Shared Office Visits

Photo Credit: Jenny Fitzgerald

Recent articles in Time and The Oprah Magazine discuss the intriguing concept of “shared medical appointments”. Here’s how such appointments work. Up to a dozen or more patients assemble for the visit. First, a nurse or physician’s assistant evaluates vital signs such as body weight, blood pressure, and heart rate. Next, if the patient is to be examined (apparently exams are optional in human medicine these days), the nature of the visit dictates whether this happens privately or fully clothed in the group setting. Lastly, a group discussion takes place during which time the doctor addresses each patient (everyone in attendance signs a confidentiality agreement) with time left for discussion and questions.

A report in Clinical Diabetes discusses the benefits derived from shared medical appointments, particularly for management of chronic health conditions such as asthma, diabetes, and high blood pressure. Increased compliance with the physician’s recommendations has been documented. Patients report that they benefit from questions asked by other patients, and that they learn more about disease prevention in the group setting than they would during a one-on-one office visit.

Shared office visits aren’t for everyone, particularly those who tend to be more private by nature and may avoid discussing important health issues in a group setting. According to data collected by the Cleveland Clinic where almost 10,000 group appointments have taken place, 85 percent of people who attend one shared visit sign up for another

Some physicians seem to prefer shared appointments because the process streamlines the way they deliver health care. Rather than providing the same blood pressure or diabetes management spiel multiple times during the course of the day, they can deliver this important information to a dozen or so patients in one fell swoop. According to the American Academy of Family Physicians, since 2005 the percentage of family medicine practices within the United States offering shared visits has doubled from 6% to 13%.

Interesting concept, eh? Naturally, when I read these articles I began thinking about how the concept of shared office visits might work in veterinary medicine. In all seriousness, I really do believe shared office visits would be effective, particularly for annual wellness exams. My experience tells me that clients love chatting with one another and “comparing notes”. I’ve witnessed many an impromptu “support group” form in busy veterinary hospital waiting rooms, complete with exchange of telephone numbers and email addresses. And, given the choice, I think most veterinarians would relish the opportunity to give their nutrition/flea control/vaccination/heartworm prevention talk once a day rather than ten or twelve times daily.

Based on the dog park model, it might be wise to separate the big dogs from the small dogs during shared office visits. Folks with the little guys would hear about dental disease and symptoms of heart failure. The big dog people would hear about arthritis management and cancer prevention. How about group visits for kitties? Hmmm, this one makes me a bit nervous. And mixing dogs and cats together would surely be a recipe for disaster!

What are your thoughts about shared medical appointments for yourself or your pets?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available at www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

 

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18 Responses to “Shared Office Visits”

  1. lynne says:

    Thank you so much for posting! “shared medical appointments” is new to me, I always glad to hear about new trends. I think it’s a great idea, and I would really like to send my own dog to such an appointment. Thanks again!

    Click Here

    :-)

  2. Julie says:

    I am not in favor of sharing time I have paid for for either myself or my pet companion in matters regarding health issues. One can’t control the time others take to communicate their issues, nor can one control the behavior of others’ pets in group settings. Imagine being caught up in a group where one pet owner is more interested in bragging about his/her companion than dealing with medical issues, or worse yet, boring the group with non-medical related conversation. A long-time doctor becomes like a member of the family–nursing your family members through sickness back to health and eventually to the end of life. The doctor-patient relationship is both professional and personal. I’ll take mine one-on-one, thank you.

  3. Cindy Pina says:

    Dr Kay I have 4 toy poodles. Their ages are 3, 6, 12 & 12. One of the 12 yr old has issues but the other 3 are basicly healthy and I don’t see anything wrong with taking two in at a time. This would make it a lot easier on me for their annual check-up. But to have an appt with a stranger and strange dog wouldn’t cut it with me . As the others have said above if your dog is diabetic or has heart conditions it’s a different matter. I also agree with what Courtenay above says.It makes a lot of sense. Especially the costs.All of us need a break but want to do the right thing for our pets.

