When is a doctor not a doctor?

When they're A Concierge.

Its not like I've never been dumped before. Still, I was ill prepared to be dumped by my GP. For 12 years I thought we got along O.K. Now I continually ask myself, "Was I not sick enough for her?"

The first red flag was the single-serve coffee machine in the waiting room, featuring festively flavored international coffees and chai. I eyed it nervously. Had there been an article in an AMA journal offering hints on transforming your drab, predictable reception area into an upscale medi-café? At my next flu shot, would I meet a barista and be offered a selection of assorted biscotti?

"No, no," I said to myself. "Don’t get carried away. Current wisdom dictates that when her practice becomes successful, she must personalize her brand."

If this were a documentary, the tone of the music cues under the footage we were now watching would begin to take a darker tone as we moved into a montage of the increasingly obvious shifts in waiting-room decor, building up to the day that the gleaming glass display cases containing extravagantly priced bottles of anti-aging moisturizer were installed. Out go the magazine racks and potted plants. In come the expensive looking glass containers of pastel gels, salves and emollients, surrounded by lovingly arranged floral displays or calming photos of the sea. "I guess pricey moisturizers are considered medicine now?" I rationalized, wondering about the ever more porous boundaries between beauty and health. It’s impossible not to notice that these barriers have now become so permeable that even professional adolescent and accused sexual problem creator Russel Brand has been able to slide under them by calling himself a “wellness” advisor.

As the documentary continued, the music cues continue growing steadily darker until we cut to a scene where we are watching me, waiting to be tested for covid while completely surrounded by pamphlets for "facial fillers" and "injectables" like Juvéderm and video loops explaining Coolsculpting™. Maybe, I think, if I test positive, my doctor will recommend that, in addition to paxlovid, I also get a spray-on tan? “When you look good, you feel good,” she will say, while handing me a coupon offering a 10% discount on eyebrow lamination. This does not seem impossible.

Though it occurs to me that it’s finally time to look into getting a new GP, I put the thought aside and decide to remain loyal because…come on… I liked her. I trusted her. She’d been my doctor for 12 years! Her office still called to remind me that it was time to get a checkup. Or watch my glucose levels. So what if she wanted to branch out a little?

At least that’s how I felt until I got The Letter.

"I'd like to wish you and your family a happy holiday season and a prosperous new year," it began. Interesting word choices, I thought.’Happy’ and ‘Prosperous’ rather than ‘Healthy.’

Her reasoning became clearer as the letter went on to explain that my husband and I would be dropped as patients unless we signed on to a $12,000-a-year per person retainer for her services. This extra money would NOT count toward any charges for medical visits, the letter explained. Patients would still need health insurance. But the new annual fees would entitle us to a variety of rock-star privileges like "Direct access to the doctor, 24/7."

And as my doctor, she would now be taking on a new title! "Our nation is faced with the most difficult time in the history of our health care system," the letter went on. "As a result, I will now be transitioning my practice to A CONCIERGE medical service."

Concierge? Another interesting word choice. It is defined in the dictionary as "a member of a hotel staff in charge of special services such as arranging for theater tickets or tours. A porter. A doorman. A janitor." So did it mean that my doctor would now offer, along with a needed prescription for an antibiotic, a few restaurant recommendations and some tickets to The Lion King?

As it turned out, she was offering a two-tiered plan with levels designated Gold and Platinum. In Gold, which was slightly less expensive, her patients could reach her only via office phone and email. But if they were smart enough to sign up for Platinum, which of course was more money, their options widened to include texting, Skype, Facetime and Google Hangout. Sadly, the letter forgot to mention whether there was a separate charge for patients to become verified and get a blue check beside their name on the client list.

There were other differences between the two plans. Platinum carders got house calls, 20% off on Botox, a complimentary session with a fitness trainer and "prompt telephone feedback with test results by [the doctor] herself." The Gold carders, who had already publicly shamed themselves by trying to cut corners on their wellness, would have to be content speaking with whoever was answering the phones that day. Would they be trained medical personnel or someone in a call center in Mumbai? You pays your money, you takes your chances.

Both plans, however, were eligible for "fast and easy prescription renewals" and "a dedicated support staff.,” two things I seem to recall being the very foundation for normal expectations when going to a regular non-concierge doctor. However, in their new capacity as a concierge service, my doctor's website boasted that her flashier, more tuned-up practice would now traverse a medical high wire reaching from "congestive heart failure” to a pandemic for which there is still no known vaccine;"muffin top." In a follow up group-e mailing, they also offered an invitation to attend an event called “Wine Down Wednesdays.” where patients could meet with “our Master Injector” “our Master Hairdresser” and set up a consultation with a representative from a firm that offers“the finest diamonds in the world.”

Below is part of the scroll down e-mail brochure for that event.

If you, like me, are new to the word Dysport, I just saved you a google search: It’s an alternate brand of Botox.

Just to refresh your memory, because I have been going on about this for paragraphs now, this was contained in a message from the person that I used to go to when I had strep throat or needed an x-ray. She now was offering her patients the chance to be part of a medical practice that would like to sell them diamonds.

I am not remotely a nostalgic person. I look back at most of the cultural trends I’ve lived through, in every age and decade, and find them silly and riddled with ridiculous details with which I am embarrassed to have played along. So when I say that these bulletins about the concierge experience made me nostalgic for ‘the good old days’, I guess I am mainly sad that I ever naively assumed that people who trained as doctors and took the Hippocratic oath were people who were interested in the field of medicine. That oath ends,"May I long experience the joy of healing those who seek my help." I always felt grateful that there were people like this, better people with bigger hearts than me. The thought that they existed made me happy. It never occurred to me that emergency rooms might now be fundraising so they can build extensions with enough space to hold a chic champagne brunch that could double as a showcase for diamonds.

Now I’m just waiting to get an update from their office informing me how much extra they' will charge if you want them to LIKE your rash or your mammogram on their fan page.