How Healing Works with Dr. Wayne Jonas

Group Medical Visits: How can this model support clinicians and patients financially, emotionally and physically?

• Dr. Wayne Jonas • Season 2 • Episode 8

Share episode

Send us a text

Summary
Dr. Jeff Geller discusses the use of group medical visits as a treatment for loneliness and a way to provide healthcare in underserved areas. He shares his journey of starting group visits and the various types of groups he has facilitated. Dr. Geller emphasizes the importance of listening to patients and connecting their health to what matters to them. He also highlights the benefits of group visits, such as reducing loneliness, providing support, and improving outcomes. The conversation explores the definition of group visits, the role of facilitators, privacy and HIPAA considerations, and the potential of group visits in cancer care.

Takeaways

  • Group medical visits can be an effective way to address loneliness and provide healthcare in underserved areas.
  • Listening to patients and connecting their health to what matters to them is essential in group visits.
  • Group visits can reduce loneliness, provide support, and improve outcomes.
  • Facilitation is key in creating a safe and supportive environment in group visits.
  • Group visits have the potential to enhance cancer care by addressing the social and emotional needs of patients.
  • Providers can benefit from group visits by experiencing greater job satisfaction and efficiency.
  • Group visits can mitigate burnout and improve clinical wellbeing for providers.
  • Training and resources are available to support the implementation of group visits.

Chapters
00:00 Introduction and Background of Dr. Jeff Geller
02:12 Starting Group Medical Visits to Address Loneliness
04:35 Benefits of Group Visits: Reducing Loneliness and Improving Outcomes
08:00 Defining Group Visits and Shared Medical Visits
10:29 Different Types of Group Visits and Facilitation
17:28 Privacy and HIPAA Considerations in Group Visits
20:03 Group Visits in Addressing Social Determinants, Behavioral Change, and Mental Health
24:52 Benefits and Challenges for Providers in Group Visits
31:35 Group Visits in Cancer Care
38:17 Resources and Training for Implementing Group Visits

Resources

Check out the book: "Healing and Cancer: A Guide to Whole Person Care"
Visit https://www.healingandcancerbook.com/ for more information.

Connect:
Twitter: @DrWayneJonas
Facebook: Dr. Wayne Jonas
Instagram: @drwaynejonas
LinkedIn: Dr. Wayne Jonas
LinkedIn: Alyssa McManamon

Visit Healing Works Foundation www.healingworksfoundation.org for more information.

Dr. Wayne Jonas is a board-certified physician and Dr. Alyssa McManamon is a triple-board certified hematologist/oncologist. The opinions expressed on this show are those of the hosts and guests and do not necessarily represent the views and opinions of their places of employment, the Department of Veterans Affairs, or the United States government. The opinions expressed on this podcast are meant for entertainment and education and should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Dr. Wayne Jonas and Dr. Alyssa McManamon have no relevant financial disclosures.

Please note that this transcript is produced electronically and may not be an accurate representation of what was said. It may not be reproduced, edited, altered or modified in any way without prior written permission. Any use of quotes or excerpts from this interview requires explicit permission from Healing Works Foundation. Please contact us at healing@healingworksfoundation.org if you would like to use any part of this transcript for quotes or other purposes.

“How Healing Works with Dr. Wayne Jonas & Dr. Alyssa McManamon”

Group Medical Visits: How can this model support clinicians and patients financially, emotionally, and physically?

Wayne Jonas (00:02.846)

Hello everyone and welcome to another episode of How Healing Works. It is my great pleasure to introduce a friend and a colleague, Dr. Jeff Geller. Jeff, okay, if I call you that. Jeff has been practicing and innovating in healthcare in Lawrence, Massachusetts and really all over the world since 1996. He is particularly known for innovating group medical visits as a treatment. Initially, I think it was for loneliness, wasn't it?

Jeff Geller (00:15.623)

Absolutely, yep.

