"doctors can be more efficient and patients can have more time with their doctors."

I guess "quality time" is not in Edward's dictionary.

As you say, Amy, a dctor might miss things when dealing with a crowd.

There is also the issue of patients interacting with each other that will affect their diagnosis as well, no? Let's say that Mrs. Hypochondriac is in the group and she is a loudmouth. Won't her worries and her bossiness affect the diagnosis the doctor gives to her and others; especially others who are "wallflowers" and are hesitant to speak up anyway?

This clearly hasn't been thought out well.

Keep in mind that psychiatry and behavioral medicine groups have been run successfully for decades--typically even without the need of signing a confidentiality release. -- Nofsinger's site

Basically group therapy is to have people participate in helping each other, and usually none of them talk about it outside the session. Then you have groups like AA which is based on anonymity.

But if you live outside of even a minor metropolitan area, everyone has a clue who you are. You no longer have the anonymity to say I'm having a bloody stool every other week.

A group meeting even in a major area that I don't know anybody in the room, and am sworn to secrecy, I still wouldn't want to say it.

This is bad medicine no matter how you slice it.

Oh fuck no. Group therapy works because it's talking about feelings, not checking blood pressure and scraping cervix's. I'm thinking DIY medicine is going to get real popular here soon.

I can't even fathom how the group thing is SUPPOSED to save time. They still have to check and talk to each person, right? Or are we just going to talk about how our illness makes us feel from now on, and not treat it? Cheaper, I suppose.

How Obama has avoided assasssination thus far astounds me.

Never seemed to work for Eliot Carlin.

It will get worse. Now that ObamaCare towers over most people.

"This is bad medicine no matter how you slice it."

Well, no, not at all. Group visits for chronic conditions such diabetes - where patient self-management is very important to good health outcomes - have been shown to be MORE clinically effective. Here's one article below; a quick PubMed search will give you a lot more.

http://clinical.diabetesjournals.org/content/26/2/58.full

I worked at a community health center at which we implemented a group visit model for prenatal care and pediatric care - it's called Centering. We were literally the first clinic in the country to do both prenatal and pediatric, so they are still conducting the study but patient satisfaction is very high. There are very clear provider requirements in terms of billing for group visits and the provider must do a one-to-one consultation with each patient.

It theoretically saves time because a provider (or team of providers) can see 12 patients in 60 or 90 minutes, vs. 4 -6 15 minute individual appointments. But mostly this is a better way to serve patients ( granted not for every patient and not for every condition.) In our group model, mothers got 90 minutes of service, not 75 minutes of waiting and 15 minutes of service from a provider. They loved it.

Sorry, but you can't treat patients in a group setting unless it's flu clinic where everyone is there just for a flu shot or it's blood pressure check day. I work at Kaiser and they do groups for various conditions, but they are education sessions only, not treating. I went to one when I had gestational diabetes. They talked about it in a group of 20 women and it was mainly about weight management and diet, none of which I have the slightest issue with. We then filled out a questionnaire to turn in that was scanned into the chart for our doctors to review and discuss at the next appointment. They run diabetes groups, menopause groups, hepatitis groups, and HIV groups like this. It's not treating anyone, but it is helpful to them as a lot of self management is necessary for these conditions.

Sam: "Well, no, not at all. Group visits for chronic conditions such diabetes - where patient self-management is very important to good health outcomes - have been shown to be MORE clinically effective."

When they talk about "group visits", they're not referring to groups like health education classes, psychiatric group therapy, community support groups or 12-step programs. They're talking about the actual delivery of medical care to patients in groups, a model that is uncommon now, but expected to eventually become the norm under obamacare.

Other terms for "group visits" are "shared medical appointments", "group medical appointments", and "group appointments". At the website linked above it says, "They can be used for follow-up visits, physical examinations, new patient intakes, and chronic disease management."

The current practice of group sessions is described well in BunnyGirl's comment above.

I'm sure you have to agree to waive some confidentiality. But I don't think it'll be a problem for the people on this site. We've already prioritized health care and won't be the group that is being given insurance. I'm not sure those people would be so diligent to argue about their confidentiality.

You guys KNOW this violates all of the HIPAA laws, right?

http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/index.html

I'm with Flynne too: I do not see how the doctor can possibly remain in compliance with HIPAA doing this sort of thing. For instance, the doctor would be unable to discuss lab test results with a patient if other patients are in the room. My understanding is that the law specifies that a patient can never be required to waive these rights.

Flynne and Amy are wrong.

It's not a violation of HIPAA. Lawyers ain't that dumb.

having all patients (as well as any support persons accompanying them) sign a confidentiality release specifically drafted for this purpose by the physician's corporate attorney or medical risk department.

If you want care, you'll sign the paperwork, thus making it legal. You can waive the HIPAA confidentiality - and you'll be required to.

Tada. (Think of it as a software-EULA to get the drugs to save your life. Got an infection? Want some antibiotics? Well, either wait 2-3 days, or hey, sign this paper and...)

Cousin Dave: "My understanding is that the law specifies that a patient can never be required to waive these rights."

Re: Confidentiality and HIPAA, from the web site linked above:

"What About Confidentiality?

"Confidentiality is handled very conservatively in DIGMAs [Drop-In Group Medical Appointment] and PSMAs [Physicals Shared Medical Appointment, a term for group physical exams] by having all patients (as well as any support persons accompanying them) sign a confidentiality release specifically drafted for this purpose by the physician's corporate attorney or medical risk department. Also, confidentiality is thoroughly covered in the behaviorist’s introduction to each DIGMA or PSMA session. In addition, the fact that these are group visits is made clear in all promotional materials as well as by schedulers making the appointment. Keep in mind that psychiatry and behavioral medicine groups have been run successfully for decades—typically even without the need of signing a confidentiality release."

Of course you cannot be required to give up your confidentiality rights. And a health care provider cannot be required to provide you with services.

Flynne and Amy are wrong.

It's not a violation of HIPAA. Lawyers ain't that dumb.

I have to respectfully disagree, Unix. In 2010, there was a PANIC amongst the powers that be at Yale University and Yale New Haven Hospital. A nurse's laptop was stolen, and it contained a large quantity of PHI from thousands of patients. At GREAT expense to the hospital and university, we were required to upgrade ALL university AND hospital computers, AND ALL smart phones and personal computers of doctors and any other personnel that dealt with patient information. It took MONTHS. (And I know this because I was responsible for overseeing and accounting for the upgrading of the WHOLE section of Pulmonary and Critical Care Medicine at Yale Med School.That was over 200 people with their various devices. Not an easy task, but we were 100% compliant before the end of 2010. Thankyouverymuch.) The hospital also paid a few MILLION dollars in fines. ANY compromise of PHI is a breach of confidentiality UNLESS the patient signs a waiver. And if they're stupid enough to do that, then whatever. But I do NOT want my or my daughters' information compromised EVER. And I want the option to sue those who do compromise it.

>> I choose to tell people that I have ADHD,
>> in hopes of helping destigmatize having it and
>> other brain issues, and in hopes of
>> destigmatizing taking prescription drugs to
>> manage a brain issue. Not everyone is
>> looking to reveal this.

I have a long-term disease that I don't want anyone to know about in case I want to get decent continued rates on my Term Life insurance.

I treat it assiduously, but it is probably a life long condition. Looking up rates for Term Life, I would have to pay an extra $2K a year even though I will lose maybe a year in life expectation. So I should pay an extra $40K for about a $1200 in the actuarial tables?