Friday, October 17, 2014

SMAs at FHCOE, an Early Clinical Experience

FLASHBACK SERIES: Blog posts written during my medical school days at Pacific Northwest University - College of Osteopathic Medicine

by Kim Ha Wadsworth, OMS I

It is a typical Wednesday afternoon at the Family Health Care of Ellensburg (FHCOE). Eight pre-diabetic patients sit comfortably in a semicircle, chatting with ease among themselves while waiting for the start of their "Shared Medical Appointment" (SMA) with Dr. Byron Haney, MD, founder of FHCOE. In the front of the room, a large LCD touch screen monitor displays each patient’s name, age, gender, vital signs, blood test results, relevant history on smoking, aspirin prophylaxis, and health care maintenance tasks. A female medical assistant sits quietly off to the side, ready to enter information into the EMR system on her laptop and to order any Rx or additional tests. Myriad questions pop into my head: Why are patients willing to share their medical stats to the entire group? Will they openly discuss their progress and health goals with others present? How will Dr. Haney manage his different roles in such a group setting—medical expert, advocate, educator, facilitator, supporter?

Dr. Haney introduces the six medical students sitting in the back of the room. Then, he efficiently interviews each patient, from youngest (50 yo) to oldest (72 yo) in the group. The touch screen transforms into an interactive whiteboard as Dr. Haney makes notes of trends from each patient’s last appointment three months ago until today, flying between screens as he explains metabolic syndrome; defines the standard targets for A1c, FBS, HDL, LDL, TG and BP; shows a short 2-minute video on diabetic retinopathy that can lead to blindness; uses an interactive calculator that charts the risk of cardiovascular disease based on various factors; and explains the role of genetics versus other controllable components such as diet, exercise, smoking and depression.

As I observe the patients’ interaction with Dr. Haney and each other, I become fully aware of the concern, camaraderie and support—even friendly competition—that help each patient set their own health goals and stay on track. Dr. Haney notes that his patients bring up things in this group setting that they don’t necessarily say to him alone. On cue, one patient opens up about his depression that contributes to his obesity while everyone listens attentively. Dr. Haney reassures the patient that they will work on these issues together. I feel inspired as I witness firsthand the power of such transformative practice of medicine.

The benefits of these SMAs are clear. In 90 minutes, Dr. Haney provides complete, efficient, accurate care for his eight patients. How could he possibly cover the same depth of information during a traditional one-on-one medical appointment that only allows him 15 minutes per patient? Dr. Haney thoroughly educates his patients on common topics instead of repeating the same information individually, which allows more time for him to answer their specific questions and concerns. Moreover, the patients learn from each other and gain motivation to improve their health incrementally. All of this is accomplished in a little over 11 minutes per patient. What about concrete outcomes? Dr. Haney states that in the six years that he established SMAs as a standard of care in his practice, he has never had a single patient go from being pre-diabetic to diabetic.

According to the authors of The Health Advocate Role,1 “ advocacy comprises all of the activities that physicians do to advance the health and well-being of individual patients, communities, and populations.” Given this broader view of the role of physicians—called for by the public—as good advocates not only for their individual patients but also for the overall welfare of communities, Dr. Haney certainly makes a significant impact on both patients and public health policy by providing innovative solutions to address broad health issues and the biological, psychological and social determinants of health. He demonstrates responsiveness, efficiency and accountability in his patient- / community-centered care. He goes beyond his core activities as a physician and applies different skills in collaborative ways in order to interact further (and more deeply) with his patients while bringing together the shared experiences within a group setting. Dr. Haney’s Shared Medical Appointment is an incredible model for patient advocacy, health promotion and disease prevention.

1 Dharamsi S, Osei-Twum J, Shroff F, Mu L, Woollard R. The Health Advocate Role: Preparing Future Physicians for Socially Responsive Practice.  Vancouver, BC: The University of British Columbia; 2010. Accessed October 18, 2014.