Wayne Jonas (00:33.482)

That could be used to provide healthcare, especially in underserved areas and for many people that were in safety net hospitals in the poor. He has numerous awards and publication, ran the largest group medical visit in the country and provided services to overcome the barriers for integrative medicine as he inserted those. And we'll ask about that.

He helped to found and was president now of the Integrative Medicine for the Underserved, or was president, I'm sorry. And in 2020, he was named family physician of the year, awarded by the Massachusetts Academy of Family Physicians. Congratulations on that, Jeff, what an accomplishment. This award is given in honor of his work and community for over 25 years in Lawrence.

Jeff Geller (01:18.313)

Thank you.

Wayne Jonas (01:27.422)

Initially at the Greater Lawrence Family Medicine Center and now running the Integrated Center for Group Medical Visits and working at Kronos Health in the same area. Jeff, welcome to How Healing Works. Our podcast is about all things healing and whole person care. And how do you make it routine and regular. And I hope we'll get into how group medical visits make that easier. I'd love to hear from you a little bit more about your background, how you decided to get into this area after your medical training,

and why you think it's essential for meeting your patient's needs, and then started the integrated center to help people elsewhere do it . Welcome and thank you. Tell us a little bit more about how you got into this.

Jeff Geller (02:12.325)

Thanks Wayne thrilled to be here happy to see and talk to everyone who's gonna receive this Podcast and for the work that the Healing Works Foundation has been doing so thanks so much for having me I started this journey as you'd kind of hinted at as a treatment for loneliness I'm not sure why so young in my medical career, I was able to key in that loneliness is bad for your health. Certainly everyone knows that loneliness is bad for you,

but it really sent me on a journey, which if nothing over these 25 years, actually closer to 30 now. And with what the US Surgeon General is saying, loneliness is the biggest problem in health care potentially. Nothing but reaffirmation that I was on the right path and that we need to do something to treat loneliness. And so I brought people together in groups.

They were mainly my patients and a variety of different illnesses. And that's where I kind of got things started. You may not believe this now, but I was an introverted person and a bit shy. I entered a community which spoke only Spanish and I did not speak Spanish. And so I think along the way, I had some good hints that it's more important to listen to your patients and say, “what do you need to get well? And what do you need to get healthy?”

And yeah, so that led to a diabetes group and then weight loss group and then children's groups. And name the chronic illness, we've done that group. We take care of people who have different types of disabilities. And in the community health center, it actually was a huge revenue generator for our clinic. We would see five or six patients an hour. And we were in an underserved community, there weren't enough doctors. So...

The model really took off and for many, many years did well. And I'll share with you that we're now moving towards a capitated world, which I like better. And the models also do well in that world. So loneliness led me to bringing people together. And then it turns out there's a little bit of an art in a skill to do in that. And where you're searching for how healing works, I think reducing loneliness is one of the major ways that healing works.

Wayne Jonas (04:35.954)

Yeah. Well, I mean, you know, for those of us in this area, this sort of seems like a no brainer. The cure for loneliness is companionship and connection is coming together, right? And, and, you know, the mechanism to address and empower patients is to find out what's important to them and then connect their health to that process, right?

Jeff Geller (04:47.944)

Right.

Wayne Jonas (05:04.014)

And find out what matters and then connect it to what's the matter and try to help them move along in that arena. I think that's brilliant. And the fact that it actually can make money and doesn't need as many physicians to be part of this so that the one-on-one visits require could be at least a partial solution to our physician shortage, couldn't it?

All these people are saying we're going to be without physicians, primary care physicians are not growing, everybody's retiring in that area. There's not training programs going in those areas. But if the team is doing it and you can do these kinds of visits with less physician input, then that would at least partly mitigate that issue. Wouldn’t it? 

Jeff Geller (05:54.933)

It really does. And there's another thing behind this too. Loneliness in itself is bad. It's not something we can bill for or take care of. But when you provide someone with a community, especially if you can do it in advance, when they're well and then they become ill, oh, it is just one of the most beautiful things to see people who are also ill supporting one another.

