As we approach the October opening of the health insurance exchanges mandated by the Affordable Health Care Act, we've been hearing lots of news stories about health insurance. Along with the increase in stories about health insurance, I've been hearing more and more stories about doctors and patients who boycott medical insurance altogether. Instead, patients pay a retainer fee out of their own pocket, in return for which their doctors provide annual checkups, vaccinations, treatment of illnesses, and sometimes even house calls. According to a recent Boston Globe article, these practices go by the name retainer practices and direct primary care. Boutique medicine is another term for it that I've seen.

But the name that seems to be overtaking all of these alternatives is concierge medicine. These days there are concierge practices consisting of concierge doctors, concierge physicians, or maybe concierge dentists, all offering their versions of concierge healthcare. How did the word for the guy in the hotel lobby who can get you show tickets, a restaurant reservation, or almost anything else you need, come to refer to this kind of ultra-personalized medical care?

Actually, the hotel meaning isn't the earliest one. As perhaps you've guessed by the "zh" sound, concierge comes from French. In fact, it goes back to Old French, and originally referred to a doorman or caretaker, or if you want to sound mystical, a keymaster. Earlier than that, its origin is unknown. The Oxford English Dictionary's earliest English attestation is from 1648.

The hotel-related meaning came late, apparently only in the latter half of the twentieth century. The earliest attestation I've found (via Google Books) is a 1955 Travel Guide to Europe, but even this first attestation shows that the meaning has come to be less about taking care of a building than taking care of the people who inhabit it:

Lobby plus cozy bar; escalators to whisk you to the reception desk; fairly large restaurant; all units with radio, telephone, and balcony; spotless maintenance; concierge service ...

Despite this mid-century example, it wasn't until the 1980s that the word caught on widely. Newspaper and magazine articles throughout the decade went about introducing the word concierge to readers unfamiliar with the word; for example, a 1987 piece in the Fort Lauderdale Sun Sentinel defines it like this:

In hotel parlance, he's known as a concierge, a nice French word that sounds as rich and buttery as a fresh-baked croissant. [This concierge], however, prefers "superintendent of service," a more down-to-earth description of what he did before hiring on with a limo service last month.…

Regardless of the title, the job looks the same to an outsider. A concierge books reservations, points out tourist attractions, recommends restaurants and tends to a guest's every need. In short, he serves. He's a detail man, eliminating the bumps that might jar an otherwise smooth vacation or business trip….

The article also gives a brief history of the development of concierge services:

At luxury hotels, concierge-type services have existed in form if not in name for decades. Now, in newer hotels, even a step or two below the luxury level, the concierge desk — planted in the middle of the lobby so guests can find it — is popping up as a new feature.

But even as the idea of a hotel concierge was spreading during the Me Decade, it was already escaping the confines of hotel lobbies. In 1980, a Boston Globe article reported that the Pittsburgh Hyatt had invented a concierge floor, which modern hotel guests will recognize as that one floor that the elevator won't take you to unless you insert your special VIP card into the slot by the button. Mid-decade, the concept of the concierge broke free of hotels entirely, as office concierges made their appearance. In 1986, a company calling itself The Executive Concierge liberated concierges entirely from buildings. As a 1987 article described it, the company:

will do just about anything to help those who don't have the time to help themselves. The company's services range from basic personal chores such as grocery shopping, gift shopping, and housecleaning to organizing events of all sizes, including wedding receptions.

In the decades since then, similar concierge firms and concierge businesses have sprung up, and not just for rich people, at least according to their publicity materials. A 2005 USA Today article (found in the Corpus of Contemporary American English) quotes the president of the National Concierge Association as saying, "The popularity of concierge services has grown from the image of a privilege for the wealthy to the everyday needs of moms and dads in the workplace."

So with the idea of a caretaker in a specific location lost, and only the idea of personalized service remaining, concierge has spread during the 1990s and 2000s to refer even to services provided remotely — but by actual people — to perform tasks such as provide assistance via your onboard car navigation system or advantage of your credit card's cashback rewards.

The development of concierge medicine seems to have begun in 1996, with the founding of MD2 by Howard Maron, MD. In light of all the earlier developments in the concept of concierge, its use to refer to this kind of personalized, members-only medical practices isn't surprising at all.

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Neal Whitman blogs at Literal-Minded, where he writes about linguistics in everyday life from the point of view of a husband and father. He taught English as a second language while earning his degree at Ohio State University; has published articles in Language, Journal of Linguistics, and other publications; and writes occasional scripts for the podcast "Grammar Girl's Quick and Dirty Tips for Better Writing." Click here to read more articles by Neal Whitman.