Working physician notes on longevity medicine, executive health, hormone optimization, and how to think about modern primary care. Written by Nishant Sahni, MD — board-certified internist and former Mayo Clinic faculty.
2026-05-15 · Cancer Screening
Galleri and the new class of multi-cancer early detection blood tests claim to find 50+ cancer types from a single blood draw. The technology is real; the published data is more nuanced than the marketing suggests. A working physician's review of the CCGA, PATHFINDER, and NHS-Galleri evidence, the false-positive math, who benefits most, and how to integrate MCED with standard cancer screening.
2026-05-15 · Men's Health
Testosterone replacement therapy works when it's indicated. It's also one of the most over-prescribed and under-monitored treatments in adult medicine. A walk-through of Endocrine Society diagnostic criteria, what a proper pre-TRT workup includes, what monitoring is actually required, what the TRAVERSE trial showed about cardiovascular safety, the fertility conversation, and how to evaluate the difference between real oversight and mailed-vial telehealth.
2026-05-15 · Patient Experience
Patient satisfaction scores in direct primary care and concierge practices run substantially higher than insurance-based primary care — typically 90+% satisfaction vs. 60-70% national average. The gap has structural explanations and one honest caveat (selection bias) worth naming up front. Published data from CAHPS, J.D. Power, MDVIP, AAFP and the DPC Coalition.
2026-05-15 · Healthcare Structure
The short visit isn't your doctor's choice — it's a structural consequence of how insurance pays for primary care. A walk-through of the payment math, the prior-authorization burden (43 requests per physician per week per the AMA), the polypharmacy problem in older adults, what insurance actually is good at, and what direct primary care changes about the structure.
2026-05-15 · Executive Health
Legacy executive health programs (Mayo, Cleveland Clinic, EHE, Princeton, Sollis) publish pricing in the $10,000–$25,000 range for comprehensive evaluations delivered as one- or two-day events. A modern alternative: the same workup distributed across the year you actually live, paced by you and your labs, coordinated by your physician and your longevity advisor. Included with Concierge Internal Medicine membership.
2026-05-15 · Longevity Labs
Function Health, InsideTracker, and Quest Direct all offer comprehensive consumer lab panels for $339-$499. We test 15 markers, included with membership. Here's a working physician's breakdown of how the different models compare, what's actually in a 100+ biomarker panel, and how to pick the model that fits your situation.
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