Because I don't think anything makes you happier than helping other people. Right. And so, you know, there's another depth to this, you know, the meaningfulness of this level of care. Yeah.

Wayne Jonas (06:36.286)

Yeah, meaning and purpose is a key part and helping other people is a key way in which human beings feel good about their life, right? And judge themselves as a success. I don't know what the recent data is, you probably do, but I've heard that high levels of loneliness are as bad as smoking for your health. And we screen and try to address smoking all the time, but rarely do we ask about loneliness.

So we need to at least ask about it and try to get people involved.

Jeff Geller (07:08.909)

Yeah, the US surgeon general really did a good job. I don't know if it was him or his team, but research is very important and it's showing that I think loneliness was equal to a half pack of smoking a day. 

Wayne Jonas (07:29.778)

Yeah, not good. Well, we've already talked about group visits. Can we define them here? Can we actually, can you describe what actually is a group visit and how does it relate to things like shared medical visits that you often hear about? And, you know, does it provide better time? You know, providers and clinicians are always saying, I don't have enough time to do this. What are group medical visits and how do they relate to shared medical visits? Why don't we start there?

Jeff Geller (08:00.637)

Sure, you know, I think the initial term that was used for medical visits were group medical visits. Ed Noffsinger is one of the people who used it maybe 30 years ago, a couple of years before I started doing group visits. The shared medical appointment is a term that's come later, but in many ways, there's no difference in the terminology of the group. Sometimes there's a different emphasis.

What I've noticed is that like a shared medical visit tends to be more education-based. You know, sometimes there's a curriculum involved. So I know that like the Lifestyle Medicine Group, which is an amazing group, tends to call them shared group medical visits and they tend to have a curriculum. I tend to do group visits that are more open and we're asking people, what do you wanna do today, right? So there's still a curriculum, but it's not as planned.

I don't think we're sharing a resource, we're sharing time together, but I like to think that we have more. Group medical visits tends to be the term I use, but there's also medical group visits. Paula Gardiner, who's my partner in crime at ICGMV, does a lot of research nationally. She's shown that the term group medical visits is still the predominant term being used, but shared medical visits is coming up,

but it doesn't really matter what you call them. The key element of a group visit is you have your patients. Patients can be grouped in many different ways. So I run 30 group visits every week currently. And we maybe have, I'd have to think it through, but eight distinct different types of groups, even at just our one site. Some groups are service oriented groups. People will come and get acupuncture or massage,

and then they get a visit with the doctor, you do a little bit of billing, a little bit of evaluation on how they're doing. Some groups are more connection-based. You sit and you talk the whole visit, and those need to be very carefully facilitated by someone who knows about group visits, sometimes facilitated by the doctor, sometimes facilitated by the participants,

Jeff Geller (10:17.413)

which might sound crazy to those of you listening, but some of my groups have existed for over 25 years. And I assure you the need for the physician gets less and less as time goes on for something like that. So, the key components of a group are you have your patients, they come together. I think I feel a group has to have more than six people. Some people will say four people. And then you bring people together.

Wayne Jonas (10:29.622)

Yeah.

Jeff Geller (10:46.685)

There's a moment usually called a check-in at the start of a group where maybe you introduce new people, you connect, how was your week, rose and thorn tell me something good, something bad, you do something to connect people. Then a group tends to have an activity and it could be a lecture, it could be cooking, so they're cooking groups, it could be yoga, it could be anything really.

