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Ask the Expert Communication Series: The Patient Voice

Q: How do shared medical appointments improve patient communication?

In our past two posts in this series, I talked about provider-to-provider communication and provider-to-patient communication.  In this blog, I want to focus on one of the biggest benefits of shared medical appointments – empowering the patient voice.

Before actually doing shared medical appointments, I imagined that the group setting would be more intimidating to patients than traditional one-on-one visits. While it is true that some patients are initially shy in the group, I discovered that many times the group seems to foster greater openness and more communication from patients. In my experience, SMAs help patients find their voices. I have wondered a lot about why this may be.

I wonder if being among other patients provides a sense of security and support, allowing them to be more open. The group setting is more relaxed and less time constrained as well, creating greater opportunity for exchange among providers and patients, allowing more time for education, and improving shared decision making. Patients learn from other patients and there is enough time for them to ask questions.

Many of my patients are less inhibited when speaking to me in an SMA than in an individual visit. Most patients are reluctant, or even afraid, to tell their physician that they are doing things that might be classified as non-compliant. In an SMA, patients who are reluctant to disclose excursions from their intended behaviors often loosen up after less inhibited participants pave the way. This may be because they observe other patients modeling open, honest communication and see that they are not judged or dismissed, but are supported. It may also be because they are really speaking to a group of their peers rather than to me. In addressing the group, they can indirectly, rather than directly, communicate with me. This removes a barrier that people may feel when they are communicating with someone whom they see as an authority figure.

In SMAs patients see other patients struggling with problems similar to their own. The SMA seems to foster a spirit of camaraderie that promotes honesty in a very organic way and helps to keep patients from feeling isolated.  Some patients are more comfortable being honest with other patients, and some with non-physician providers.  There are plenty of people for patients to speak to if they don’t want to speak to the physician provider. The SMA seems to neutralize any power differential a patient may perceive between herself and her doctor.

For lifestyle change, one of our SMAs, the group format allows the care team to encourage patients to practice changing their language to focus on the positive, rather than the negative. The group helps patients change statements such as, “I didn’t do this”, to “Here’s what I was able to do and here are the areas I want to work on”.  Once patients experience the positive, it opens the door for providers to acknowledge areas of non-compliance as opportunities for improvement, without condemning them.

In one of our lifestyle SMAs focused on weight loss, I looked over to see a Snickers wrapper escape the confines of one patient’s pocket and float to the floor under his chair. He had been successful in losing a significant amount of weight in preparation for a vacation.  I chuckled and pointed out that even the most successful slip up sometimes, to which the patient smiled and acknowledged, “Yes, and it was sooooo good too!” The room erupted in laughter and other patients in the room – especially the less successful – began to share their stories. I might not have said a word had the same thing happened to a patient who had not experienced successful weight loss, but it helps struggling patients to see that successful ones have bumps in the road as well.

Finally, and most perhaps most importantly, the support, knowledge, and insights that patients offer each other are invaluable.  If a patient is struggling with their condition, other patients can empathize and offer tips on how they have been able to cope.  For example, one of my patients was struggling with her CPAP machine tubing at night, and it was driving her nuts.  She was at her wits end, and wanted to stop using the machine altogether.  Another patient, who had experienced the same thing, suggested a method she had discovered for securing the tubing that kept it from disturbing her sleep. Several other patients chimed in with their experiences and suggestions as well. This was incredibly valuable advice that prevented a patient from giving up on an important therapy.   It was advice that I, as a provider, would not have been able to offer because I have never had to sleep with a CPAP machine.  And I now have information to share with other patients as well. This type of support often extends outside the SMA as well--patients who have been in SMAs with one another sometimes start checking on one another or getting together to exercise as group.  These external behaviors serve to reinforce the power of the shared medical visit.

In my experience, the support, education, and sharing in an SMA, promotes patient confidence in making health care decisions.  It empowers patients to make their voices heard and to take control of their health.