Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

This featured recipe is a Spinach and Artichoke Dip. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Spinach-Artichoke Dip

Adapted from: Food Network, Houstons
Prep time: 25 minutes
Total time: 30 minutes

Ingredients:

2 (10 oz) bag spinach, destemmed
1 tbsp butter
2 tbsp onion, minced
2 cloves garlic, minced
3 TB all purpose flour
1 ¼ cups milk
½ tsp lemon juice
1 tsp worcestershire sauce
1 ¼ cups parmesan cheese, grated
¼ cup sour cream, plus more for serving
½ cup white sharp cheddar cheese, shredded
½ cup artichoke hearts, squeezed dry and roughly chopped
Salt
Tortilla chips for serving

Instructions:

1) Bring a large pot of salted water to a boil. Stiri in the spinach and cook until bright green, about 30 seconds. Drain and rinse under cold water; squeeze out the excess moisture, then finely chop.
2) Melt the butter in a large saucepan over medium heat. Add the onion, garlic and ½ tsp salt and cook until the onion is soft, about 2 minutes.
3) Add the flour and cook, stirring, until lightly toasted, about 1 minute.
4) Whisk in the milk and cook, whisking constantly, until thickened, about 1 minute. Remove from the heat. Stir in the lemon juice, worcestershire sauce, parmesan and sour cream.
5) Return the pot to medium heat. Add the spinach, cheddar and artichokes and stir until the cheese melts and dip is heated through. 
6) Serve with tortilla chips, salsa, and sour cream.

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

This featured recipe is Orange Cranberry Scone with Orange Glaze. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Orange Cranberry Scone with Orange Glaze

Adapted from: Just a Taste
Prep Time: 15 minutes
Total Time: 1 hr 

Ingredients For Scones:

2 ½ cups all-purpose flour
2 ⅓ teaspoons baking powder
¼ teaspoon baking soda
Pinch of ground nutmeg
½ teaspoon salt
1 cup frozen cranberries
6 tablespoons cold unsalted butter, cubed
¾ cup greek yogurt, plus more for topping
2 large eggs
2 teaspoons vanilla extract
2 tablespoons orange juice
1 tablespoon orange zest

Ingredients For Glaze

1 cup confectioners’ sugar, sifted
1 ½ teaspoons unsalted butter, melted
1 tablespoon greek yogurt
2 ½ teaspoons orange juice
2 teaspoons orange zest

Instructions:

1) Preheat oven to 400 F. Line a baking sheet with parchment paper.
2) In a medium bowl, whisk together all of the dry ingredients of the scones.
3) Grate butter into flour mixture on the large holes of a box grater; use your fingers to work in the butter until mixture resembles coarse meal.
4) Add the cranberries to the flour mixture.
5) In a separate medium bowl, whisk together the yogurt, eggs, vanilla, orange juice and orange zest.
6) Using a fork, stir yogurt mixture into flour mixture until large dough clumps form. Use your hands to press the dough against the bowl into a ball. The dough will be crumbly at first, but as you press, the dough will come together.
7) Place on a lightly floured surface and pat into a 7-inch circle about ¾-inch thick. Use a pizza cutter to cut into 8 triangles; place on prepared baking sheet, about 2 inches apart. 
8) Bake until golden, about 15-20 minutes. Cool for 10 minutes and prepare the glaze.
9) In a medium bowl, prepare the glaze by mixing together all of the glaze ingredients. Whisk until smooth. If glaze is too thick, thin it with extra orange juice. Drizzle over the warm scones and enjoy.

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

Erectile Dysfunction

In this post I am discussing a common condition that I see at my clinic: erectile dysfunction. Let me repeat that last part- a common condition. If you suffer from erectile dysfunction, you are not alone. Those two words can make any man nervous. It affects all men but becomes increasingly prevalent as we age. At least 12 million U.S. men between 40 to 79 years of age have it, but can occur at any age. Older individuals are more likely to experience health conditions that require medication, which can cause or even worsen ED. It is a very emotional and sensitive topic to discuss.

Anatomy & Physiology

The penis consists of two parallel cylinder-shaped tissues called the corpora cavernosa that run the length of the penis, a hollow tube called the urethra that is responsible for expelling urine and ejaculate, erectile tissue surrounding this tube, and various arteries and veins. The process of erection involves increased blood flow and pressure to the penis, and those cylinder-shaped tissues mentioned above become engorged and expand- thus an erection. Erectile dysfunction (ED) occurs when those tissues fail to become engorged or the penis fails to maintain rigidity and resumes a normal shape.

Essential Components for Function

How ED is affecting one male may not be the reason for you. Your doctor will help to differentiate which components are affecting you and this is important in differentiating treatment options.