And then there's a closing moment of the group where you say, well, what are we going to do next week? If it's a group where you're trying to figure out what your participants want to do, or you let them know what's, what's coming in the future. Uh, some groups go on indefinitely. I just mentioned I have groups that are 25 years old. Uh, some groups are for a prescribed amount of time, you know, so maybe you have asthmatics and you're going to just go through your curriculum and teach them how to use inhalers. Uh, maybe you have an oncology group where, you know, you have everyone with

let's say breast cancer, and you can talk through all the things they're going to go through as a group. So that would be enclosed. Or you could have a more open group, which means it doesn't have a defined endpoint. So there you might say, hey, we're going to bring women together with breast cancer, and then ask them what they want to do with this time and see what would be helpful.

So groups are very, very flexible. You know, there tends to be a clinician in the groups because of our current billing system. You need a clinician to bill. But certainly groups, you know, I just made it sound like I was part of the invention of groups 30 years ago. Not true, groups have existed forever. And especially in the military, the more I hear there were groups at different Air Force bases and different places in the 50s, 60s. So getting people together in groups is...

is an idea, but the group medical visit is because it's about a medical condition and you involve the patient. 

Wayne Jonas (12:44.088)

Yeah, no, I think.

Jeff Geller (12:48.593)

Yeah, the value of groups comes from a shared collection of knowledge, where someone who is facing a problem, maybe someone in the group has already faced that problem, right? And they can give advice. You have much more time with the patients. The hamster wheel of a 15-minute visit, and many of you listening are in that hamster wheel where you wanted to spend more time with your patient and you can't. In the group, we get a full hour, a full hour and a half, and it's really wonderful.

Wayne Jonas (13:25.266)

Yeah, now that's great. What a wonderful summary. Thank you. That really hit all the key high points including the time issues and you're right the DoD has done a lot of group work and the VA has embraced this, you know, you know a lot and they do a lot of group visits in a lot of their clinics a lot of their settings that you know involves a trained facilitator. So it's important. It sounds like to have a trained facilitator to help with this. So is that training that you all help provide? It doesn't have to be a physician, right? But what does a trained facilitator got to know?

Jeff Geller (14:03.197)

So you're right. We've been working with the VA systems recently in South Texas. They have a big initiative to start group visits, mainly to have better outcomes, to have better provider satisfaction. So it's hard for providers sometimes to stay in the VA system and to be cheaper, right? So if you can treat someone with acupuncture versus a back surgery, it's cheaper. So VA is a capitated system. And so saving money means more to them.

But when you get at the concept of facilitation, how do I explain something that I've spent 25 years thinking about in a second? But some people are more extroverted, some people are more introverted, and it turns out that the introverted people may not enjoy group visits naturally. It might be something that you have to help them embrace. And you do that by the way you set up your group.

And that is all facilitation. So usually the first five, six visits of a group, if they're very well facilitated, no one drops out, more people come, your group grows. And if it's not well facilitated, meaning your more extroverted people are talking the whole time and the introverted people feel like they can't get a word in edgewise, those people might leave.

Jeff Geller (15:30.161)

I’m not using any high-level definition of an introvert versus an extrovert. I'm just saying some people feel comfortable talking in a group or about their illness and other people don't, right? And so there are a lot of strategies. You can break people into small groups. You can make an activity. It's with our kids groups, most of the conversation happens when they're doing art, for instance. So there's just a lot of opportunity. And so-

Facilitation, we've been training maybe 100, 200 people a year in how to do the facilitation. And once a provider or group has a good facilitator and knows how to facilitate, they get so much more joy out of the group. You learn it's not about the curriculum, Wayne. It's about how someone feels. And so if you have the best curriculum in the world, but people don't feel like you care about them, they don't feel motivated, they feel

Jeff Geller (16:27.785)

alone, not a lot of change happens. But if you have people pulling for one another, you can facilitate the group so that the extrovert likes the introvert and the introvert likes the extrovert. Everyone has their role and we're all different people. Then you're really cooking and that requires facilitation. So yeah, we offer training in that. We're a nonprofit. So if you can't afford it, just let us know. We will train you for free.

Jeff Geller (16:58.053)

We've been training VA systems lately. Yeah.

