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 accumulate prescriptions. Each one made sense to the physician who started it, and nobody owns the total. We review the whole list against the Beers criteria and stop what is no longer earning its place.
It is worth being straight about what that does and does not buy. Deprescribing reliably reduces the number of medications a patient takes, and trials show it is safe to do. What it has not been shown to do, in any randomized trial that asked the question properly, is lengthen a life. We do it because fewer drugs with clearer purpose is a better way to live, not because we can promise it extends life.
The evidence that deprescribing is safe is strong, even though it's not yet clear whether it prevents falls or extends life.
Memory and Cognition
When a patient or a family raises a memory concern, we evaluate it: history, examination, the reversible contributors worth ruling out, and a frank conversation about what the findings mean.
We do not screen patients who have no symptoms, because screening has no proven benefit. The US Preventive Services Task Force still finds the evidence insufficient to recommend screening older adults who have no symptoms. Evaluating a concern someone has actually raised is a different act, and that one is worth doing.
Screening people without symptoms has no proven benefit. But early changes can be subtle, and when a patient or family raises a concern we take it seriously.
Falls and Mobility
If you want one intervention with strong evidence behind it, it is balance and functional training. Cochrane rates it high certainty for reducing falls. That is a narrower claim than the usual advice to exercise, and it is the one that holds.
Comprehensive falls assessments are worth doing, though they have not been shown to prevent fractures. We will tell you which part of this is solid.
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
When several specialists are involved, someone has to hold the whole picture. We communicate directly with them, consolidate the records, and stay 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.
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 holding the calendar, the records and the worry, we work with you directly on communication, scheduling and logistics, always at the patient's direction.
Your parent remains our patient, and the relationship is with them. In our experience that distinction is what makes the arrangement work: nobody wants to be managed, and most people are glad to have the paperwork lifted.
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, specialists and hospitals go to Medicare-contracted providers and are billed and covered as they normally would be. So membership covers our time and attention, and the rest of your care stays inside the system you already have.
We chose this because it lets us practice in your interest without a payer setting the length of a visit or the frequency of contact. It is not a way to spend less on medical care.
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.