When It's Serious

When it stops being simple, you're already in the right hands.

A diagnosis that changes everything. A condition that has resisted answers. Too many cooks in the kitchen, without a head chef. Whether for yourself or someone you love, this is the medicine we're built for.

Arranging care for someone?

Spouses, adult children, assistants, and advisors are often the first to reach us. If you're the one holding the calendar, the records, and the worry, we work with you directly: communication, scheduling, and logistics, always at the patient's direction.

How We Work

What serious care looks like here.

The communications hub for your whole case

Serious care rarely happens in one building. Our members have been evaluated at Mayo Clinic and MD Anderson, treated by UCSF and Stanford physicians, and cared for at home in between. We arrange the consultations, transfer the records ourselves, and keep every specialist working from the same picture.

Independence that answers only to you

We are physician-owned and independent. When your case needs a specialist, we choose on one criterion: who is best for you. Sometimes that's across town. Sometimes it's across the country. The referral goes wherever the answer lives.

A physician within reach, all the way through

Serious illness keeps odd hours. Members reach a physician 24/7: before the procedure, after the scan result, at the moment a question feels too big to sit with overnight. We have all the latest technology available to augment your care, but there's always a human when it's important.

Three stories from the practice. Details are changed to protect our members; the medicine is real.

Coordination

A Rare Cancer, Three Institutions, One Plan

For one member in midlife, a routine annual exam turned serious in a single visit: a bedside ultrasound, done in our office, found a large abdominal tumor. The diagnosis was a very rare cancer, the kind only a handful of specialists in the world see regularly. We arranged an urgent remote consultation with MD Anderson, transferred every record ourselves, and coordinated the in-person evaluation that produced his treatment plan. Then we brought that plan home: oncologists at UCSF delivered his treatment locally, with our practice serving as the communications hub that kept every specialist in sync. At his request, we kept watch on the emerging science for his condition, so that he and his oncologists could weigh new developments together. World-class expertise in a rare disease, guidance through every handoff, and treatment close to home. That is what coordination means here.

Judgment

When the Answer Was Less Medicine

A woman in her thirties with lupus came to her annual exam worn down: fatigue, body aches, brain fog. With lupus on the chart, the easy assumption is that the lupus is responsible, and the standard move is more immunosuppression. Dr. Padula looked at the whole person instead. Her lupus was actually quiet. What he found was sleep apnea and a significant vitamin D deficiency. Treating those, with her immunosuppression left unchanged, brought her energy back and restored her sleep. An autoimmune diagnosis deserves respect, but so does everything it can hide. Rheumatology-aware care that considers the whole person found two treatable conditions and spared her further immunosuppression.

Persistence

A Mystery Rash, Solved at Mayo

A professional in his fifties had a rash that was taking over his life: pervasive, relentlessly itchy, and unmoved by everything tried against it. He had already been through excellent local dermatologists and two of the Bay Area's leading academic allergy and dermatology programs, with round after round of testing and treatment, each working from the same regional toolkit. Dr. Abramson recognized the case needed a wider net and orchestrated an expedited evaluation at the Mayo Clinic, where the allergy specialists test against a far broader panel of allergens than is available in the Bay Area. The answer: an allergy to a specific ingredient in his personal care products, and to nickel. He removed both, and the rash resolved completely. Independence means the referral goes wherever the answer lives.

Start with what you're facing.

Managed Here

Complex chronic disease management

Heart failure, diabetes with complications, kidney disease, autoimmune illness: conditions like these are managed week over week, for years, and the management itself is the medicine. We hold the whole picture: the medication list every specialist adds to, the plans that quietly drift apart, the lab trend that deserves a call before it becomes a hospitalization. One physician team, keeping the thread through every specialist and every year.

Led by Dr. Padula

Rheumatology & autoimmune care

Autoimmune disease is a long conversation among flares, labs, and treatment tradeoffs. Dr. Anthony Padula practices concierge rheumatology here: complex autoimmune care with the time to weigh the whole person, in the same practice as your primary care. Rare anywhere.

Meet Dr. Padula

Managed Here

Medication complexity & careful deprescribing

Twelve medicines, five prescribers, and a body that keeps changing. We review the whole list, simplify where simpler is safer, and taper deliberately when a medicine has outlived its purpose. Benzodiazepines are the most common request. Gradual, monitored, and always with you in the decision.

Complex & undiagnosed illness

When a diagnosis is elusive, the case needs new eyes, more time, and a wider net. We take a fresh look at everything, put every diagnostic option on the table, and bring the persistence these cases demand.

Second opinions at MDMG

Geriatric care

We respect our elders, and have specific geriatric expertise including complex pharmacology, cognitive health, home care, and healthspan. We can make house calls across San Francisco.

Healthy aging at MDMG

Addiction Medicine

Care for alcohol and substance use disorders, destigmatized and discreet.

We treat addiction as serious medicine, because it is. Dr. Abramson is board certified and deeply experienced in addiction medicine: medication support, psychotherapy, and steady structure, integrated with concierge medicine or its own treatment track. Private, confidential, and customized.

Tell us what you're facing.

Every inquiry is read with care, and we'll be straightforward about whether this practice fits your situation.