Tuesday, April 26, 2016

Group Medical Appointments Utilizing Cooking Classes to Teach About Chronic Disease Treatment & Prevention

It's been about six months since the my co-authors and I published the journal article "Shared Medical Appointments: A Portal for Nutrition and Culinary Education in Primary Care-A Pilot Feasibility Project" in Global Advances in Health and Medicine.

This project was spearheaded by former head of the Clinical Nutrition course at Harvard Medical School, and good friend of mine, Dr. Helen Delichatsios. She is a primary care physician based at the world-renowned Massachusetts General Hospital. When I was a third-year medical student, she and I were at a conference learning about shared medical appointments (SMAs, also called group medical visits), when we began talking about how we could create a new type of SMA that utilized cooking classes to teach about healthy lifestyle, treatment and prevention of chronic diseases related to obesity, inactivity and other unhealthy habits.

Class Recipe: Veggie-Packed Fresh Spring Rolls with Peanut Dressing

Definition: Shared Medical Appointments / Group Medical Visits are when a group of people see a doctor together for one long visit rather than individuals seeing a doctor at many, separate short appointments. There are many types and structures of SMAs.

After a lot of hard work on Helen's part to figure out how to introduce a completely new style of visit into her existing clinical practice--including getting buy-in from the clinic, arranging staffing, reserving space, learning how to bill for these types of appointments, and recruiting patients--we worked together to develop content for the visits. 

Class Recipe: Healthy Smoothies
Each 90-minute visit ran like this:
  1. Patients arrived, got their vital signs taken, then were escorted to a regular conference room and seated around a long table.
  2. They signed a confidentiality agreement and anonymously wrote questions that they had about their condition(s) or how to make healthy changes on an index card.
  3. Once everyone had arrived, Dr. Delichatsios and either myself or another assistant did an icebreaker activity with the patients.
  4. There was a short (10-15 minute) lesson on a health issue important to everyone in the room.
  5. Then, there was a facilitated group discuss/Q&A while I (or another chef) demonstrated how to prepare a simple, inexpensive, healthy dish.
  6. Everyone was given the recipe and the opportunity to taste the food.
  7. At the end of the visit, patients were given instructions about their follow-up visits or health care maintenance items that were due. If anyone had an urgent medical concern, Dr. Delichatsios had a short visit with them individually after the group class (this rarely occurred).
Class Recipe: Mexican Quinoa (or Brown Rice) Salad with Citrus Vinaigrette

We hadn't intended to write about this project for publication, but when we realized that patients loved the visits, they didn't cost any more than traditional visits, and they didn't require a special space or a lot of special equipment, we knew that we needed to spread the word that this could be done in ANY primary care clinic as it exists TODAY. Since we started the visits nearly 8 years ago, some specialty clinics and direct primary care clinics have begun to install dedicated teaching kitchens. While this is very exciting (!), we published this last year in an effort to help clinics and practitioners realize that they don't need to wait for someone to fund an expensive teaching kitchen for their clinic. If you have a conference room, table and a sink, you can run group visits and demonstrate basic, healthy cooking for patients. You also don't have to be a chef to demonstrate healthy cooking--once I went off to residency and other assistants moved on to other projects, Dr. Delichatsios took over the cooking demonstration piece of the sessions as well!
Sample Curriculum, Nutrition Topics, and Recipes for Culinary Nutrition-based Shared Medical Appointments.

For more details (and a better picture of the table, above), check out the full article.

Finally, I went on to replicate these type of appointments on my own (without the help of an assistant) in my residency primary care safety-net clinic (a clinic that treats patients regardless of income or ability to pay) with similar results. While I recommend that doctors enlist an assistant, rather than go it alone like I did, I believe that this is a great way to spend an extended amount of time providing lifestyle counseling/coaching to patients. This method also allows patients to learn from each other--both things impossible to do in a traditional primary care visit.

Have you dreamed of getting a cooking class at your doctor's office? Are you a physician who has struggled to get patients to change their eating habits? Why not try this today???

Reference: Delichatsios H, Hauser ME, Burgess J, Eisenberg D. Shared Medical Appointments: A Portal for Nutrition and Culinary Education in Primary Care. A Pilot Feasibility Study. Global Advances in Health & Medicine. 2015;4(6):22-26.


  1. Michelle--you are a shining star. Thank you for providing such wonderful instruction and advice.

    1. You are the nicest person ever--who is that giant adorable muppet in your pic? Love!


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