Wayne Jonas (17:01.502)

That's great. And as with many group interactions, so much of the work, the really good work and the glue in this occurs in the breaks, right? When people, you know, connect one-on-one and then they come back together and share things and that type of thing. And that's part of the facilitation process. Do you run into any privacy and HIPAA issues with this? And how do you deal with those?

Jeff Geller (17:28.753)

Yeah, you know, we have special consent forms, which you can download for free from our website, see what we've used, what our lawyers approved, that sort of thing. But we really haven't run into HIPAA issues over the years. When someone's entering a group visit, you make it clear that, hey, we're in a shared space and if there's something you don't want people to know, we're not going to force you to say anything. So those of you who run groups, you know, keep that in mind. You don't want to...

force your participants to say things or put them in a position where they might feel uncomfortable. And then we, in addition to a written consent, we have a verbal consent. Hey, someone has just said something pretty sensitive. It's okay to think about it and they shared it with us, but let's maintain the privacy. And I wanna knock on wood, I don't have any around me, but=

we have really not run into any problems. And at one point, we were doing over 50 group visits a week. We use HIPAA compliant. When we were doing Zoom visits during COVID, you have to have HIPAA compliant computers. Zoom was great at that. Gmail can be HIPAA compliant. The ways you invite people. And then you have a lot of comments with your group. So I like to ask the groups,

Jeff Geller (18:48.253)

“Would it be okay if people can just say whatever they want in the text bar below on the Zoom?” Do you block it and you know? I would invite everyone to have their own conversations about what people feel comfortable with in their groups.

Wayne Jonas (19:03.946)

Yeah, great, very, very helpful, thank you. There is some skill in learning how to do that, I can see, but once you do it, then it really can flower. It sounds like the way you have set up group visits, it really has the flexibility that is needed in healthcare to address what I call the whole person, okay? Because everybody comes to the table with different needs and we know there are different drivers of health

from the behavioral component and lifestyle issues to the physical environment, to the social and emotional issues, to mental health issues, and even to meaning and purpose, the spiritual components of that. But it sounds like the way these are designed, do you have examples of how these visits can really address things like social determinants and behavioral change and complementary and integrative health and mental health issues?

Jeff Geller (20:03.137)

Oh my God, Wayne, too many to mention. I feel everyone who participates in a group program gets something out of it. We have one group that we're calling the functional medicine group, and it's really become a nutrition group. And this past Thanksgiving, there's 25 people in the group, but there were eight people who had nowhere to go on Thanksgiving. And so we said, okay, well.

Jeff Geller (20:28.957)

Thanksgiving's on a Thursday. We can stay open a little late on Wednesday to accommodate your group. And that network of eight people are really supporting one another like a family. And we do, what do we do in that group? Lately, they just have wanted to try the most amazing foods in the world. So this is a group that's been together for some time. And

I had been to Sri Lanka, long story, Wayne, but I came home with what are considered the world's best cashew nuts. And who did I want to share them with but with this group, right? And this is a group where we don't tend to group people by disease anymore. For those of you starting groups, it makes sense to group people by disease because you're going to want to talk about diabetes or cancer or...

chronic pain. We have a lot of chronic pain opportunities. But, you know, so through this work they said, huh, you know, we're not, so the people I take care of aren't wealthy, Wayne. They've never get to try the good stuff. So then I went and I bought a $15 orange, like a sumo orange, and we cut it up and we all tried it. And we all feel just so, so special. And during those visits, while we're doing things...

There's a young girl who's kind of estranged from her mom and the older patients in the group are telling her how good she is and how they'd be happy if they were her daughter. And the older people don't necessarily have children. And so it's very complex and it's not what we can say. It's not as clean as medicine would be, but these are people who use the emergency room frequently. That's why they were grouped together.

And now they don't use the emergency room. They come every Wednesday and we talk. And so the administrators like it because it saves money. But really what it is people have found their tribe. They found a group of people who understand them, which is a key part of loneliness. It's not just being with other people. People have to understand you. They don't have to be like you at all, but they just have to really understand you. And you don't get to that with...

