While U.S. troops were fighting in World War I during the summer of 1918, President Woodrow Wilson underwent treatment for a breathing problem in a hushed episode that foreshadowed worse health troubles.

"The patient is progressing most satisfactorily, so far, and I have good reasons to hope for a most beneficial result," White House physician Cary T. Grayson later wrote to his wife. "It is one secret that has been kept quiet, so far, and I think it is safe."

Wilson had the best care available-and the most discreet. Fast-forward almost 100 years and the commander-in-chief still has a team of doctors at the ready that can diagnose and treat him on the fly, both literally and figuratively.

These days, however, you don't have to win a national election to receive a similar level of care.

Founded in 2007 by Dr. Sean O'Mara, a former White House physician under several administrations, and his brother Brian, Charlottesville, Va.-based Guardian 24/7 is a medical concierge boutique for ultra-high-net-worth clients that has privatized what it describes as "presidential medicine."

Guardian 24/7 doesn't have its own Air Force One, and because it focuses on remote care, it can't duplicate the hands-on care delivered in the White House, but it is similar to the president's medical care in some respects. The firm's staff of doctors, for example, is made up of four former White House physicians who have access to remote technologies that give them the ability to monitor, diagnose and treat a patient in minutes. The firm uses technologies-so-called "telemedicine"-that allow doctors to examine and treat patients who may be thousands of miles away.

Guardian 24/7 physicians say they strive to provide their clients with a similar level of service, and privacy, that was the normal protocol at the White House.

"I used to enter the White House right from Pennsylvania Avenue," explains Dr. Robert Darling, who kept members of the Clinton Administration healthy during Clinton's second term, from 1996 to 2000. "That awesome feeling and being in constant awe has never left me. So we all share the highest level of dedication, service and extreme discretion."

Many of Guardian's patients-they have about 36-have a "ready room" in their homes that is outfitted with gadgetry that sounds like the stuff of science fiction novels. One unit has the look and tamper-proof armor of an ATM machine. That's because it contains up to 200 prescription medications that are dispensed, remotely, by Guardian doctors. The rooms also include a video teleconferencing unit that can zoom in to eyelash level, an EKG monitor and a portable X-ray machine.

On its Web site, Guardian notes that the ready room can "close the gap" between the time a medical emergency strikes, and when a first response team arrives at a client's home-giving the service life-saving capability.

"We make sure a layperson can operate the EKG system, with the help of a spouse or by himself or herself-but we have a certified X-ray technician come to the house," explains CEO Jonathan Frye, who, while new to the company, knows a bit about high-end service. He owned and operated the Lindquist Group, the nation's largest and oldest domestic staffing firm, with clients that make up 10% of the Forbes 400. 

To ensure that clients get focused care, Guardian 24/7 doctors each are assigned a limited number of patients. This allows doctors to spend more time with appointments, which patients can schedule on short notice.

"We go far beyond concierge medicine," says Darling.

Guardian 24/7 feels the technology it uses gives it an edge over its competition.

"We differ from concierge medicine in a few key areas, all dealing with remote care," O'Mara says. "We have the equipment to remotely diagnose, monitor and treat in addition to having the ability to prescribe and deliver medications on demand and have a physician virtually there."

With Guardian, after an initial in-person office visit, the service model is built around long-distance medical care, diagnosis and treatment with convenience as the primary selling point, according to officials with the firm.

"We can do away with many office visits or visits to the emergency room by virtually bringing the physician into the room to diagnose and treat the client in their home," O'Mara says.

In cases where conditions or emergencies fall outside the scope of the virtual ready room, "their own doctor outside of the relationship with us kicks in," he says. "We believe somewhere around 50% of the visits to the ER or physician's office can be handled in the client's ready room."

Privacy and convenience are the prime selling points of the company's services.

"We have a 93-year-old man in Washington State who has a history of congestive heart issues," explains O'Mara. "By way of our ability to monitor this man via the VTC, we were able to actually inform him before he felt ill that his oxygen level was dangerously low. A tech was immediately dispatched to his home and the situation was resolved quickly and conveniently for the patient."

Since not every medical situation can be taken care of remotely, Guardian does have services that support on-site response to immediate emergencies. The firm, for example, can outfit a vehicle at the client's home that can be used to transport clients to medical facilities.

"You have no wait time for the ambulance to arrive," O'Mara says. The firm also has relationships with local contractors who can drive and staff the vehicle, and are given detailed instructions on how to get to the client's home, to avoid delays, he says. The firm also has relationships that provide medical airlifting services in extreme emergencies.

The firm also provides a service that essentially installs a medical ready room on a client's private jet plane or yacht.
"We provide medical solutions that range from $50,000 in medical equipment up to about $300,000," Darling says.

"Basically we provide the same best-of- breed emergency medical solutions that we offer in a client's home, but in this case designed for the limited space of a jet."

Guardian 24/7's baseline service offering costs $25,000 annually for a single person or $50,000 for a family of four. This gives clients immediate access to the firm's physicians 24 hours a day, seven days a week, via telephone. It also allows for a comprehensive offering of consultation services, including planning for medical needs during overseas trips, a database of top specialists and customized personal medical kits.

The ready room is an added service. It can cost up to $1 million to equip the ready room, according to Guardian. The clients own the equipment, which is maintained by Guardian.

Despite a sagging economy, many ultra-high-net-worth families are kicking the tires and considering this type of coverage. "I would say interest has spiked a bit in response to the idea of major government intervention into health care," Frye explains.
With little advertising, Guardian 24/7 relies on word-of-mouth referrals to grow its business. "There are a number of different sources connecting us with clients. We have White House staffers suggesting us, since they are obviously aware of the level of service required to work in such an environment," Frye says. "But we are most often contacted by single and multifamily offices where advisors to ultra-high-net-worth families find us in their research process. We also have many concierge doctors refer clients to us."

All of Guardian's doctors are currently former White House physicians, but as the firm grows, it is prepared for the day when it will utilize doctors who have not served presidents. "Yes, there exists a finite number of doctors with this type of experience," Frye says. "But when we get to that bridge, our new staff will be vetted and will be required to practice at the same level of excellence."

Guardian's current clientele cuts across a number of demographics, according to Frye. Clients include those nearing retirement age, people between 55 and 60 who want to improve their level of medical care as they age, he says. The majority of clients, however, start their relationships with Guardian while healthy, he says.

The firm, Frye notes, is not designed to provide the full scope of care required by those with serious chronic illnesses.

"We do not perform surgery and we do not treat for cancer," he says. "We do take care of almost exclusively healthy patients, but do have a few people with chronic or even terminal illnesses. Most people do invoke our services in case of a dire medical emergency, but those who renew say it's the convenience that hooks them."