It’s one thing to share a taxi with a friend, or a garden with a neighbor. But a doctor’s appointment with one or more complete strangers?
At first, the idea seems a little extreme, given what is generally considered an understandable desire for privacy when it comes to the specifics of our bodies or health conditions.
But writing recently at NEJM Catalyst, Kamalini Ramdas, PhD, of the London Business School, and Ara Darzi, MD, Director, Institute of Global Health Innovation, describe the opportunities of so-called “shared medical appointments” as part of the NEJM’s new innovation series.
For starters, they point out, shared appointments aren’t necessarily as new to healthcare as one might first assume. Think Weight Watchers or Alcoholics Anonymous, for example. Or, more recently, PatientsLikeMe, which connects patients to peers with similar conditions.
No one can deny the success of these and similar programs, so why aren’t doctors routinely using them to treat physical and mental conditions? In their view, four crucial components are missing.
First, there’s still not much in the way of rigorous scientific evidence supporting the value of shared appointments. “(L)ike most delivery models, shared medical appointments aren’t easily amenable to randomized, controlled trials. Patients like to decide for themselves how they’ll see their doctor. And unlike a study drug and identical placebo, shared and one-on-one appointments differ visibly from one another.”
Compounding that challenge is the fact that it’s not easy “to pilot and refine shared-appointment models before applying them in particular care settings.” Moreover, there’s a significant need for “contextual knowledge” that would enable the customization of care delivery. “Shared medical appointments at a poor, inner-city health care facility will look different from those in a wealthier suburban setting,” they write. “The two facilities might have different no-show rates, require different communication approaches, and need to address different opportunities for patients to make lifestyle choices.” Consequently, there’s a need for “in-depth observational studies and use of patient-reported outcome measures that can highlight subtle contextual variation,” which would subsequently allow health systems and individual physicians to tailor shared appointments to specific patient populations.
And then, invariably, there would be a need for regulatory support and “participation incentives” designed to encourage the adoption of shared-appointment models. For example, “clinicians managing shared appointments can often charge payers for each patient at the same hourly rate used for one-on-one appointments. Advertising this incentive should increase uptake.”
And then, finally and perhaps most critically, there would need to be education for patients and providers alike. “Businesses that can profit from changes in customer behavior invest in client education,” they note. “Even for mundane tasks such as using automated checkout machines at the grocery store, offering initial assistance accelerates adoption. Education can also help clients adjust to new delivery modes and locations. Offering a single trial of a service — such as a new type of fitness class — can dramatically influence a potential customer’s adoption.”
As for doctors, one idea would be for large healthcare organizations to “experiment with new care models and invite doctors within their system to observe and learn.”
And then what they learn, they can share with others, colleagues and patients alike.