By Shera Dalin
When Heather Crist moved with Wachovia to St. Louis, she began searching for a doctor for herself and her family. Crist wanted to tap one of the hottest trends in medicine—a doctor who makes house calls.
Before leaving Richmond, Va., she and her family had been cared for by a concierge physician there. After a bit of searching, she found a similar concierge doctor in St. Louis—Dr. Elizabeth Laffey. Laffey is a board-certified family physician who has an office in Kirkwood, but often comes to patients’ offices and homes. She is available by cell phone and e-mail round-the-clock without the gatekeeper of a nurse or answering service.
For Crist, her husband, Danny, and 9-year-old son Patrick, the convenience and personal care make the investment in concierge medicine well worth the expenditure. As the chief administrative officer of Wachovia’s Latin American Division, Crist’s time is at a premium.
“I have probably in all my concierge visits spent a total of five minutes in the waiting room,” she says. “That’s huge for me.”
But even more than avoiding a waiting room, Crist is sold on the extra attention and accommodation she gets from Laffey.
“Dr. Laffey is even better than the doctor I had in Richmond,” she says. “All my appointments with her are on Saturday. That is huge, huge.
“I also do a lot with her by e-mail, and that’s not something I’ve ever experienced with another physician. I can just send her an e-mail and she will be fantastic. She even arranged for shots when I went to Paraguay, and she made it really convenient.”
Since the days of the doctor with the black bag visiting a patient at home, medicine has become impersonal and faster paced. But the return to personalized care began in 1996 with the spa-like MD2 practice in Seattle. The practice charged $20,000 per person.
Retainer doctors limit the number of patients they accept so they have more time to spend with each one in exchange for an annual fee of between $1,000 and $1,600 in this area. Concierge doctors don’t accept insurance or Medicare, but their fee can be paid through a health savings account. Only a handful of physicians offer concierge medicine in this area, led by Dr. David Katzman, an internist who converted his practice in 2003. But more doctors may switch as they demand higher quality of life, more time with their patients and less frustration with managed care companies.
Concierge practices are particularly suited to executives and entrepreneurs, who are more likely to be able to afford the fee.
When the CEO Gets Sick
Before she became a concierge patient, Chrissy Nardini, president of American Metals Supply Co. in Fenton, went to urgent care clinics when she got sick while traveling. She would waste an hour or more in the patient waiting room. And that was often the case when she tried to see her doctor when she wasn’t traveling.
So after hearing about concierge medicine from her dad, she opted to give it a try. She signed up with Dr. Laffey about three years ago and wouldn’t switch back to a traditional office practice.
“A couple of times she’s come to my office to draw blood for a cholesterol test and once she came to me when I needed a vaccination to go to Mexico,” Nardini says. “If I call her, sometimes it’s just to ask a question about a medication or an article I read. And she remembers me so I don’t have to remind her, ‘Hey, I’m the one with the allergies.’”
It’s not uncommon for concierge physicians to spend an hour or more with a single patient. They will ask about more than just the immediate problem. The doctor can delve into family issues or, by being in the home, seeing the environment and how it might affect a patient’s health.
“Concierge medicine is better for the patient, because their physician knows them better,” Laffey explains. “The average doctor has about 3,000 patients; I don’t take more than 200. I have time to discuss treatment options that I can tailor more specifically to patients, and that’s very rewarding for me and the patient.”
Patients are more likely to follow their doctor’s instructions when they thoroughly discuss the problem, solution and treatment options, Laffey says.
“Instead of, ‘Here, take this pill and I’ll see you in a month,’ patients have a better understanding of why they are doing something.”
The extra time the doctor spends with patients gives them a greater comfort level to speak more freely with the doctor, in part, because they have a deeper, more familiar relationship.
“You are there and you talk about different things that may impact your overall health—things you wouldn’t necessarily say with another doctor,” Crist says. “It feels like the whole self is involved rather than just being another patient for that day.
“I also feel like I need fewer specialists because I am having a deeper conversation with her.”
Laffey will accompany her patients to specialist visits if they request to ensure that the patient has an advocate present and all issues are addressed.
Her patients with children report that seeing the kids at home rather than in a busy, loud doctor’s office is less fearful for the child.
“I had to give one 5-year-old patient five vaccinations. I gave them in his room at home and it wasn’t so hard for him,” Laffey says. “I have patients run up to me and say ‘Dr. Laffey, Dr. Laffey’ and give me a big hug; you don’t see that in an office surrounded by white coats.
“In their natural habitat, you can see where they are at developmentally. You can also pick up on preventative health issues,” she says. “If the kid is outside riding a bike without a helmet on, it’s a good opportunity to discuss bike safety.
Crist predicts that as more St. Louisans learn about concierge medicine, they will opt for it, just as I did.
“If people were to find out about the convenience of this, I think many would switch,” Crist says.
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