Should we keep our rashes to ourselves?

Skin rashes are usually something we cover up with the most delicate of care.

So why do some people think sharing their skin ailments with other patients is the future of medical care delivery?

I have heard about these “group medical visits” increasingly over the past couple of years. It’s where patients with similar concerns have a group meeting with a nurse – including a PowerPoint or video presentation about their condition – and then each meet with a doctor for a shorter one-on-one meeting.

A study in the April 2010 Archives of Dermatology found that physicians were able to see more patients per hour and generated more profit from the group visits than from individual appointments. This was especially true in dermatology, where physicians saw nearly eight more patients an hour and made a whopping $1,000 more in profit per hour.

Sounds good, right? More patients get care and the doctors make more money. But at what cost?

Let’s say a patient calls requesting a group visit for a rash. How will the person on the other end of the line know if his or her rash is truly a “similar condition” to the other group members?

And once the group gathers, what happens to the patient who agreed to a group visit just because he was desperate to get in to see a doctor? What happens when that patient starts discussing more serious ailments – or when it becomes clear to the group through general chatter that his mole is really a symptom of something much more serious?

And what about using shared appointments for an even wider range of medical specialties? Are there cases where an ailment is so personal on its face that we need to draw the line?

I acknowledge that this model doesn’t take away one-on-one time with a physician, though it makes those visits shorter. But in a world where medical appointments in many instances are consistently shorter anyway, can we afford to make any concessions with the amount of time a patient has left to talk to his or her doctor?

The medical profession as a whole is working hard to save costs and improve access, and arguably, the “group thing” could accomplish both of those goals. But could it, in some cases, compromise care?

What do you think? Can group health care be delivered in such a way that it doesn’t offend social norms or laws dictating health care privacy?

I am not so sure. And at least for now, I am keeping my rashes to myself.

- Reni Gertner, MPH