Shared medical appointments

Domain V · Systemic, relational, group & community · Edward B. Noffsinger, John Scott · 1991 · Kaiser Permanente, USA

What it is

Shared medical appointments (SMAs), also called group medical visits, are not a psychotherapy. They are a way of delivering medical care. A group of patients, often with the same condition, has its medical visits together in one extended session, usually about 90 minutes. Each patient still gets…

Format

• The sources do not describe treatment phases. SMAs are structured at two levels: programme set-up and the session agenda. Which model you use determines both.
• Launch and early sessions. Debrief after the first session, then hold a team meeting each month.

Who practises it, and how they are trained or regulated

• Training. Centering requires every group leader to attend its Basic Facilitation Workshop 1–2 months before groups start.
• DIGMA and the Physicals SMA have no formal certification in the sources. Bronson & Maxwell stress following the model closely. CenteringPregnancy is a licensed model: you need the Centering trainings, and Site Approval confirms fidelity.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the debrief being dropped once the group has "bedded in".
• patients leaving without knowing the next date. Confirm it.
• rows of seats facing a lectern. That layout invites lecturing.
• measuring only satisfaction. Include a census or access measure.
• guest specialists lecturing. Brief them beforehand to keep it interactive.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.