Here, Real Health talks to Kadisha Rapp, MD, a board-certified emergency medicine physician. Rapp launched a medical concierge service that treats celebrity and business clients. Her concierge service caters to individuals who lead busy lives and need above average levels of privacy when they require medical care.
Where do you work?
|Kadisha Rapp, MD|
Briefly describe the differences between your work as a freestanding emergency room doctor and what happens in your concierge practice.
Well, my work in freestanding ERs and [in] a hospital-based ER is that it entails being in one place and seeing anyone who comes to the emergency room. We do our physical history and physical exams in the ER. We treat patients accordingly and if a patients needs to be admitted from a freestanding emergency room, we may call and have the person transported by ambulance to a nearby hospital where they go straight to a room. In hospital ERs, we just call the doctor upstairs and have them transported upstairs once that doctor accepts the patient. With my concierge service, patient-clients call me. They can call any time of the day, and it will always be me not just whatever doctor is working. The patient tells me what their issue is, and based on their comfort level and need for privacy, that will determine where exactly we’ll meet for me to get the history of their present illness. It could be at their home, I’ve met people at their mother’s house or it could be my residence, anywhere that they feel comfortable and their confidentiality and privacy is not compromised.
Then, I’ll do the exam and treat accordingly. The patient’s condition determines whether or not I can treat their condition on the spot. As an emergency medicine physician, I’ve sewn up lacerations, lanced abscesses in private residences, done all kinds of things. There are a number of things I can do at a person’s home, and if the condition calls for more than that, or calls for a hospital visit, I can drive them to a hospital or their assistant can drive us to the hospital. But on the way I would notify the hospital that I’m bringing someone in whose privacy may be an issue. That way, they could have registration ready on the spot so we can expedite their treatment and either discharge or admit the patient to the hospital.
If I have privileges at the hospital, then I will be the emergency physician treating them directly. If I do not have privileges then the treating ER doctor and I will be in constant discussion. And if that doctor is busy as they usually are in an emergency room, I still am there. As a medical concierge doctor, I have the time because I’m devoted strictly to this one person. If possible, I’m with the patient even after they’re admitted. And even after admission, I continue explaining things to the patient that the doctor might not have time for, and I ask all the pertinent questions.
Do you sometimes go out on tour with some of your celebrity clients?
I’m set up to do that, but now I see patients in Houston and Los Angeles, or they will call me from Los Angeles or Houston, depending where I am. When tours come up, I will often go on tour. But because I still work in an emergency room, my ability to go on tour would depend on how much notice I’m given. If I’m given enough notice—like at least a month— then I could do the entire tour [with my patient]. If it’s short notice, then I have to work with my schedule and theirs.
What are the differences between treating a regular patient as opposed to a celebrity?
Of course we’re all human beings on a basic level, but let’s say the patient is a celebrity who has a concert to perform in a couple of hours versus someone like you and me who can just go home and rest. The celebrity might need IV fluids for quicker rehydration versus you and I who could just go home and drink more fluids. That’s that extra need that a celebrity has that my medical concierge service is set up to fill. What’s more, with athlete-patients, they might need more aggressive treatment just to get them back on their feet faster because of the demand on their bodies for competing, or they might need to be treated in their house because even the hospital staff can interfere with their treatment. Hospital staff can leak to the press that an athlete is there, so some of these folks just need to have treatment at their house. They can’t afford to go out.
How do you see the average person benefitting from this kind of medical care?
I see it all the time when people come into hospital-based ERs and they come into freestanding ERs. Even though freestanding ERs have a homier or clinic-type feel to them, sometimes, a patient’s blood pressure may still spike because they’re stressed having to go into these care settings. When the doctor comes to see you in your own house, where you’re, literally in your comfort zone, that takes stress off of you. And then some folks, whether they’re celebrities or not, we’re all entitled to privacy, and some of us want more privacy than others, so there’s that benefit. As a concierge doctor, I’m in your house; there’s no one on the other side of the wall or curtain who can hear what’s going on with you. And I have all the time in the world just for you, and the patient in the next room isn’t complaining that I haven’t been in there.
Do you see this business model expanding in the future where just regular people will take advantage of concierge medical services?
Yes indeed because, with universal health care, more people are going to be seeking treatment than ever before. Those of us who can pay a little more, who value convenience as much as they do their money will, I believe, look more toward concierge doctors to meet them at home, or meet them at their work place, and things like that. Because as waiting rooms fill up in the coming years, all of us are going to have to wait longer for health care. And just the simple fact of being in a waiting room with more people increases your chance of catching something else. You may go in there for a sprained ankle and come out with a sinus infection. So, yes, I definitely see concierge medicine expanding.