Jeff Geller (22:51.021)

unless you let people talk to one another, right? Unless you try things. And so what should we bring in next week, right? And you have an interesting conversation. Yeah.

Wayne Jonas (23:03.342)

What's interesting in my mind, when this started from the medical side, and even now for the billing purposes, it's still about a clinical disease, right? So a diabetes or an obesity group or a cancer group or something like that. And yet the science is now showing us that the fundamental underlying drivers, the biology of chronic disease, rest in a few types of things.

that drive inflammation, drive immunity, drive basic metabolism, et cetera, et cetera. And so it's almost independent of what your condition is if you can facilitate those wellness components, right? And that includes social issues and includes behavioral issues and nutrition, like you've just mentioned, and sleep and other things like that, that almost independent of what your chronic illness is, things get better.

and will improve. So it's a health promotion or a salutogenic model instead of a pathogenic model. But figuring out how to fit that into the square peg into the round hole of medical thing, which says here, you've got to have a diagnosis and you have to have a group that's going to do that is a challenge to make that mind shift change, isn't it? In those areas.

It sounds like you've got, you clearly have gotten a lot of patient feedback and improved your processes over the years. What about providers? What can you tell providers about the benefits and the challenges that they get from stepping into this field if they haven't done it already?

Jeff Geller (24:52.913)

Yeah, so the data is very clear and Paula Gardiner again, I'll mention her name again, she works with me. So our nonprofit is the Integrated Center for Group Medical Visits. We have an annual conference and the people who are doing group visits, the people who are doing the most group visits attend the conference, right? Because we're innovating and we're trying to build community for those of us who do groups.

And she's been doing a great job tracking who comes and asking why are they there and what type of groups they do. And it is clear that those who do groups have better satisfaction with the jobs they do. You know, it's one thing to, I mean, here I'm sampling fun food with a group of people and I'm treating their diabetes and their obesity and their depression. And I get to be part of the group.

We're a very efficient organization, so my notes are done usually by the end of a group visit too. Our busiest groups are things like a Suboxone group where you might have a number of people all coming and getting a refill of Suboxone, which is a narcotic medication for those who have had substance use disorder. I will see nine, 10 people in one hour, but I sat with them.

My staff did most of the notes and we just treat each other like people and then the hour's gone. They're happy because you don't need an appointment. They know you just come in one day and then it's every Wednesday at one o'clock and they can just show up and they'll be taken care of. It just makes everyone's life a lot easier. We've started a fellowship

where we train people in group medical visits and people will come. And we call it a week-long fellowship, but usually after the second or third day, people get it, right? We're doing 10 group visits a day. They come, they see the first couple, they see our staff, how they work, they see how I work. They notice that even though I'm doing groups, I have time to talk to them, right? And take care of my groups.

Jeff Geller (27:05.293)

My groups usually feel special when the fellows come, right? Because it's new doctors that they're helping to train in this model that they love. So the feedback is tremendous. And I think that there are some people who do group visits where they look at it as a class, Wayne, and they say, okay, I need a good curriculum and I need to do all the work. And I'm not going to write any of the notes until the end of the day.

You know, I respect those people. They're hard workers. They want the best thing for their patients. But if I'm doing 10 group visits a day, I just can't do that, right? I have one group come, I have another group leaving, you know, so you have to rely on your whole team. And that includes the patients to say, hey, what are we doing this week? You know, what is our curriculum? Does anyone learn anything new?

Wayne Jonas (28:01.651)

Yeah.

