Dr. Greg Corinaldi listens as nurse practitioner Patsy McCarthy leads a group discussion on “Aging Well” a book written by George Valliant, M.D. This group is different: they're visiting the doctor together.
They are going into their fifth year of meeting once a month at Kaiser Permanente in Springfield for their group appointment.
Corinaldi clarifies that the group visit is not intended to replace individual doctor visits. Cooperative Health Care Clinics (CHCC), the technical name for the group, is an education tool used to support one-on-one visits. “We try to educate,” Corinaldi said. “We try to educate people by coming in here and talking to the patients in terms of learning about medical problems, but part of that education is empowering them to take care of themselves and learn what they must do to maintain their quality of life and improve their life.”
Begun by John Scott, M.D. in Colorado in 1992, the idea of group visits encourages bringing together a group of patients who are experiencing similar medical conditions and educating them about the issues at the same time. Doctors have seen an increase in independent living, a decrease in length of hospital stays, and an overall higher satisfaction of both doctors and patients who are involved in a group appointment. In the case of Corinaldi’s and McCarthy’s group, members must be over 65 year old and be experiencing chronic medical problems to qualify for the group.
“These people have multiple health problems,” McCarthy said. “It’s like the well sick people in the book. They all have multiple health problems, but that’s not what they talk about. That’s not their focus. Whereas some people that’s all they are — their illness.”
AND THAT IS THE ATTITUDE that Corinaldi and McCarthy try to propagate. They have both seen growth and attitude change in the patients that attend the group. The biggest improvement they have seen is the independence the patients take on after coming to the group. Before attending, many were frequent visitors to the office, they called often and some visited weekly. Now with the group appointments scheduled once a month, Corinaldi and his staff find that the patients seem less anxious and more readily accept a treatment that has been prescribed. “They are taking more control of what they need to do for themselves,” Corinaldi said. “They’ll apply the treatment that I’ve given knowing that I’ll see them and ask them, ‘How are you doing? Have you been doing what we’ve talked about?’”
Another factor in the seniors taking on a more independent role is the positive peer pressure they feel from the others in the group. Clara Gipson, a resident of Kingstowne, said, “You have a backache and you find out that someone else has a backache and a toothache and you realize you’re not in bad shape.” She and her husband, Francis, have been attending the group for four years. “It gives me something else to do on Wednesdays,” she said. “Ordinarily I help make 600 peanut butter and jelly sandwiches at my church and then come here.” When asked if they had read the book for the day’s discussion, Gipson replied, “She read the book. I don’t have time.”
AFTER RETIRING from the National Park Service, Gipson and his wife visited a local cemetery to check on their burial plots. The manager was so impressed with his personality that he was recruited on the spot to explain the cemetery packages to other senior citizens. At 79, he has worked for them for six years. McCarthy asked him to speak with the group about his work. “I brought everyone a little package and the first thing I told them was ‘here we are at Kaiser facility and Dr. Corinaldi and his staff give us great service. But in spite of all of that good service, sooner or later you’re going to have to come to the cemetery!’”
But beyond the medical information and the independent growth, the group appointment offers a social aspect. William Elzeer, who recently turned 90, and his wife Maxine have been with the group since a week after it started. They live in a retirement village in Springfield and enjoy the different speakers that come to the appointments. Both like the fact that the doctors and nurses are there. Maxine Elzeer said, “I come for the camaraderie and the information, plus it gives us a chance to slip in an appointment.” And William Elzeer feels that the group appointments allow a person to have a better relationship with the staff. Without the limitations of getting patients in and out in 15 minutes, the medical team can take their time speaking with each patient, answering questions that, inevitably, more than one person has, and getting to know each patient beyond the medical problems.
“THERE’S A CONNECTION there that we have formed from the association. Somehow they are in a group, but they feel they are going one-on-one, they have their doctor’s undivided attention for an hour and a half. They are thrilled to have that much time with their doctor,” said McCarthy.
She has been the force behind the CHCC from the beginning. She heard about Scott’s group in Colorado and after doing some research, was convinced it was a great idea. Corinaldi was hesitant to lead the group at first, but is now glad he did. He was afraid that group meetings would decrease the intimacy with the patients, but has found the opposite. “It is supportive of the relationship you already have and that makes it more successful in the outcomes.” He said. “It’s really about the patients. They have control over what goes on here. We talk before and after the meeting about what they want to hear. I think that’s why it keeps going because of the enthusiasm of the folks that show up and the interacting with one another.”