was sure to die in the hospital. We were finally able to convince her that this was a very rare circumstance, and she agreed to go.

Lastly, in one of the groups, there was a woman who felt like she had a ball in her throat. She ate a piece of fish and a bone lodged in her throat. She felt particularly bad because the fish was her pet! This was pretty funny and all laughed, including the patient and her husband. Since we could, I got an ultrasound to see if there was a fish bone, mostly for reassurance, and although there was no fish bone, we found a small 5 mm thyroid nodule. So, she probably had globus hystericus ( a condition where the patient feels something is in the throat, but there really isn’t anything there), plus a new thyroid nodule that will need follow up.