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My First SMA

I attended my first SMA about a year ago. Actually, I attended five of them.

I admit – I was a bit skeptical when I first heard about SMAs. If I were the patient, I thought, I don’t know that I’d want everyone else eavesdropping on my doctor’s appointment. I couldn’t imagine sitting there for 90 minutes without getting bored. I wondered what I could possibly learn from other patients.

Boy, was I wrong. On all accounts.


Let’s start with the sharing. In all of the five appointments, there were at least three different types of patients:

  1. The sharer – This is the person who has no qualms about sharing. This person has either attended a SMA before, or joined one because they actually LIKE the idea of sharing.
  2. The eavesdropper – This is the patient that doesn’t want to participate. They listen to everyone else, but don’t offer up information unless asked. They’re like the people on Facebook or Twitter who read everyone else’s posts but don’t post anything themselves.
  3. The fence sitter – This is the patient who is hesitant about this whole “SMA thing”, but warms up to it as the appointment progresses. This patient is often quiet at the beginning of the appointment, but willingly participating by the end.

In five visits, I only observed 1 patient that fell in the final category: The outsider. This patient was different from the eavesdropper in that she wasn’t engaged. I am not an expert in statistics, but 1 patient out of about 40 is a pretty low percentage.


Which leads me to my next observation – engagement. Remember how I was worried about being bored? I was anything but bored at all of the appointments that I attended. And I was only an observer!

All of the patients except 1 were engaged, participating, asking (and answering) questions, and supporting their peers. I was pleasantly surprised how many of these patients felt comfortable offering advice about their condition, asking about another patient’s meds, or guessing at a diagnosis before the physician.

Did this take coaxing? Sometimes. Sometimes not. Two of the SMAs that I attended consisted of a group that met monthly. These were the most engaged patients that I observed. They knew each other by name, spoke to each other outside of appointments, and were the most comfortable challenging the doctor when appropriate.


Last but not least, the education. I heard comments like, “Of course I remember that, doc – you draw diagrams!” I saw patients taking notes, analyzing their own test results, and participating in the evaluation of a fellow patient. The behaviorist (who works as a facilitator or health coach), kept everyone on track, making sure that they got the information that they needed. But the patients drove the majority of the conversation with their comments, medical exams, and questions.

It was also obvious during the recurring appointments that both the physician and the behaviorist worked very hard at helping their patients achieve their health goals. “I failed to exercise this month as much as I said I would,” said one patient. “Why do you think that is?” asked the physician. “Honestly, I just didn’t feel motivated. I wanted to go to the gym, but couldn’t actually get there.” “Do you have any friends that go to the same gym?” asked the behaviorist. “Sure,” said the patient. “Well, why don’t you guys pick one day a week to go together?” The behaviorist and physicians took high level goals – like exercising more – down to a simple, attainable goal, like going once a week with a friend.

We all need support and guidance in our lives. When it comes to our health, I think it is a huge benefit to get this from people with like medical conditions. After all, they understand what you are going through. And it’s different when you are held accountable not only by your physician, but also your peers. Peer pressure and role modeling are powerful tools.

Despite all my skepticism about shared medical appointments, I was turned into a believer. It’s why I took this job. Shared medical appointments are one of the few things in healthcare that feel like a win-win: Better care for the patients, more access to providers, and more satisfied and efficient physicians. Where is the downside in that?