Elaine Massaro believes in the power of treating people with diabetes in group settings. She's an RN and CDE who was recently honored as 2010 Diabetes Educator of the Year by the American Association of Diabetes Educators (AADE) for her success in "improving the effectiveness and efficiency of diabetes patient education by using this (group) technique with patients at Northwestern University in Chicago." She's also one of an elite group of CDEs teaching the use of new Conversation Maps (group visit aids) to healthcare professionals across the country.
So while the "group" idea may initially make you squirm, I'd ask you to listen to Elaine's voice on this option today...
A Guest Post by Elaine Massaro, CDE
If you've never done the group thing or even considered it, I can understand. Many people wonder "what exactly is a 'group medical visit' and why would I want to attend?" Actually, this type of shared medical appointment has most components of individual visits including face-to-face clinical evaluation by a physician — but it also involves a team approach with a diabetes educator, dietitian and other experts.
Here's how it works: a group of 8-10 patients meet together in a room with a doctor, a CDE, and a nutritionist. The first hour or so is spent with patients taking turns having individual discussions with each provider (kind of like "stations") around the room. A medical assistant downloads each patient's glucose meter, takes their blood pressure and weight, and reviews their medication list, etc. so that suggestions for adjustments can be made. This is no different than what you'd do at a traditional doctor's appointment.
But the second hour is then spent in guided interactive discussions, usually focusing on a different topic at each session. This sometimes includes a guest speaker, like a behavioral scientist (psychologist) who might talk about challenges in changing lifestyle habits.
A great deal of information sharing takes place through this group participation. And this way, patients get their regular doctor appointment taken care of, while also getting enriched information on nutrition, physical activity and lifestyle management. In other words, it's the best of all worlds.
(btw, patients do have to sign a privacy waiver, although their clinical stats are not formally shared with others present. We don't put people's results up on a white board, as suggested in the Wall Street Journal story on this topic; patients share whatever they want to share, and whatever is said stays in the room.)
You still might be wondering why a person would trade the traditional 1:1 time with a physician for the group model? Well, in the group setting patients not only have access to the physician, CDE and dietitian, but also have access to each other. I don't have diabetes, but I can attest to seeing how incredibly powerful it is to mix with others who experience the same issues and struggles of living with diabetes as you do. Some of the topics discussed relate to self-management skills, blood pressure and cholesterol management and basic survival skill management. But there's also just a lot of personal sharing, relating of stories, and general empathy. It's most definitely not a lecture-style model where patients sit in a group and listen. Rather, their interaction is key to the success of this model because the group takes on a life of its own, encouraging everyone to become more engaged and to feel free to add to the discussion — for like Oprah says, each individual has a story and something important to share.
What's key is that the educator in charge has to have the group facilitation skills to pull it off. They have to be able to move on from one idea to the next and make it flow, otherwise the group can get stuck on one topic and nothing gets accomplished. This is an important skill since the group needs to keep on track — avoiding too-long tangent discussions — and various challenging behaviors or personalities always need to be addressed in each session. The leader needs to know how to deal with it if someone gets negative, purports to know everything, or is dominating the discussion in any way.
I find it's important to facilitate these sessions in a firm but encouraging style. The setting really does work to instill hope by allowing participants to see examples of success in managing diabetes. It automatically encourages an unselfish regard for others and positive role modeling within the group. Also, I find that when particularly difficult topics are discussed, it often allays anxiety and individuals walk away feeling that they are not alone; the obstacles and issues that they experience in every day life are shared by others!
My experience is that these sessions are rewarding for both patients and professionals. Doctors and we CDEs tend to repeat ourselves over and over with each individual patient visit. This way, we're more efficient and we can set ongoing goals for each visit; we also ask patients what they want to address in the next session, of course.
For patients: lo and behold, a bonding experience often occurs. They become like like a little club, and put pressure on one another to come to the next appointment. This phenomenon is quite similar to that of the separate Support Group meetings I lead in the evenings, but those differ in that no physicians are present and no clinical information is gathered (ie. no treatment). As with a support group, bonding during these group medical visits makes the whole thing fun. It's not boring and people feel that it's worth their time. We can even discuss some more holistic and therapeutic approaches to care versus the traditional route.
Patients can come to these group visits in lieu of their regular checkup, and they are covered by insurance just like any office visit.
Since this model has grown in popularity, group medical visits are now available in many regions across the country. Unfortunately, there is no formal place to look up group medical visits offered in your area. But it's worth checking with your local clinics and hospital about the closest sessions. Give it a try so you can experience it for yourself; you may be glad you did.
Thanks, Elaine. We do much of our support / sharing online, but there's still no substitute for the face-to-face factor, especially if you can get your endo visit taken care of at the same time!