Jeff Geller (28:01.921)

And that allows the providers to not only be efficient and effective, but kind of rejuvenated by the whole thing as well. So, you know, and then the people who've come and done our fellowship, I just got a text the other night from a group in Holyoke, Massachusetts at a community health center, and they were just so ecstatic. They started a group visit and they knew that they did a good job with those introverts and those extroverts and that they were confident

people felt listened to. And so they were just so energetic about their work. But like I said, if you're thinking like all about, okay, I'm running the show, it's gonna be my curriculum, it can cause some stress. And that's something to think about when you choose what sort of model you're gonna do and how big you want your operation to be.

Wayne Jonas (28:56.574)

Yeah, so properly managed, this is also something that can mitigate another epidemic going on in healthcare, which is burnout, right? And a drop in clinical wellbeing, which has gotten even worse during the pandemic and is still very high in these areas. So this actually can help offset and mitigate that, it sounds like, and that's one of the feedback components that you've gotten from providers.

The approach that you're taking is very different than what we learned in medical school, okay? You know, the treat and street, the pill and procedure approach, we're in the driver's seat, right? We do things to you. You come in, you have a problem, we do things to you. But there is an entire science of behavioral change that says and there's lots of good evidence. So it's not that this isn't evidence-based, it's really grounded in evidence that's very different, okay? That is about facilitation of readiness, engagement, empowerment, et cetera. And that's a very different understanding you know to these. And these are essential. That kind of science has to be brought in and skills have to be brought into this process, right? Very different than physicians, usually were trained to treat their diseases. Can we talk a little bit about cancer? Okay, we're doing an initiative on cancer and this is part of a series where we're talking about whole person cancer care. And it includes oncologists, they're important in this thing, but whole teams of social workers, advanced providers, nurses, nurse practitioners

and the front desk folks, the management folks, as well as the oncologists, nutritionists, et cetera. We have a book coming out, I'll plug it a little bit here called Healing and Cancer, which is about whole person cancer care, because the usual approach in cancer is that let's kill that tumor, right? And the person sort of be damned.

Wayne Jonas (31:13.202)

Or at least we don't have time to address the person or hear what matters to them and accommodate our care so that it really addresses their well being in those areas. Can you talk about, are there differences for people with cancer or if you run a group for people with cancer than there are in other areas?

Jeff Geller (31:35.377)

Yeah, so I think cancer might be one of the more perfect places to use group medical visits or shared medical appointments. It's a place where people can suddenly become lonely. There's a term I use called relative loneliness, where your kids are fine, your husband still loves you, but wait a minute, am I going to live? Am I going to suffer? Am I going to lose my hair?

Jeff Geller (32:05.033)

There may be some things that people don't think they can now talk to about others. They feel different. And so if you could bring a group of people who all feel that same difference, then they'll be understood. You'll feel like there's someone there for me. And the benefits of loneliness and cancer, I'm not an expert on that, Wayne. I can only imagine that there's some advantage to it at a minimum of just how you feel,

you know, just how you feel, right? Cause it's not a good position to be in to have cancer. The groups I run, I do not have specific cancer groups. And I think it's because I'm a small operation. You know, I'm currently in a private, I call it a private practice for the underserved. And I am now practicing capitated medicine. So I'm living a good 10 years ahead of the rest of the world, right? So we're kind of experimenting with how this goes. And...

What happens more likely is I have patients in my existing groups who get cancer. And so we take a moment, now we would take a moment if someone lost a loved one in a car accident. We take a moment when someone, so this is just another one, another thing that we wish it didn't happen. Even if there's a clear cure, we wish this didn't happen. And so you can be that,

place that person can go to outside of their family, outside of other places, and share how they're doing. And we've had a number of people actually die who've been in our groups and we memorialize them. You know, we might name something out after them, we think about them and people know that's going to happen. And I think that gives you a sense of a longevity or part of something bigger than yourself. And that might be negative. This may sound negative, right?

At the same time, we're all just here for an amount of time and you got to enjoy the moments you have. One of the participants in that nutrition group does have cancer and they're eating some of the best food in the world. You could even just have a moment where you're feeling normal. But there are other advantages too. There's a whole other way to look at group visits for oncology.

