Daniel Khani was feeling healthy, but he did have a medical problem or, rather, a problem with medicine: he thought he wasn't getting enough of it. The basic physical he got each year was, well, basic. Khani, a wealthy real-estate investor, was accustomed to better treatment in the rest of his life. So in September, he went to the Concierge Medicine clinic in Los Angeles for what he considered the ultimate in medical care: the same kind the president gets.
As part of his Presidential Physical, over two days Khani, 66, underwent a battery of fancy-sounding tests not usually included in a standard exam—"dilated direct opthalmoscopy," "fiberoptic nasolaryngoscopy," several ultrasounds, a tuberculosis test—all of them based on the regimen that White House physicians administer annually. "It made me feel good to be getting the same thing the president's getting," says Khani. Doctors sat with him for hours, lavishing him with personal attention, and they sent him for something even the commander in chief doesn't always get: a skin consultation. (Hey, it's L.A., not D.C.) A cardiac workup and an angiogram turned up a minor heart blockage that a less thorough exam might have missed. Docs opened it with a stent; they also gave him tips on managing stress and cholesterol. Now Khani says he's "feeling much better." Remember, though, he felt fine before.
The lure of "concierge medicine"—the concept behind dozens of practices that have sprung up in the past few years—is easy to understand. Most primary-care physicians take on hundreds of patients and barely spend 15 minutes with each. In concierge programs, they see far fewer people, making each feel—for a few hours, anyway—like the most important person in the world. The presidential program goes further, making each patient feel like the leader of the free world. The price of a Presidential Physical starts at $1,400. Since the clinic started offering them last November, about 600 people have had one, says Concierge's medical director, Dr. Raphael Darvish. "Most of them are pretty healthy," he says, "but no matter how small their problems are, they get addressed." These patients want the best, and, Darvish says, when you think "presidential," you think "the best."
But is this really the best medical care? Or is it an appeal to narcissism—luxury in medical trappings? Patients do benefit when docs take time to sit down and listen to them. (Would that we all got such attention.) But they don't benefit when overeager physicians run unnecessary tests. Concierge medicine should be personalized, not "a cookie-cutter checkup for the worried well," says Dr. Deborah Rhodes of the Mayo Clinic's Executive Health Program. Just because the president gets a TB test doesn't mean you should, too.
Regardless of how wealthy their patients are, many doctors are known to recommend scans and procedures that aren't entirely appropriate—partly, says Shannon Brownlee in the new book "Overtreated," because "most of them are paid for how much care they deliver, not how well they care for their patients." Khani benefited from part of his thorough workup, but overtreatment can make for bad medicine. "Unnecessary treatment and tests aren't just expensive; they can harm patients," Brownlee writes. An arbitrary test may reveal a hidden condition, causing patients to demand drugs or surgery—even if the condition is benign.
For most people, intensive and expensive checkups are out of reach. But maybe we don't all need them. With unnecessary tests driving up health-care costs nationwide, it's worth remembering that more isn't always better. What matters most is how wisely your doctor spends his time with you, not how much time he has to spend.