Westport, CT: Praeger, 2008. 200 pp. $34.95 (cloth).


After years of traditional medical practice and the frustrations of dealing with Medicare, government regulations, and third-party payers such as HMOs, Dr. Steven Knope, an internist, opened a practice in the emerging field of concierge medicine. Concierge medicine, Knope explains, is “a form of private medical care in which patients pay a physician directly for increased time and access to that doctor.” Although there are many variants of this model, they all “represent a return to the privatization of medicine” (p. 10). Knope’s book, Concierge Medicine: A New System to Get the Best Healthcare, describes the advantages of a concierge practice for both doctor and patient. The chief benefit for the doctor is a return to the autonomy afforded by a direct financial relationship with the patient, unmediated by third parties such as Medicare or HMOs. This enables the doctor to spend more time with the patient and to have more control over his own compensation. The chief benefit for the patient is the better care afforded by increased time with and easier access to the more-focused, better-compensated doctor.

Knope stresses the importance of a physician’s time—time spent reviewing the patient’s past medical history, listening carefully to the patient’s description of his current problem, examining the patient, thinking about and researching the patient’s problem, discussing with the patient his diagnosis and options, discussing the patient’s case with specialists, reading to stay current with medical literature, and so on. He shows how declining Medicare reimbursements and HMO compensations require doctors to spend less time with each patient in order to stay profitable. While recognizing the importance of sophisticated medical tests, Knope explains, “Most diagnoses are not made in the CT scanner. Most diagnoses are made with the mind of the doctor,” and that mind requires time to do its job properly (p. 20).

Using examples of typical days’ schedules from his own practice before and after adopting the concierge model—and describing actual patient cases and his management of them under the concierge model—Knope illustrates the differences between the kind of practice most common today and a concierge practice. Anyone who has been to a doctor will recognize the standard medical model and see the marked difference in concierge care. . . .

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