Jeff Geller (34:33.225)

My father just survived prostate cancer this year and it was a big stress in our family. I tried to encourage him to go to groups and he wouldn't because the oncologist had groups, though I would say there were more classes, Wayne. More like, if you go here, we'll teach you about radiation versus a prostatectomy or things like that.

You know, I really feel there wasn't a good opportunity for him because he would say, well, I could learn those things on the internet. You know, I don't need the group for that, but I feel that if the office had just simply said, look, every Tuesday, I want you to come in, you're going to be with other guys and we're going to, it's going to help us. Cause we'll be more efficient. We'll tell you guys all the options. And not only that, we're going to have people who've already gone through it, come.

And then you can say, hey, did you have the prostatectomy or did you get the radiation or did you have seeds implanted or did you? I'm sorry if you don't know much about prostate cancer, but these are some of the things you talk about in prostate cancer or the decisions you have to make or do nothing. And you ask and so my father was feeling pretty alone. Hey, dad, if you're listening to this, sorry to share that. But then now he's...

Jeff Geller (35:52.985)

you know, cured Wayne, right? So he's doing a lot better, but he went through a real dark time and it would be great to give people support, you know, during a life-changing diagnosis, yeah.

Wayne Jonas (36:08.51)

Yeah, no, I think you're right. It's one of the reasons we are starting this initiative on whole person cancer care, is to try to get the person back into the care. And why we call it person centered, not patient centered care in this area. I was in fact, just this morning talking to a radiation oncologist, a breast radiation oncologist. So she sits all day and radiates breast cancer. And she said,

Man, this is just not very fulfilling. And she started a set of group visits and she works in a very large health center that is really doing exactly what you described. And the benefits and the challenges are along the same lines, but she said the rewards are so great that despite the system challenges to try to get this out and grow it and make it routine and regular, she is continuing

to fight that good fight. And so our discussion was how can we help make that happen? And you have a lot of ways to help make that happen for those that are listening to this and want to do this. The Integrated Center for Group Medical Visits, we'll put the website here, connected to this interview. You've got a conference every year, you've got tools and training abilities, you got forms and resources people can do. You mentioned

the facilitator training, you've got the fellowship. I mean, there's a lot of different things that should make it easier for people to actually get started in this area. I remember you came up to a big safety net hospital right after COVID, they'd been hammered in COVID, big safety net hospital in Queens, and serving about a million and a half underserved patients

and you trained them in group visits. And that was done virtually, you did it virtually. And now they're running them. They're running groups right and left in this area and seeing the tremendous benefits of doing this. So yes, you too can do it if you're listening to this. And here's the person to talk.

Jeff Geller (38:17.049)

And particularly, if you're an introverted person, you might say, oh, groups aren't for me. I don't want to be leading it. I find that the introverted people make the better facilitators. Sorry, extroverts. Because you listen, right? You take in the information. So don't count yourself out if you say, huh, I'm not that funny or I'm not that energetic of a speaker. You might be the perfect person to allow the patients to have that spotlight,

right, and to feel better. And yes, thanks, Wayne, for the shout out. We have a lot of those trainings. The fellowship is something particularly that we save for organizations that want to do, you know, spend a day with us and you will feel really well trained. And then we also have all the videos from our past conferences. So there was a presentation from the University of San Francisco, UCSF, their oncology group, and

You can view those things probably for free. I believe on the website I'd have to dig that out. But yeah, thanks for allowing us to spread the word.

Wayne Jonas (39:24.458)

Well, thank you for being here and having this great conversation, lots of detail. We got out in a short period of time. And just giving us hope and a reminder that taking care of the person means, as you just said, first listening. So thank you so much for coming and look forward to your continued working for you and your continued work.

Jeff Geller (39:50.321)

Yeah, thanks for the work you're doing. Look forward to the educational component of the Healing Works. And thanks for all the work you do.

Wayne Jonas (40:00.594)

Take care.