Quaternary Plus Care Model, Communications, Emergencies, and Admissions

Dr. Boles has several other vocational responsibilities beyond patient care, including consulting for physicians, laboratories, and attorneys, and lecturing to medical/graduate students, physicians, and patient organizations. Patients seen by Dr. Boles are expected to have a primary care physician, and in most cases additional specialists, to follow the patient throughout the year. Dr. Boles’ practice is predominately quaternary care, meaning that the intent is to advise the various specialists, as well as the primary care physician, caring for you/your child. Follow-up visits generally are scheduled semi-annually or annually (often dependent on how far away you live and your ability to travel), but in some cases other schedules are appropriate. In addition, you also may chose to have an initial evaluation with Dr. Boles but to seek follow-up elsewhere.


Patients in this practice are generally complicated and issues may develop in between office visits. Email is the primary form of communication, both with the family and with other providers as needed. On occasion, other forms of communication may be appropriate. The office consultation note will be delivered by email to the patient/family, and any other providers as desired by the family, generally in the same week as the office visit. By joining and continuing to be followed in this practice, you are consenting to email communications. Email is not checked 24/7/365, so urgent and emergent requests should not be handed by email.


Dr. Boles tries to be available to his patients, but provides no urgent care or emergency services. For true emergencies, call 911. Urgent/emergent services are to be handled through the primary care and/or specialists following the patient, and/or the emergency room. In particular, Dr. Boles travels frequently to deliver lectures, and is not always available.


Dr. Boles does not have privileges at any hospital, and his patients live throughout the USA and occasionally abroad. He cannot admit or consult on any patient within any hospital. However, in important cases, his families/patients are encourage to ask the treating physician to contact Dr. Boles by email or cell phone, to discuss the case. While management is legally the responsibility of the treating physician, a conversation with Dr. Boles often results in the treating physician making changes in management based on a wider understanding of the disease process.




Dr. Boles’ son Henry and daughter Caroline at Halloween 2015