How Concierge Medicine is transforming healthcare in Czechia and around the world

The concierge medicine concept (also known as boutique medicine or direct primary care) may sound like the domain of the rich and famous. But for patients and doctors alike, it represents an important new frontier in healthcare, one that’s focused on personalized, “patient-centered” care.

In May 2021, Concierge Medicine Europe opened in Prague’s Pankrác district, representing one of the continent’s first Medical Centers of Excellence for Prevention and Lifestyle Medicine. The clinic, based in Parkview, an innovative green building concept designed by New York-based architects Richard Meier & Partners, is currently accepting patients who want to take a more proactive approach to their personal health.

So what exactly is concierge medicine and how is it filling a void where traditional models of doctor-patient care are failing? We spoke with Dr. Jana Yanova, Co-Founder and Medical Director at Concierge Medicine Europe to find out.

This interview has been edited for clarity and length.

You spent part of your career in Hong Kong. What lessons did you learn during your time there?

I started out in Taiwan where I became a general practitioner and then we moved to Hong Kong where I taught at the Department of Family Medicine of the University of Hong Kong and studied Public Health as part of the U.K. Faculty of Public Health Membership program. That’s when I developed an interest in the overall health of populations and the effect of lifestyle factors on health. I came to see how evidence-based medicine and disease prevention connect family medicine and public health, as two sides of one big circle.

How did that professional awakening lead you to concierge medicine?

My experiences outside of the Czech Republic taught me that when you have time for the patient you can prevent a lot of issues and diagnose early. It taught me that prevention is better than treatment. It’s about going upstream to prevent people from falling into the river of sickness, rather than rescuing them while they’re drowning under the waterfall. Concierge medicine allows doctors to provide personal, enhanced care, including a principal commitment to limiting patient loads to ensure adequate time and availability for each patient.

I think people hear ‘concierge medicine’ and picture oligarchs and CEOs but that’s a misconception, right?

We are here for anybody who wants to invest in their own health, not just for the executive types. Our patients are foreigners and Czechs alike, families and individuals who want to be more involved in their own health care. Our concept is rather about providing highly individualized continuity of care. We put a lot of emphasis on lifestyle and I think that is our big differentiating point. We have a great team of general practitioners, pediatricians, and specialists, as well as a lifestyle support team that includes a lifestyle coach, nutritionists, and trainers.

I think an even bigger misconception is that some companies claim they provide “concierge medicine,” but merely organize patient specialist examinations in various facilities. There is no holistic approach.

But there is a level of convenience built into Concierge Medicine’s services?

Yes, our clinic is very user-friendly. We’ll do all the planning of yearly checkups and scheduling of specialist visits for you. We work with first-class specialists, many of whom have also experience working overseas. We work together with the patient to provide one-stop comprehensive care at our modern and welcoming clinic in Parkview.

How does concierge medicine as a concept differ from other subscription-based healthcare providers in the Czech Republic?

Many subscription-based healthcare providers end up signing up too many patients. Personal healthcare is then compromised. We limit the number of patients per doctor to a maximum of 650 with the promise of same or next-day appointments for general practitioners or pediatricians for acute problems.

You also differ in your focus on prevention as a Lifestyle Medicine Center. Is this approach to patient care a fairly new idea in the Czech Republic?

Lifestyle medicine is an evidence-based approach in which comprehensive lifestyle changes (including nutrition, physical activity, stress management, social support, and environmental exposure) are used to prevent, treat and reverse the progression of chronic diseases by addressing their underlying causes.

The idea that lifestyle medicine espouses, that we need to go up the stream to prevent these conditions from developing in the first place, isn’t new but isn’t commonplace. 

Multiple studies conducted by US researchers have shown that five low-risk lifestyle-related factors – never smoking, healthy weight, regular physical activity, healthy diet, and moderate alcohol consumption – could prolong life expectancy at age 50 by 14 and 12 years for female and male adults respectively, compared with individuals who adopted zero low-risk lifestyle factors.

Are there other ways that traditional models of healthcare both here in the Czech Republic and worldwide are failing patients?

This would involve a lengthy discussion, but basically, the medical systems are overloaded, impersonal, with constantly shrinking times for consultations – patients are instead passed off to specialists. Too much focus is put on treatment rather than prevention. It is frustrating both for patients and doctors.

I have a colleague in the UK, for instance, and doctors there have 10-minute slots for consultation. You come to the doctor with a problem and they just try to solve this problem – they are well trained and have a great education, but just don’t have time to do more.

Having practiced as a primary care physician in a typical Czech clinic for some years, it was the same for me: a dilemma between letting the patients wait too long or taking too short a time for the consultation. It’s a no-win situation. I think it could also be said that continuity of care isn’t built into the Czech public healthcare system.

That continuity of care is something that is difficult for foreigners in the Czech Republic to maintain since a lot of us change doctors or move around.

Exactly, the downfall when you don’t see the same doctor is things can be overlooked, especially if a doctor is rushed. Taking a proper medical history is so important.

In the short time we’ve been open we have had a few serious diagnoses among our patients and were able to provide treatment very quickly.

One of our patients came for a preventive check-up only with some tiredness after having Covid. We did a detailed examination and identified a serious heart problem and the patient had a life-saving operation within a few weeks from his first examination.

Has Covid increased the popularity of patient-centered practices like Concierge Medicine Europe?

Covid has shown everybody how important is to take care of our health. We have seen how people with risk factors such as diabetes, high blood pressure, obesity, had a much higher risk for a serious course of the disease.

That said, are there certain patients, chronic illness sufferers for instance, who benefit more from lifestyle medicine? Where is the value if you are relatively healthy and just need a yearly check-up?

Both types of patients can benefit from our care. Patients with chronic conditions will benefit from regular expert care and our lifestyle support team, while patients without health problems will benefit through a preventive lifestyle approach in the long term. 

Even “healthy” patients can benefit from preventative healthcare and better lifestyle habits. We like to say that we help our patients add life to their years, not just years to their life.

Our clinic can not only help you to evaluate your health status, identify the issues to tackle but also help with our team of nutrition specialists, lifestyle specialists, and exercise coaches to achieve the goals you set.

Is it worthwhile to invest in your health?

For those who question the affordability of subscription-based healthcare, I'd say that prevention is always cheaper than treatment, in the long run, be it in monetary or any other aspect of it and be it on the personal or societal level.

This is where the lifestyle medicine approach comes in and this is why many of us doctors are so excited to be part of our clinic.

How is working in Concierge Medicine Europe more satisfying for you on a professional level?

Being a personal doctor is very satisfying for me and beneficial for the patient. Knowing your patients well saves a lot of possible complications. When my patients come to me for help, they don’t have to start by telling me their medical history all over again, we can solve the problem straight away. As a team of doctors and other medical professionals, we also cooperate and discuss individual patients to find the best approach and treatment. We work as a team with patients and colleagues and that is a great experience.