Meet Marcy Zwelling-Aamot, MD. A triple board-certified internist and founder of Choice Care Inc., Dr. Zwelling-Aamot, 53, works as a concierge physician providing personalized medical care to nearly 500 patients. Each patient pays her an annual fee of about $1,500, which includes all doctor visits and an extensive physical. She does not accept insurance. She made the move to concierge medicine in 2004, after years of mounting dissatisfaction and stress with her traditional practice.

Now, Dr. Zwelling-Aamot's Los Alamitos office oozes personality, decorated in warm jewel tones with custom wall finishes and artwork throughout. Amenities for patients abound, from the overhead speaker system wafting jazz in the waiting room to the plush terry robes in the exam rooms. In fact, the environment plays to all the senses, including taste and touch. Patients are treated to fresh coffee, candied pineapple and flakey cinnamon twists. And J. Solomon Katz, her Maine Coon cat, offers his silky coat for "pet therapy" as Choice Care's chairman of the stress management department.

Beyond unique to iconoclastic, the office is a reflection of the type of service Dr. Zwelling-Aamot provides. She strives for faultlessly comprehensive, seamlessly coordinated and distinctly individualized medical care. Plus, patients have unheard-of access to her 24/7, via e-mail, cell phone and extended office hours.

Southern California Physician joins her Wednesday, Aug. 9, 2006:

Before work--I field a few calls from home. My patients have my cell phone number: I give it to them on a special card for Choice Care members only. Later, I round at Los Alamitos Medical Center, which is across the parking lot from my practice. My one inpatient there, Roberta, is stable, but I'm bothered about a situation that arose overnight.

9:10 a.m.--I arrive at my practice with one thing on my mind--untangle why Betsy had lumbar fusion surgery that I didn't know about until she called me at 2 a.m. from the hospital complaining about pain. Disgusted by the disjointed medical environment, I'm looking for answers from the orthopedic surgeon. I call, but he's not in. I leave a message.

As a concierge physician providing primary care, one of my main goals is to oversee the whole medical experience for each patient, so I need to know when something like this is planned. Betsy wasn't cleared medically, and the surgeon didn't call me.

9:15 a.m.--My staff is running the front smoothly even though I'm preoccupied. John arrives for some lab work. They greet him warmly, "Be with you in a minute," says Jeannine McNally, my office manager. Then, Cathy Heroux, my assistant, comes to get him: "Hello, Mr. Skinny. You look great!" John's been on a diet.

9:30 a.m.--I'm in the front office when I see Katherine arrive. "Are you better?" I ask. "It's been five days since we talked." Cathy takes Katherine to an exam room to prep for her annual physical. Around here, that means a 90-minute office visit.

9:40 a.m.--Back in my private office, Cathy brings in a stack of lab reports for me to review. I check some e-mail and make a few notes in patient charts. I have a full electronic medical record system, so all recordkeeping is digital.

10:10 a.m.--Betsy's orthopedic surgeon is on the line, and I restrain from using expletives. I tell him: "This is not how I take care of things. If I had known about the surgery, Betsy would have been pre-oped appropriately and we could have prepared a plan to deal with possible complications beforehand."

The medical system is crazy, and patients can get lost in it even when they have a determined medical advocate like me. My concierge clients want and pay for that advocacy--so I step in and bail the surgeon out. I call Long Beach Memorial Hospital.

10:20 a.m.--Betsy's nurse, Brenda, is describing her symptoms--tachycardia and a drop in her oxygen saturation--which means a likely pulmonary embolus. I order tests and make a mental note to call back in a few hours for the results.

10:25 a.m.--I start Katherine's physical in an exam room. We mostly talk about her recent problem with a medication and her answers to my questionnaire on health status. It's no ordinary form. I ask patients to comment on their stress, relationships, nutrition, exercise and more.

10:40 a.m.--Ducking out of the exam room to retrieve some information, I hear Cathy chatting with Jeannine about today's schedule. There are nine patients coming in, a fairly typical Wednesday. I see patients on Monday, Wednesday and Friday, and try to reserve Tuesday and Thursday for administrative duties. As usual, both women are wearing bright smiles, and patients love that they are so personable. That's what Choice Care is all about--keeping patients happy and feeling nurtured.

11:25 a.m. --I complete Katherine's physical and return to my office to call Los Alamitos Pharmacy about Vaniqua, a hair removal cream I'm thinking of prescribing for her. I want to see what my pharmacist friend knows. While I'm waiting for him, I look up the cream on Epocrates on my computer. I print out some information for Katherine. The pharmacist comes on, but says he doesn't have much experience with dispensing that cream. Special research and attention to detail are hallmarks of my service, and I love operating this way. I have the time now. I don't have 3,000 patients anymore.

11:40 a.m.--I type a personalized list of Katherine's 12 medications. I translate all medical jargon so she doesn't have to wonder what "TID" means. I toss in a joke--Katherine likes a joke--so after the explanation of one drug, I write, "Research shows that by taking this medication you may win the lottery."

Jeannine tells me Linda, my next patient for an annual physical, is ready. "Sweetie, tell her I'll be right there."

11:50 a.m.--I invite Katherine to hang out with my staff for lunch while I see Linda. Everyone orders from the cafe down the hall, including me.