• Your interest and desire for sexual activity (libido)
• Ability to obtain and maintain an erection
• Ejaculation (orgasm)
  

Select Causes of ED

Male sexual arousal is a complex subject. Discussing in broad terms, ED can generally be separated into two categories: physical and mental health. Many instances of ED may involve causes from both categories.

Physical Causes

• Medications: Take a look at your existing medications. Several medications may lead to ED. As example, anti-depressants like SSRIs (citalopram, fluoxetine paroxetine, sertraline) used to treat mental health concerns and Beta-blockers (metoprolol, carvidilol, labetalol)  used to treat blood pressure can cause ED. Review all your medications with your doctor.
• Smoking: Compared with men who have never smoked, the risk of ED is increased by 51% in current smokers and 20% in ex-smokers. Ask your doctor for help in quitting.
• Diabetes: If you’ve ruled out other causes, there’s a chance your ED is due to diabetes. Patients with diabetes are three times more likely to develop ED. Review your risk for diabetes or work with your doctor to bring your sugars under control.
• Low Testosterone: Also called hypogonadism, is a condition that generally occurs to all men as they age. By age 80, 50% of men will have testosterone levels in the low range, however the decline is faster in some men than others. Testosterone levels can affect  a man’s overall health including sex drive and sexual function.
  

Mental Health Causes

• Sexual Performance Anxiety: This happens when a man anticipates a problem during the sexual encounter and, as a result becomes anxious while attempting to have sex. Doubt and insecurities may take over your thoughts: “Will I get hard enough?” “Will I maintain an erection?” “How do I compare?” “What if I can’t finish?” These pervasive questions can ruin any performance. Talk to your doctor because once people understand the mental that cause anxiety and how to reduce or eliminate them
  

Treatment

• Exercise and Nutrition: A change in eating and drinking habits can potentially reverse the contributing causes.
• Therapy: Seeing and talking to an accredited sex therapist can lead to an overall happier sex life for men and their partners.
• Medications: The availability of oral medications such as Viagra, Levitra, and Cialis, make it much easier to treat erectile dysfunction. However, medications should be part of a more comprehensive long-term plan. At Beyond Primary Care, we wholesale generic Viagra 100 mg, 10 pills to our patients for $4.20.
• Testosterone Replacement Therapy: For men experiencing sexual frustration and have low testosterone, testosterone replacement therapy is a safe and effective way to return T-levels to the normal range.

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

Greek Lemon Chicken Soup

This featured recipe is Greek Lemon Chicken Soup. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Prep Time: 25 minutes
Total Time: 45 minutes
Adapted from: Food Network

Ingredients:

3 tbsp olive oil
3 carrots, chopped
1 onion, chopped
1 cup farro
4 cups chicken broth
3 cups water
Zest of x2 lemons
Juice of x2 lemons
1 cup rotisserie chicken, shredded
3 large eggs
1 cup crumbled feta cheese
1 tbsp chopped dill
biscuits (or any bread on-hand or easily obtained)
Salt and pepper to taste

Instructions:

1) Preheat oven to 350F.
2) Heat the olive oil in a large pot over medium-high heat. Add the carrots, onion, ½ tsp salt and a few grinds of pepper. Cook, stirring occasionally, until the vegetables soften.
3) Add the farro and cook, stirring, until toasted, 1 minute. Add the chicken broth and water; cover and bring to a boil.
4) One boiling, add the lemon zest, reduce to simmer, uncovered, until the farro is almost tender, about 15 minutes. Stir in the chicken.
5) Whisk the eggs and lemon juice in a bowl; drizzle ½ cup of the hot broth into the eggs, whisking constantly. Gradually stir the hot egg mixture into the pot. Cook over medium-low heat, stirring constantly, until thickened, about 3 minutes. Season with ¼ tsp salt.
6) Combine the feta and dill in a small bowl; season with salt and pepper. Fill the biscuit halves with the feta mixture and lightly brush with olive oil.
7) Transfer to a baking sheet and bake until cheese melts, 2-3 minutes.
8) Top each serving of soup with dill, season with pepper. Serve with stuffed biscuits.

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

This featured recipe is Pesto topped Scrambled Eggs with Bacon. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Pesto Topped Scrambled Eggs with Bacon

Adapted from: Spoon Fork Bacon
Prep Time: 20 minutes
Total Time: 45 minutes
Serves: 4

Ingredients:

3 garlic cloves, whole
3 tablespoons walnuts
1 ½ cups basil leaves
⅓ cup olive oil, divided
3 oz parmesan cheese, grated
Salt and pepper to taste
8 eggs
3 oz whole milk
2 tbsp butter
8 strips bacon
1 large french baguette

Instructions:

