The Value of Wisdom and Presence
In a productized and disconnected age
On Friday afternoon, I spoke with Phil, an ER doctor transitioning into concierge medicine.
A friend connected us because Phil is struggling with a challenge many professionals face: communicating the value of his presence and wisdom in a product-driven world.
Phil’s move into concierge medicine is part of a growing industry where patients pay an annual or monthly fee for personalized care. Unlike traditional practices, concierge doctors prioritize time, attention, and holistic well-being.
Instead of rushing through 20–30 patients a day, they see only 6–10, dedicating 30–45 minutes per visit. They don’t just treat illness; they foster long-term health and build real relationships with their patients.
Despite this, Phil is grappling with ‘sales.’
His clients will pay $7,500 a year for access to him, but he worries that he might not be offering enough. He’s considering adding a suite of products and tests to justify the price.
I told him no.
The value isn’t in the products or services he could provide—it’s in him.
His presence, wisdom, and ability to deeply listen are what set him apart. These qualities are incredibly rare, not just in medicine but across all industries.
The Scarcity of Presence and Wisdom
In most healthcare systems, time and attention are luxuries.
My cousin, a GP in Dublin, dreads hearing a patient say, “Now while I have you…” She doesn’t have time for extra concerns. She’s on a relentless schedule, seeing a patient every ten minutes.
She once joked about advising someone on their diabetes medication while eyeing a Snickers bar in her desk drawer—a desperate snack between patients. The irony isn’t lost on her.
This pressure isn’t just hard on patients; it’s exhausting for physicians, too.
Last summer, during a workshop with renowned psychiatrist and trauma researcher Bessel van der Kolk, I met nurses and doctors who were burnt out from their hospital work. They wanted to practice medicine differently—more expansively and meaningfully—but felt trapped by the current system.
Why Is Phil Struggling?
Phil’s difficulty in communicating his value stems from a deep conditioning within the medical field. Healthcare systems often evaluate ER doctors based on metrics like "relative value units" (RVUs). These tie a doctor’s compensation to the volume and complexity of procedures performed, reinforcing a mindset where value is linked to transactions: “I must deliver a product or service to justify my worth.”
This conditioning does two harmful things:
It reduces a physician’s self-perception to that of a provider of products, not a steward of healing.
It prioritizes offering solutions over deeply observing what the patient truly needs.
When your worth is tied to transactions, it becomes almost impossible to recognize the immeasurable value of presence and wisdom—the very things patients crave and are willing to pay for.
A Lesson from Other Industries
This challenge isn’t unique to medicine. I have two friends, E and J, who help business owners optimize operations for more time, profit, and fulfillment. Their approaches couldn’t be more different.
E is product-focused. He specializes in using Notion to streamline company operations, doing much of the work for his clients and teaching them to use his system.
J is wisdom-focused. He helps his clients rethink systems and processes altogether, coaching them to delegate effectively so their businesses can run independently. He’s platform-agnostic, empowering them to choose the tools that work for them.
E earns around $150,000 per year and works tirelessly.
J earns over $2 million annually and takes a six-week vacation every year. Why? Because J’s value isn’t tied to a product; it’s rooted in his presence and wisdom. He teaches his clients how to think, enabling them to grow beyond the immediate solution.
The Compression of Value
Productizing your work compresses its true value. It reduces something expansive and transformative into something transactional. By contrast, offering your presence and wisdom empowers others to expand.
Phil doesn’t need to add products or tests to justify his fee. He needs to embrace the rarity of what he’s offering: time, attention, and care. These are not commodities; they’re the foundation of meaningful relationships and transformative health.
In a productized and disconnected age, the most valuable thing you can offer isn’t something you can measure or package. It’s the unique combination of your wisdom and your presence—and that’s worth far more than any product could ever be.
Brilliant insights and wonderfully written. I have had a concierge doctor for quite a few years and I now consider that to be the most necessary item in my discretionary spending list.
“Wisdom and presence” - essential elements of all worthwhile belief systems, as well as good business practices.
Thank you Patrick! I’m repeating “wisdom and presence’ over and over. Thank you for refocusing my attention back to my true value