Retainer medicine is practiced by physicians who have decided to drop out of all third party payer programs. These practitioners have offered a limited number of patients the opportunity to pay a fixed annual fee in exchange for premium services and amenities. Retainers doctors generally limit, by a drastic amount, the number of patients, which they will service. This makes the most sense for primary care physicians and those specialists who have ongoing and regular relationships with their patients. Many retainer practices also provide amenities which patients often do not get when Medicare or an insurer pays the doctor, including access to the physician’s cell phone, e-mail correspondence, same-day appointments, and plenty of face time during appointments. However, whatever the specifics of a particular practice may be, the key that defines “retainer medicine” is that the doctor works for the patient. It has become impossible in practical terms and in ethical terms for traditional primary care physicians to fight the pervasive pressures upon them to ration healthcare at the bedside. To escape this fate, they must become either specialists or a retainer practitioner. That is, primary care physicians must choose between remaining in a system that ruthlessly pushes them toward a practice of bedside rationing or, one way or another, getting out of traditional primary care medicine altogether. Retainer medicine restores the professional integrity of medical practice, and re-establishes a doctor-patient relationship in which the physician can again assume the duty of a true advocate. It is perhaps the only remaining means to restore the foundational medical ethic of always placing the patient first. Retainer fees let one practice handle more patients by phone or email.

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Personalized Medicine

Personalized medicine is a medical model emphasizing the systematic use of information about an individual patient to select or optimize that patient's preventative and therapeutic care. Personalized medicine is the products and services that leverage the science of genomics and proteomics and capitalize on the trends toward wellness and consumerism to enable tailored approaches to prevention and care. Over the past century, medical care has centered on standards of care based on epidemiological studies of large cohorts. Personalized medicine seeks to provide an objective basis for consideration of such individual differences. Traditionally, personalized medicine has been limited to the consideration of a patient's family history, social circumstances, environment, and behaviors in tailoring individual care. Personalized medicine uses new methods of molecular analysis to manage a patient’s disease or predisposition toward a disease. It aims to achieve optimal medical outcomes by helping physicians and patients choose the disease management approaches likely to work best in the context of a patient’s genetic and environmental profile. Such approaches may include genetic screening programs that more precisely diagnose diseases and their sub-types, or help physicians select the type and dose of medication best suited to a certain group of patients. Personalized medicine is an extension of traditional approaches to understanding and treating illness. Since the beginning of the study of medicine, physicians have employed evidence found through observation to make a diagnosis or to prescribe treatment. In the modern concept of personalized medicine, the tools provided to the physician are more precise, probing not just the obvious, such as a tumor on a mammogram or cells under a microscope, but the very molecular makeup of each patient. Looking at the patient on this level helps the physician get a profile of the patient’s genetic distinction, or mapping. By investigating this genetic mapping, medical professionals are then able to profile patients, and use the found information to plan a course of treatment that is much more in step with the way their body works. Genomic medicine and personalized medicine use genetic information to prevent or treat disease in adults or their children. Having a genetic map or a profile of a patient’s genetic variation can then guide the selection of drugs or treatment processes. This can minimize side effects or to create a strategy for a more successful outcome from the medical treatment. Helping the physician cover all the bases is imperative. Genetic mapping can also indicate the propensity to contract certain diseases before the patient actually shows recognizable symptoms, allowing the physician and patient to put together a plan for observation and prevention. Personalized medicine, when coupled with personal pharmacogenetics, is a unique approach that may be well suited for the health challenges we face in the new millennium. Although the medical and scientific communities, through research and discovery, got the upper hand over many of the diseases we have encountered since the advent of advanced medicine, many diseases that are more complicated. Diseases like diabetes, heart disease, cancer, and Alzheimer’s are caused by a combination of genetic and other factors. Coupled with the fact that they tend to be chronic, they place a significant burden on not only the patient, but on the healthcare system as a whole. Personalized medicine aims to provide the tools and knowledge to fight chronic diseases and treat them more effectively than ever before. Genetic profiles can help physicians to better discern subgroups of patients with various forms of cancer, in addition to other complex diseases, helping to guide doctors with accurate forms of predictive medicine and preventative medicine. With personalized medicine, the physician is intending to select the best treatment protocol or even, in many cases, avoid passing the expense and risks of unnecessary medical treatments on to the patient altogether. In addition, personalized medicine, when used correctly, aims to guide tests that detect variation in the way individual patients metabolize various pharmaceuticals. Personalized medicine is working to help determine the right dose for a patient, helping to avoid hazards based on familial history, environmental influences, and genetic variation. 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