Built around the appointment, not the prescription.

Our medical director spent fifteen years in academic urology before starting this practice. The thing that finally prompted it was not a grand idea about men’s health. It was the repetitive experience of meeting men in a hospital clinic who had been carrying erectile dysfunction for five or ten years, had been given a starting-dose prescription somewhere along the way, and had concluded from its failure that nothing could be done.

In a large proportion of those cases something could plainly be done, and often something quite simple. The dose had never been escalated. The sleep apnea had never been diagnosed. The testosterone had never been measured before ten in the morning. The beta blocker had never been reconsidered. Each of these takes time to find and none of them fit inside a standard appointment slot.

So the clinic was built around the appointment. Ninety minutes, because that is how long the assessment honestly takes. Out of network, because being paid per visit is what compresses appointments in the first place. One condition, because specialising is what allows a physician to recognise the pattern in the fourth minute rather than the fortieth.

Nothing here is a novel idea. It is ordinary medicine, given enough time to be done properly.