  4. As a physician and a patient, I can endorse group appts for such things as blood pressure checks, glucose checks, diabetic counseling, and psychological counseling for humans. The downside of a group apt is that the patient will be unable to bring up any private issues that are troubling her/him. In veterinary medicine, not all patients will be tolerant of other species or other animals. I can see the merit of group for grief counseling for the loss of a pet, or oncology group for pets with cancer, but this is for the benefit of the owner, not the pet. I prefer a solitary appt for my cats, who are fearful when they are removed from my home. A group apt would not be therapeutic for them.

  5. Dr. Kate Fulkerson says:

    No interest. There is too much variation in the goals and knowledge about animal health among pet owners.

  6. Carolyn M M says:

    My husband participates in a diabetes group such as you have described. It has been a positive experience — sort of a support group, moderated by the doctor. I would have loved such a group for my previous dog with CHF and I think there is definite potential for wellness checkups. “One size does not fit all” so I can understand that it might not be appropriate for everyone. I like connecting and would definitely give it a try.

  7. Suzanne Brown says:

    We do heart and eye clinics at many of the CKCSC shows around the country during each year. We bring in a boarded specialist and it makes seeing one much easier (most being either at a vet school or in a large metropolitan area), and also cuts the cost. But these are Cavaliers who look upon such occasions as “social events”. This might not work for all breeds but I do believe that various breeds do these clinics regularly.

    As for people, my answer would be no – even for my dog’s regular visit to the vet. I don’t want my dog to be the 30th he’s seen in 15 minutes, nor do I want to be the same with my own doctor. I think one of the most vital parts of the doctor/vet/patient relationship is just that – a relationship. It’s why I’m appalled that so many internal med specialists these day use a hospitalist instead of making hospital visits themselves. Over the years, one should build up a meaningful relationship with ones doctor. It works both ways – if my doctor knows I don’t call unless it’s REALLY urgent that I (or my pet) be seen, unlike others who call at the drop of a pin, the doctor knows whom he must work in that day and who might be able to wait.

    I like to get to know my doctors and it has been very beneficial to me to do so. I think they would say the same.

  8. Sue says:

    While this sounds like an interesting concept, I can see a number of reasons why I would not be likely to take advantage of it.

    Many people already spend more time in the waiting room than they expect to because the vet is running behind or there was an emergency client that took priority. Who wants to wait while a dozen or more other animals are weighed, histories taken, examined by the vet? By the time that’s been accomplished, and then the informational discussion takes place, I can see this appointment running at least several hours, IF all the animals have the same health issue. If there are multiple health issues to discuss, then it could go even longer. Odds there are going to be some ‘talkers’ who monopolize the conversation, and less aggressive people will be left with unanswered questions.

    Having managed medical offices for many years, I understand that the professional values his time, but I’d encourage him not to undervalue his clients’ time either.

    In my mind, if the vet wants to save time, printed handouts fir specific conditions could be given at the time of the individual appointments, and the vet could offer periodic gatherings to provide information to groups of patients with similar health issues…diabetes, Cushings, geriatrics. weight loss, etc. There would be no need for the animals to be there.

  9. Taryn says:

    Many dogs react to a visit to the vet as a HIGH stress event. I’ve seen plenty of squabbles just in the waiting room. I can’t imagine putting a group of strange dogs together, fearful of what’s coming, and expecting a good outcome. I can just see a small 100 pound woman holding the leash on her adolescent Lab who desperately wants to say Hi to the stressed out German Shepherd, also held by a small woman. As the Lab yanks free, it jostles other dogs on its way the the GSD, and pandemonium ensues!

    The average pet owner doesn’t have the skill to handle this situation, nor will the average dog have the training/socialization needed.

    I would definitely NOT sign up for this, money saver or not.

