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.

12:45 p.m.--After I finish with Linda, I eat my cheeseburger and drink V8 while I answer e-mail. I get about 20 e-mails from patients each day. There's one from a patient's husband, concerned that his wife is recuperating from a surgery too slowly. I type: "My only recommendation is patience. I know that isn't much, but that's what's really needed."

12:55 p.m. --I check my list of phone messages. There's an urgent message from Dan, who wants a call from me directly. Patients often don't want to describe what's happening to anyone else.

I get him on the line. "Hi there, it's Marcy. How can I help you, love?"

"I'm falling apart," Dan says, gravely concerned. He describes having abdominal cramping and blood in his urine. I promise to call the urologist who performed a test for kidney stones yesterday. In the meantime, I ask him to come in at 4:30 p.m. I want to keep an eye on the situation.

If there's anything that concierge medicine could potentially do to improve the healthcare system, it would be to promote collaborative healthcare. The urologist didn't give Dan the information he needed so he wouldn't worry. But when doctors get paid minimally, they silo their care and do as little as possible. It's my priority everyday to share information with the patient and all consulting physicians.

1:20 p.m.--Katherine comes in my office to say good-bye, but ends up playing with Solomon for a few minutes, taunting him with the tissue paper from her goodie bag. (Every patient who has a physical gets a pedometer, a sample of Z's Choice shampoo and other treats.)

1:23 p.m.--The nurse from Los Alamitos Medical Center calls. Roberta's blood pressure has dropped since I visited her in the hospital this morning. I advise her to monitor the pressure with a cuff, instead of via the arterial line. I head across the parking lot to check things out.

Having the flexibility to do this makes me happy. My patients get better care, so I feel better. I'm no richer, but the switch to concierge medicine was never about that anyway. More of my time is directed at patient care now, because I have fewer patients and can concentrate on them.

1:50 p.m.--I'm back, ready for more patients and more follow-up work. I type a few reports for consulting physicians. I never refer one of my patients without first telling the doctor what it's about. That shows respect for them and their time. Again, I can do this because I have fewer patients. All my calling, faxing, writing, talking is about patients. That's how much time good patient care takes if you do it legitimately.

2:20 p.m.--I call to check on Betsy and get the results back from the tests I ordered. I ask the nurse to get physical therapy in there to move her legs and minimize the possibility of clots. "Tell her Dr. Zwelling says to move her legs or she'll come and beat her up. She'll move. [Laughter] Thanks, toots!"

2:25 p.m.--My patient, Candice, has frozen shoulders. So tomorrow she's going for a consult. I get the doctor on the phone to discuss her complicated medical history, which includes having a pacemaker and defibrillator, fibromyalgia, reactive airway disease, allergies and thrombocytopenia. I tell him: "She has a list of physicians that goes from here to Shinola, and I will send you all of this in a memo. But her major issue is her pain." Pulling information out of my EMR system, I compile a three-page history on Candice that Jeannine faxes.

2:45 p.m.--I pick up my role as a California Medical Association trustee. There is a CMA board conference call tonight about how to tackle the unfolding ER billing crisis. I call a fellow trustee to discuss strategy. "I think we have to let the public know that health plans refuse to negotiate contracts properly," I say. I listen to his concerns and suggestions. But we are both running short on time. He has to go. "Go put in a chest tube. That takes 30 seconds on a bad day. Love you, bye." As organized medicine leaders, we are taking care of a health system while we are taking care of patients.

3 p.m.--My afternoon office visit schedule is full. Working patients like later appointment times and I accommodate them. I also make sure to give myself about 30 minutes each, which is enough time to be thorough. There are no 8-minute office visits at Choice Care. First is Monica for routine follow up.

3:30 p.m.--Routine follow up on Francis.

4 p.m.--Routine follow up on Gail.

4:30 p.m.--Routine follow up on Carlos.

4:50 p.m.--I do a quick visit to reassure Dan and share his test results. He has a bleeding bladder tear, but no kidney stones.

5 p.m.--A new patient visit with Ann. She is my last patient for the day, but I often see patients until 6 or 6:30. We work until there are no patients left to see. There isn't a set closing time for my practice.

5:30 p.m.--I hop on the CMA board conference call. I'm braced for a long one.

7 p.m.--After the call wraps, I turn back to other Choice Care tasks. In the evening quiet, I write letters, work on treatment plans, research medications and do coordination of care. I also like to call patients after they are home from work. And they call me, because I pick up my office line after hours. I don't have an exchange.

7:20 p.m.--I log on to www.z-doc.com to check my Web site. I am preparing for a redesign and expansion to include a blog, downloadable forms, and pages for patients and referring physicians. I'm even going to have audio and video podcasts available. When it's done, the site will have quadrupled in size.

7:45 p.m.--I check a few details about my upcoming seminars on weight loss, cooking and sleep disorders. I present one evening event each month. It's a great way to connect with patients and help them take control of their own well-being. I like having this personal way of giving them information. Seminars aren't available from physicians in the current marketplace because they aren't financially viable. But in my practice, they make good sense for marketing and building relationships.

8:30 p.m.--I leave my office, but I'm not heading home yet. I'm going to Long Beach Memorial to see Betsy because it's the right thing to do. She's my patient, and my patients are like family.

I think concierge medicine may be the only opportunity left to practice honest medicine. I still have to fight for my patients to get a prescription, for example, but at least they get my time and energy. Other doctors can't do that when they have thousands of patients. The current marketplace has taken a lot away from us. But I've got control back and it's a breath of fresh air.

I give people a better day. I give them confidence because they have a medical advocate or I take away their pain or I give them hope. That's what I'm after. The system stinks, and I can't change all of that, but I can, within my own little microcosm, make patients feel that they do matter and there is an answer.

BIOGRAPHY
Marcy Zwelling-Aamot, MD

Birthplace: Zanesville, OH

Current Residence: Long Beach

Board Certifications: Three-internal medicine, emergency medicine and quality assurance/utilization review

Undergraduate Degree: Wellesley College, B.S. Economics, 1975

MD: New York University Medical School, 1979

Internship: Harbor-UCLA Medical Center, 1979-80

Internal Medicine Residency: Harbor-UCLA Medical Center, 1980-82

Emergency Medicine Residency: Harbor-UCLA Medical Center, 1982-84

Practice History: Choice Care, 2004-present; private practice, 1990-2004; and Critical Care Internal Medicine, 1988-90.

Memberships: American Medical Association, California Medical Association and Los Angeles County Medical Association.

Organized Medicine Leadership: Trustee of the California Medical Association, 2004-present; chair of the Los Angeles Foundation for Medical Care, 2006-present; and former president of the Los Angeles County Medical Association, 2003-04.

Practice Philosophy: "I work hard to keep my patients looking good and feeling great. In sickness and in health, I do my utmost to give my patients a better day."

Feline Partnerships: J. Solomon Katz, a 26-pound cat, is Choice Care's chairman of the stress management department. He works nearly every day and has his own digs in Dr. Zwelling-Aamot's private office. Custom-painted portraits of her other cats (living and deceased) are on the wall outside the exam rooms.