Editor Shayne Benowitz had questions about the future of the doctor’s office. Dr. Pifer was the one to ask. Eric Pifer, M.D., and San Francisco Concierge Medicine are changing primary care by using everything from advanced diagnostics and wearable devices to integrative medicine.
What would our readers find most surprising about Sutter's Concierge Medicine physician services?
DR. PIFER: I do house calls, which I enjoy because seeing patients in their homes allows me to get to know them. We can do house calls because membership-based practices like ours are smaller, so we have more time to devote to fewer patients when compared to a typical doctor’s schedule.
As we all know, access to care can be challenging. Since we are a Sutter Pacific Medical Foundation service, we coordinate access to premier specialists and medical centers across the Sutter network for our patients.
Your team also offers a robust integrative medicine component, yes?
DR. PIFER: We offer acupuncture, nutrition services, chiropractic care and even psychotherapy as an integral part of our program. This care expands health to the emotional and mental aspects, not simply the physical.
For example, we treat anxiety and depression with more than a Western pharmaceutical approach. We can offer talk therapy to give insights into emotional responses or teach mind-body practices like meditation or breathing exercises.
How do you customize lifestyle programs for patients?
DR. PIFER: It rarely works to say to patients, ‘You should lose weight’ or ‘Get more sleep.’ Instead, we start with a conversation about their lifestyle and then use advanced diagnostics to determine possible solutions. Whether a patient has significant needs such as prediabetes, diabetes, heart disease or lipid disorder, or whether they’re generally healthy and maybe want to lose a few pounds, we can personalize a program that is comprehensive but simple and effective.
Your team includes specialists in areas from Western medicine to Eastern medicine, like acupuncture. What offerings are in the highest demand?
DR. PIFER: Most people with chronic headaches, anxiety, muscle aches and pains, fatigue, GI issues or hormonal imbalances will tell you that Western, pharmaceutical-based medicine doesn’t always help them much. By contrast, integrative medicine like acupuncture can be very effective for these difficult-to-treat conditions. We integrate traditional Western therapies—that usually involve prescription drugs—with holistic therapies like traditional Chinese medicine, osteopathy and ayurvedic medicine.
Most of our patients use the nutrition service because diet is an essential aspect of lifestyle and can help treat a wide range of issues. Other services, such as massage therapy and chiropractic care, are popular—and offered through our partnership with the Institute for Health & Healing, co-located in our Pacific Heights building.
Your team emphasizes advanced diagnostics and wearable technology. What are a few examples?
DR. PIFER: Wearable technology that enables real-time tracking is advancing to the stage of being quite useful. You can get live updates on your phone from a continuous glucose monitor (CGM) to see what happens to blood glucose soon after you eat that big slice of chocolate cake. When you combine CGM data with an online food-tracking app, the combination is powerful.
We’re also examining sleep. Sleep tracking is sophisticated nowadays and can provide vital information to support a scientific approach to lifestyle medicine. For example, our program gives patients Oura Rings primarily for sleep tracking.
There’s good science behind temperature control and blue light exposure as they relate to sleep quality. We hope biofeedback approaches that reduce stress will also help. And fitness or activity tracking is excellent. Get your steps in; it matters for health—including sleep.
What elements do you find exciting in the years ahead?
DR. PIFER: Newer, more sophisticated electronic systems, including AI, can make doctors more efficient at diagnosis and treatment. But instead of reducing the consultation length from seven minutes to four, we need to use them to create a new kind of generalist physician for the modern age. In my vision, primary care physicians will use these astounding new AI tools to stay current on the ever-changing medical literature.
How does your program view membership plans and integrating concierge services into people’s lives?
DR. PIFER: To be fully available to our patients and offer a 24/7 round-the-clock connection, we have a membership fee, which keeps the practice small enough to provide this very high level of access.
What sets us apart is our focus on integrative medicine, lifestyle medicine and being a part of Sutter Health. We are connected to patients hospitalized at California Pacific Medical Center (CPMC), and we have a close connection with both the Sutter and UCSF specialist network. I have so much respect for my physician colleagues at Sutter, and my goal is to help revitalize what it means to be a generalist physician with a high-tech and high-touch approach.
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