  10. Jan Stice says:

    Depends-the key word in so many situations! I use it a lot when teaching my Pet Partner workshops about different situations dogs in particular can be in while doing pet therapy.
    I can see group visits being an asset as you said for routine visits or even maybe for the same chronic illnesses. There would definitely need to be rules as a lot of handlers would unintentionally cause problems by letting their dogs visit, play or even get into small fights. I could see people sharing ideas of how to care for their chronic illness pet-this was a help to me when my dog had DM. And as you said, routine visits would probably keep a vet from having to repeat, repeat the same needed info to a client. I guess you would charge a predetermined fee which the clients would know and agree to regardless of how much time they felt they had to discuss their dog’s health with the vet.( And a liability release too!!)
    It’s an interesting idea and I would think it would be very informative to see it tried and how it works out-with both the vet and the client and their dog.

  11. judy says:

    MAYBE for dogs who have regular appointments for chronic conditions such as diabetes, Cushings or Addison’s. Other than that, I really enjoy my discussions with our vet, and wouldn’t want to share her!

  12. Melissa says:

    I actually love the idea for puppies and kittens who are in for basic wellness checks/vaccines. An excellent socialization opportunity!

  13. Linda Townsend says:

    We do a sort of sharing…
    I have 3 dogs, a golden/greyhound rescue and two border terriers. They are less stressed during their visits when they visit together. I try to always schedule their wellness exams together.

  14. RuthAnn says:

    Wow! I see a lot of chaos in sharing appointments. I teach family dog classes and for beginners the first class is dogless just so my students can pay attention to me and not worry about what their dog is doing.

    Many pet dog people think when they see another dog, they must let their dog visit the new dog. My rule is if your dog is on leash they should pay attention to you, not the new people or dogs. I don’t know of any vet’s office that is large enough to keep a space bubble between dogs that don’t know each other.

    Many pet owners do not see their pets as professional animal people do (trainers, vet’s and staff). I had one student that said her miniature poodle accidentally scratched a woman with his teeth. We had a discussion about what constituted a “bite”. She was amazed when I told her this is a “bite” not an accidental scratch, and would be cause for her dog being labeled a “Dangerous dog”.

    Sorry but I don’t see much of a future for group appointments.

    PS: Maybe cats, as most owners comply with vet practices and bring the cats in crated. Vet can offer group information then each cat can go to a separate exam room if needed.

  15. Jana Rade says:

    Interesting. I think, like everything else, it depends. With our guys we sometimes do what you could consider a shared appointment but what it basically means that we bring both dogs in at the same time. JD, who’s been problem free gets a check-up and bloodwork etc and the girls (yeah, Cookie has been quite a challenge already too) get whatever examination and diagnostics they need.

    The only thing I’d be concerned about would be the amount of time spent per dog. As long as enough “doctor time” alloted per patient, it should work just fine.

    One thing to consider too, though, is how well all the dogs might do with being all together like that. I know Cookie would want to play and JD would try to get piece of whatever action might be going on. Just with the two this gets challenging sometimes.

  16. Courtenay says:

    Have a Vet Tech examine each animal (and in most places, vaccinate/deworm except rabies), and note any that require vet exam. The rest can go back out to their cars or wait in carriers/kennels while the humans (and the few animals who need exams) meet in a room. This would be less stress and could accommodate more clients than having everyone bring their pet in.
    Especially for vaccines, annual appointments, or specific chronic conditions.. Have a Diabetes appointment once a month, a heart care one.. At a lower cost than an appointment to yourself, this might encourage chronic-disease petowners to attend more carefully to their pets’ needs, especially right after diagnosis.

  17. Amy says:

    I think it would be a great idea for diabetic pets having curves done. I learned a lot from an online support group for people with diabetic pets. Knowing other pet owners in the area would have freed me up to do more traveling. While she was alive I never went anyplace I couldn’t take her. Boarding at a vet incurred extra expense for the insulin shots, and I didn’t know of a boarding facility around here that could take her. (I have since found one whose owner who once had a diabetic dog) I would gladly have petsat for other diabetic dogs in exchange for them petsitting for mine.

  18. Sherryanne says:

    As a human, not for me as I have no chronic, common health issues. From a vet medicine point of view..the confidentality aspect seems very hard to inforce and could ruin a breeding program for those bent on doing so..perhaps for pet only owners, there may be some merit for vaccination, food etc issues..