Caring for my elderly patients is both a challenge and a delight. For one, most of them are so complicated that a medical intern would run screaming from the room. I, however, enjoy the layers of problems and solutions...this problems has led to that problem...and that problem's treatment will make that problem worse. Through years of experience we can usually find a happy balance between treatment and just letting nature take it course.

But these wonderful people are also (most times) lovely to care for. They are so thankful to be listed to and to have people caring for them. I have learned over the years that most 85+ year olds really just want quality of life and are not so hung up on length of life. I let them know that I get it and I often can see them visibly relax.

One important service that more families should take advantage of are Geriatric Care Managers (GCM). These are typically nurses or social workers who work with patients, families and physicians to navigate the complexities of caring for elderly patients. Whether it is moving an elderly parent close to an adult child's home, transitioning from home to assisted living or just optimizing the home situation so the patient can remain in their home longer.

There are so many questions that the GCM can answer that does not require my input. They can also help interpret symptoms, medical tests and results and often can be a shoulder to cry on for for both patient and child.

I have worked with several managers in the last decade. I have recently been working closely with Tracey Driscoll, RN of Transition with Care, out of the Concord area. We exchange emails and text messages several days a week about our mutual patient. Her advocacy for her patient is something to marvel at. The patient is doing very well, mostly because of the extra time that Tracey gives her and her family.

So if you are struggling to care for an elderly parent or sposue and find that you wish you had someone to do some of the leg work, coordinate with the physician or interpret medical jargon, then consider a Geriatric Care Manager. They can often make a very challenging situation much more manageable.

Let's face it. The current medical model isn't working for either the patients or the physicians. Patients complain of not being able to see their physycian in a timely fashion and when they do, they feel rushed. Us Primary Care Physicians, which is actually an insurance company created term--I am an Internist--it says so on my diploma, are over-worked, under paid and under appreciated for what we do. And it's going to get worse.

The Obama health plan, although created in the best of intentions (work with me), is going to put even more stress on this system and push it to the breaking point. A savy patient recently pointed out that the high emergency room volume is often not due to patients without physicians seeking care, but rather filled with patients who cannot be seen in a timely fashion by their physician's office. Our physician's offices are booked to the last available second. Now we are adding more patients to the system, all well and good, but we have no capacity for them to be seen. And medical residents are not choosing primary care as a career because they rightly see the specialty as over-worked and underpaid.

It's because of this unpleasant health care climate that I started Weston Primary Care in 2007 and why I now offer my Executive Health Service in 2008 (a direct pay concierge service). Strictly speaking, my practice is a hybrid-concierge practice, ie I offer both traditional and concierge medical services. My timing wasn't great.

With the economy tanking in 2008-2009, patients were reluctant to spend discretionary funds on health care when they were not sure if they would have a job in 6 months. But since late 2009, the concierge practice has steadily grown by several patients a month. People are now ready to address their health care again.

Now some of you may claim that this is a service only for the wealthy. But at $2500.00 a year, this is close to what people spend on combined cableTV/phone/internet service per year, or what they spend going out to eat on a yearly basis. My concierge patients often choose this service, not because it is a nice perk, but because they truly need access to me more frequently, often at odd hours or on weekends, or they need longer visits (recently I spent 2 1/2 hours with a new patient during a weekend physical) to address complex or confusing problems. I also do home visits for the elderly or disabled. Patients and families rapidly learn to love the convenience and attention they receive. I also love the ability to practice "old fashioned medicine", you know when doctors had time to listen to their patients and ask insightful questions and maybe even read (!!!) about their patients symptoms and problems.

A surprising benefit has been that I have also found that I can now spend more time with my traditional patients as well. By having a more solid business, I don't need to overload my schedule and I can spend a little more time with patients or take some extra time to call a patient at home to discuss lab or test results. And some of my traditional patients like the idea that I offer this enhanced concierge service in the event that they develop medical problems in the future that will require extra time and access. My patients now have a choice, and they like it.

I may not be able to solve the nations health care system woes, but in my little corner of health care delivery, I believe I have created a system which allows me, as a well trained and compassionate physician, to be compensated for my time and effort, but also gives my patients better care and more choices in how they receive their medical care. And its going to get better.

From time to time, I will be blogging about my experiences in my practice and hope you will enjoy my postings.

More later,

Timothy Murphy, MD

Request more information on Executive Health Service