December 8, 2010
By Michelle Hauser
What if patients left the doctor’s office with a recipe for a flavorful stir-fry and a few new friends in addition to the usual prescription? As a culinary instructor turned medical student, I’m pretty excited about the idea.
This summer, Dr. Helen Delichatsios, an MGH primary care physician, and I attended a conference about shared medical appointments (SMAs), in which patients with similar medical conditions see a doctor as a group. Dr. Delichatsios and I had met because of our mutual interests in nutrition, cooking, and helping people make healthy lifestyle changes. We have taught cooking alongside nutrition together for the past few years. At the conference, we were struck by the idea of creating a modified version of the SMA for patients with hypertension, diabetes, high cholesterol, and weight issues that would pair a healthy cooking class with nutritional education.
Patients (and physicians) often have a hard time eating better because of confusing messages about healthy diets, lack of access to healthy food, the high cost of pre-made healthful meals compared with fast food, limited time to prepare meals, and previous experience with poorly prepared healthy foods that taste bad. With all of these barriers, a simple admonishment to eat better is usually not enough to make lasting change. In our experience, people respond much better to tasting healthful, inexpensive foods, and being shown how to prepare them.
So, we decided to try this out as an SMA. Instead of the usual 15-minute follow-up appointment to take vital signs, discuss medications, order laboratory tests, and briefly touch on health concerns, we developed a 90-minute session that did these things and much more.
We held our first session last month, and it was a great success! As the ten scheduled patients checked in for the appointment, medical assistants (MAs) gave them confidentiality forms, took their vital signs in individual exam rooms, walked them to a conference room, and handed out healthy snacks, water, and index cards. Once all of the patients had gathered in the conference room, Dr. Delichatsios and I introduced ourselves then addressed questions about medical conditions and healthy lifestyle changes that the patients had written on the index cards. We talked about specific patient concerns and did some basic teaching on health issues important to the group. Then, Dr. Delichatsios assisted me in a cooking demonstration of a healthy dish while we answered other questions from the group about nutrition, making healthy lifestyle choices, and achieving a healthy weight. For example, one patient asked us what affects blood pressure, and offered some of her own theories based on home blood pressure readings she’d taken after doing different activities. Others jumped in to ask follow-up questions about why they should be concerned about high blood pressure.
We were thrilled to find that patients’ feedback forms were overwhelmingly positive. Most rated the session format as nine or ten on a ten-point scale and noted that they would be willing to pay a higher co-payment than for a regular follow-up appointment to participate. Ninety percent wrote that they would recommend a similar session to others. There was a lot of variation in the frequency that patients were interested in participating: some said they would be happy with once or twice per year, while others wanted all of their follow-up appointments to follow the SMA model. All the patients who responded wrote that they still wanted one yearly physical alone with their primary care physician.
Dr. Delichatsios and I believe that the SMA plus healthy cooking class allows patients to share the engrained human experience of bonding over food while learning about their shared medical issues in a supportive environment and empowers them to improve their health. At the same time, I’ve learned a great deal from the feedback I get from patients and from working with Dr. Delichatsios. It’s just one example of a student/faculty collaboration trying an innovative approach to primary health care delivery.
Michelle Hauser is a certified chef and nutrition educator who teaches medical students, physicians, and the public about healthy lifestyle changes. She will graduate from Harvard Medical School and Harvard Kennedy School of Government in 2011 after which she plans to complete an internal medicine-primary care residency focused on improving health care for urban underserved communities.