Geriatric Medicine, Practiced as Primary Care.
Most of what geriatric medicine knows belongs in ordinary primary care: the medication review, the cognitive concern, the fall that has not happened yet. We practice it that way, for patients in San Francisco who want a physician with the time to do it properly.
Geriatric Care in San Francisco
Contact UsWhat This Actually Is.
My Doctor Medical Group is a physician-owned concierge medical practice in San Francisco. Members have a lasting relationship with their own physician, unhurried appointments, and a team that knows them well; the program and membership details are on our concierge medicine page. What this page describes is how that practice serves older adults.
Geriatric medicine is a real discipline with its own literature: the Beers criteria on medications that carry more risk than benefit for older patients, the evidence on falls and frailty, the specific way common conditions present later in life. We know that literature and we practice by it.
What we are not is a separate geriatrics department. Neither of us completed a geriatrics fellowship, and we do not hold board certification in it. Our training is family medicine and internal medicine, both of which include the care of older adults, and both of us have spent years doing it.
In our experience, the thing that changes outcomes for an older patient is rarely the specialty on the door. It is whether one physician has enough time, and knows you well enough, to notice that the new dizziness started when the third blood pressure medication was added. Most fellowship-trained geriatricians in this country practice inside institutions, on institutional schedules. That is the gap we fill.
What We Do, and What the Evidence Shows
Medications
Older patients tend to accumulate prescriptions. Each one made sense to the physician who started it, but nobody manages the list and the complexity gets out of hand. Principles of geriatric medicine apply here, such as the Beers criteria, which help flag safety risks.
But common sense also applies. Most patients would rather be on fewer medications if possible, and each one brings its own potential for unanticipated side effects. We carefully assess each medication in full context, across all specialties, and apply thoughtful principles of simplification.
Deprescribing, done carefully, has a good safety record in trials. What it has not been shown to do, in any randomized trial that asked the question properly, is lengthen a life. We find it a useful part of personalized care and shared decision-making with our patients.
Deprescribing, done carefully, has a good safety record, though it has not been shown to prevent falls or extend life.
Memory and Cognition
When a patient or family raises a memory concern, we take it seriously, with a careful history, physical examination, laboratory evaluation and imaging. We aim to find treatable or reversible causes and contributors, and we help interpret the findings to sort out what is actionable.
The US Preventive Services Task Force still finds the evidence insufficient to recommend screening older adults who have no symptoms. So we do not screen on a schedule. We look instead at risk factors, genetics, potential medical and environmental factors, and symptoms, even subtle ones, to decide who needs a workup.
The evidence on screening people without symptoms is insufficient. But early changes can be subtle, and when a patient or family raises a concern we take it seriously.
Falls and Mobility
One of the most evidence-based interventions in geriatrics is balance and functional fitness training. Cochrane rates the evidence for reducing the rate of falls (by 24%) as high-certainty.
Comprehensive fall risk assessments also reduce falls, although the evidence for assessments by themselves reducing fracture risk is weaker. So we do not stop at the assessment: we combine it with targeted balance exercises, medication review, home modifications, and treatment of osteoporosis, which is the best-proven way to prevent the fracture itself. We take a comprehensive approach.
Balance and functional training is the best-proven fall prevention there is. The evidence for preventing fractures is weaker, but preventing the falls is a worthwhile goal in itself.
Coordination and Continuity of Care
When several medical specialists are involved, someone has to hold the whole picture. We act as a hub for your medical care, communicating directly with specialists, reconciling medications, consolidating the records, and staying involved through a hospitalization rather than reading about it afterwards.
Continuity with one physician who knows you is consistently associated with fewer hospital admissions and lower mortality. That evidence is observational, so we offer it as a reason for confidence rather than a promise. We also find it more satisfying, and our patients appreciate how deeply we get to know them.
Patients who keep one physician have fewer hospital stays and longer lives, across millions of records. No trial can test this directly, but the pattern is unusually consistent.
Seeing You at Home.
For members at the VIP and Home Care tiers, we make house calls in San Francisco when there is a medical reason to. Home Care is built around them; at VIP they happen when coming to you is clearly the better way to provide care.
Most of what we do in the office travels. Vital signs, an EKG, blood draws, a full physical examination. And a home visit often tells us things an office visit cannot: what the stairs are actually like, what is in the medicine cabinet, how someone manages a day.
For most patients the annual examination still happens in our office, where the equipment and the staff are. House calls are planned visits, arranged in advance, for situations where the home adds something.
House calls are within San Francisco city limits.
If You Are the One Holding the Calendar.
Often the person doing this research is not the patient. If you are the one coordinating care, maintaining the records, and holding the worry, we help with communication and logistics, always at the patient's direction.
Your parent or loved one remains our patient, and our relationship is with them. We respect their autonomy; nobody wants to be managed. But most families are glad to have support navigating a complex health system, and to have our team ready for whatever comes up.
We are happy to coordinate with you directly.
Contact UsHow This Works With Medicare.
We are opted out of Medicare. Patients sign a private contract with us, and Medicare does not pay for our services or reimburse them.
What we order is a different matter. Labs, imaging, tests, specialists and hospital care are typically with Medicare-contracted providers and are billed and covered as they normally would be. So your membership covers our time and attention, and we work closely with the rest of your care team, be it at UCSF, Stanford, Sutter, or the Mayo Clinic.
We chose this arrangement because it lets us practice in a fiduciary capacity, without a third-party payer determining when, how frequently and how comprehensively we can care for you.
Frequently Asked Questions
How do I become a patient?+
My Doctor Medical Group is a membership practice; geriatric care is part of our concierge medicine program. The first step is an inquiry call to talk through what you or your family member needs and whether the practice is a good fit. The program and membership details are described on our concierge medicine page.
Do I need to be a member to get geriatric care here?+
Yes. Geriatric care is part of our concierge practice rather than a separate service. Everyone whose age and circumstances call for it gets that attention as part of ordinary membership.
Do you take Medicare?+
No. We are opted out of Medicare and patients sign a private contract, so Medicare does not pay for or reimburse our services. Labs, imaging, specialists and hospitals we send you to are Medicare-contracted and are covered as usual.
Are you geriatricians?+
Not by board certification. Our training is family medicine and internal medicine, both of which include the care of older adults. We practice by the geriatric literature and have done this work for years, and we would rather say that plainly than imply a credential we do not hold.
Will you come to the house?+
For members at the VIP and Home Care tiers, in San Francisco, when there is a medical reason to. Home Care is built around house calls; at VIP they happen when seeing you at home is clearly better. These are planned visits, not urgent care.
What can you actually do in the home?+
Most of what we do in the office. Vital signs, an EKG, blood draws and a full physical examination. The annual examination is usually still done in our office, where the equipment and staff are.
My mother refuses to see a doctor. Can you help?+
Sometimes. A visit at home is less confronting than a clinic for some people, and an unhurried first conversation helps. We will not press someone into care they have declined, and we will be honest with you about what is realistic.
Can you talk to my father's cardiologist?+
Yes, and we do this routinely. Coordinating directly with the specialists already involved, and holding the whole picture, is a large part of what this practice is for.
Do you manage medications my parent has been on for years?+
Yes. Reviewing the full list, including what was started long ago by someone else, is one of the first things we do. Where something is no longer earning its place we will say so and taper it deliberately.
Care That Keeps Up With a Long Life.
Whether you are planning for your own later years or helping a parent, the difference is having a physician with the time to know the whole picture.