But come on. Who makes house calls these days, even on TV? The last such doc who did was Marcus Welby, M.D., and he has been off the air for more than 30 years. So Hank Lawson, the young "concierge doctor" on USA Network's Royal Pains, is just another Hollywood fantasy, right?
Not exactly.
Meet Ronald Primas, a middle-aged concierge doctor in Manhattan, where the rich and famous dwell and where parking is usually impossible unless you happen to be a "doctor on call" with the official dashboard sign and license plates to prove it.
Primas, 49, tools around town in a luxury Range Rover with a portable EKG machine in the back and a doctor's bag in the front seat, visiting patients - some of them rich and famous, some of them not - who have figured out that you really can get anything delivered to your door in New York. As long as you're willing to pay - as little as $200 a house call or more than $600 for routine primary care. Cash on the barrel or credit card.
Primas is convinced Royal Pains (Thursdays, 10 p.m.) is based at least in part on him and his practice. Brad Bernstein, a spokesman for NBC (which owns USA), says the show is based on a story that one of the series's creators heard about a doctor in the Hamptons.
On Royal Pains, Hank Lawson (Mark Feuerstein) lives free in a billionaire's fabulous guesthouse. From there, he might be called to a beachfront palace to take care of a senator's son felled by a mysterious ailment. He's accompanied by his beautiful and efficient Anglo-Indian physician's assistant, Divya, and a fully stocked mobile medical van. (Need a portable MRI? No problem!).
Hank gets paid a lot - big, fat checks, although we never see how much. HankMed, as his endearingly schemey brother/CFO Evan has named the business, is soon a hit in the Hamptons.
Discretion is vital.
In Manhattan, Primas lives on the Upper East Side and has a small office on Fifth Avenue in the 70s across from Central Park. When he's not seeing patients there, he might be called to apartment buildings overlooking the park (the kind of pre-war buildings where the apartments are so big they take up the entire floor and the views are staggering). There he will check a CEO's blood pressure or examine a little girl for signs of strep throat while reassuring her worried Wall Streeter parents.
"My fees range, depending on the complexity of the visit, time of face-to-face contact (with the patient), waiting time (because the patient is on a production shoot or it's a visiting head-of-state), the time of day (nights and holidays are more) and ancillary testing," he says.
Despite liberties taken for dramatic effect and despite the fact that Hank Lawson is not only a doctor-on-demand but a sort of a medical MacGyver, too, Primas says Royal Pains is not that far off the mark. Hank's patients crave the same things as Primas'.
"Availability, personalized attention, convenience, discretion," (especially discretion), says Primas, as he heads for Park Avenue on his way to another call, juggling a cellphone and dodging the crowds gawking at the film crew shooting a movie with Jennifer Lopez on the sidewalk across the street from his office.
It will be another long day of seeing patients and taking calls, lasting late into the night. "My life is very hectic," he sighs. "The biggest drawback is the randomness of (a typical day of calls). The problem with celebrities is that if they're paying, they expect you to come RIGHT NOW.
"One of my patients (not a celebrity) lives a few blocks away but just doesn't want to leave the apartment. So I go there," he says. "Some of these people have become my friends, not just patients. After 17 years, I've built up a level of trust and comfort with them."
What he has built is a practice specializing in travel medicine (he makes house calls to luxury hotels to tend to ailing tourists) and the health care of wealthy people and celebrities in Manhattan. Not that he'll talk very much about the latter - discretion, after all. But he has trademarked the title "doctor to the stars," some of whom (Britney, Beyoncé, Kelly Osbourne, Ludacris, Kimora Lee Simmons) have been spotted slipping into his office.
A huge rap fan, he also has music-industry bigwigs as patients. This after starting out his career taking care of poor and homeless people at inner-city clinics in East Harlem and Brooklyn.
"He's great - he makes you feel like family, it's as simple as that," says rapper/actor Ludacris (real name Chris Bridges) by phone, who was referred to Primas five years ago by his record company. "With my strenuous schedule, I need someone on call and I need to be sure of privacy."
Across the country in Southern California, Cheryl BryantBruce is a concierge doctor with a small practice of about two dozen families, most of them celebrity athletes, executives or entertainers (she believes Royal Pains is based on her practice, too). She says many famous people are plagued by stalkers or the media.
"They all want to be sure that no one can access their medical information, because their jobs depend on it," says BryantBruce, who makes house calls and frequently travels with her patients all over the world. "Concierge doctors can offer them that. "
Hotel concierge referrals
But you don't have to be famous or even very rich to get Primas to come to you: About half of his patients are strangers in town staying in hotels; they've fallen ill and have been referred to Primas by the hotel concierge.
On a recent midtown hotel call, Primas took care of Matias Pavan, 15, visiting New York with his family, Argentines who live in Italy. They were afraid Matias had swine flu. Speaking good Spanish, Primas takes a patient history, checks Matias' temperature, swabs the inside of his nose and tests him for flu. It's negative. Matias' parents, Alex Pavan and Laura Sanchez, are relieved.
Later, Primas heads downtown to visit Kelly Klosterman, 38, a marketing consultant from St. Petersburg, Fla., who was in town on business when she started feeling sick. Was it swine flu?
"I went on the Internet and found him," she said, coughing as Primas examined her in the loft overlooking the art gallery where she had been working. "I prefer someone come to me rather than go sit in an office with a lot of other sick people. I figured in New York City, you can find anything," including a doctor who makes house calls. She didn't have swine flu but she did have a sinus infection that migrated to her chest; Primas wrote her a prescription for an antibiotic.
There are an estimated 5,000 concierge, or "boutique," doctors in the country, depending on how you define the term. It's a term much in the news lately for a confluence of reasons, the most obvious being Royal Pains, a surprise summer hit and the top-rated new cable series. Medical dramas are old hat on TV, but this series has enough new twists on the tired formula to attract growing numbers of viewers - more than 7 million at last count.
Another reason for the attention: the death of Michael Jackson, who was taken ill suddenly in his Los Angeles home on June 25 while under the care of what his family called his "personal physician," a cardiologist named Conrad Murray. State and federal authorities are investigating Murray's role in Jackson's death.
There is some question whether Murray was actually a concierge doctor; for one thing, he had only one patient - Jackson - and concierge doctors typically have at least several dozen patients and often several hundred. But in the extensive press coverage of Jackson's death, the term concierge doctor has been applied to Murray.
The third reason for the attention is the ongoing debate over the nation's insurance-based health care system, which concierge doctors have escaped. They provide routine primary care only, don't take insurance, and can charge from as little as $1,500 a year to as much as $25,000 or more charged by elite practices catering to the wealthy. This is on top of the catastrophic health insurance the patient buys to cover serious illness. If a patient has a serious illness, his concierge doctor refers him to specialists and coordinates his care.
Thomas LaGrelius, a concierge doctor in Torrance, Calif., and president of the board of the Society for Innovative Medical Practice Design, a group of concierge doctors, says that 30 years ago almost all doctors were concierge or direct-practice doctors like Marcus Welby. He likes Royal Pains, even though he says Hank Lawson's practice is not typical of most concierge practices today. Even so, LaGrelius says, "any publicity is good."
Concierge medicine may be a niche market now, BryantBruce says, but "people are hearing about it, they're seeing it on TV and they want that, they wish they could afford that," she says. "They're looking back to the days of Marcus Welby, when we all had personal attention from our doctors."
As for Hank Lawson, Royal Pains has just been renewed for a second season.
By Maria Puente, USA TODAY
Posted by: Scott W. Yates, MD, MBA, MS, FACP