1) Turn oven to 400 F.
2) Spray a cookie sheet with a non-stick spray, place over a cooking tray. Lay bacon strips on top, bake bacon for approx 20-25 minutes.
3) While bacon is cooking, prepare pesto sauce. Place garlic and walnuts into a food processor and pulse until small pieces. Add basil and 2 tablespoons oil and pure and roughly chopped. Add remaining oil into the food processor. Season with salt and pepper. Add in parmesan. Set aside.
4) Slice the baguette lengthwise. Once bacon is done cooking place on top of the cookie tray (not in bacon juice) face up and lightly toast.
5) Using a non-stick saute pan over low-medium heat, melt butter.
6) Crack eggs and cream into a mixing bowl and whisk.
7) Place the egg mixture into skillet, using a wooden spoon to stir eggs until they break up. Once eggs set, remove from heat.
8) Butter baguette slices if wanted, tehn top each with crispy bacon, divide the eggs evenly over the baguettes, and drizzle with prepared pesto. This can be served immediately or allowed to cool and placed in the refrigerator wrapped in wax paper until needed.

Hi, thank you for coming back for the latest edition of Beyond Primary Cares blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care is a Direct Care clinic serving patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

In this post I am answering a common question that I receive, and that is how does Beyond Primary Care (DPC) keep laboratory costs low for it’s members? Offering low bill rates for labs is a key feature of virtually all Direct Primary Care (DPC) practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic phlebotomy and can provide numerous laboratory studies to their patients at a tenth of the costs that many hospitals and fee-for-service providers can provide.

How DPC Practices Keep Laboratory Costs Low

To start DPC practices typically do their own phlebotomy (that is the collection of blood from your veins) and rarely bill for these services. This starts the savings before a single drop of blood is collected. DPC practices then contract with laboratory diagnostic companies, many times the same companies that service smaller hospitals or fee-for-service clinics. My clinic, Beyond Primary Care, uses a few laboratory diagnostic companies, Quest Diagnostics, True Health, and Aurora Diagnostics. 

Prior to drawing any labs for our patients, DPC practices negotiate what we call ‘client bill rates’ with these diagnostic companies. A client bill rates is basically saying, what is the lowest cash price for a particular laboratory study you can offer to my clinic’s patients? Compare this to smaller hospitals or fee-for-service providers. They bill for phlebotomy (U of M states they charge $9 for this service alone) and then these providers bill the labs through your insurance. Often times the laboratory costs often never negotiated down on behalf of the patient because there is no incentive from the practice to do this. 

DPC gets these low laboratory fees for their members in this innovative manner because our primary business is taking care of you and NOT being just a blood-draw center. Your membership for care to a DPC practice allows for this innovation.

Savings from Laboratory Costs

I have a colleague who recently had a pap smear completed, which is a diagnostic test used in females to detect cervical cancer.  She claimed she had ‘Cadillac Health Insurance’ through her employer, meaning basically she thought she had really great insurance that would cover the costs of her healthcare. Look at her bill below and what she was left to pay out of pocket. At my clinic, Beyond Primary Care, the procedure of completing the pap smear if part of the membership. No extra charges. The fee for the pathologist (that I have negotiated) is $44. The difference in costs in this ONE laboratory study alone would pay for months of healthcare at any DPC clinic.

DPC Members can obtain Labs other Doctors Order

DPC providers understand you may need to see another specialist from time to time, and these providers may want their own labs completed. A common question I receive is if the other specialist request labs, can I get them done through your clinic? 

Yes, absolutely this is another great way to minimize your financial impact. No doctor or hospital can force any patient to have routine laboratory studies done only at their location or where they tell a patient to complete them at. That is against the law. They may use convincing language saying ‘the results integrate into our electronic system faster,’ or ‘those other providers may not know exactly what I want.’ Stay firm and request a written and signed order for your labs. Your DPC clinic will complete the exact same labs, bill you at the much lower rates (compared had you used your insurance), and will promptly fax the results over to the requesting specialists that meet their needs. As noted by this Wall Street Journal article analysis of medical services, prices tend to be higher when services are performed in hospital outpatient facilitates instead of at doctors’ offices.

Hi, thank you for coming back for the latest edition of Beyond Primary Care’s blog; where I highlight healthy and fun recipes, healthcare news, advice for medical conditions, as well as how membership for care works! Dr. Jeff O’Boyle is the owner of Beyond Primary Care, which is a new approach to family medicine and addiction medicine that creates the time and space your healthcare deserves. Beyond Primary Care serves patients in Ann Arbor and throughout Washtenaw, Livingston, and Wayne County.

The primary purpose of the blog is to introduce healthy lifestyle concepts and answer common questions I receive from patients that I believe are important. I want to start discussions that will help educate, benefit, and improve your well-being. 

This featured recipe is Huevos Rancheros. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Huevos Rancheros

Adapted from Gina’s Weight Watchers Recipes
Prep time: 10 minutes
Total time: 30 minutes

Ingredients

1 teaspoon vegetable oil
1  yellow onion, minced
4 plum tomato, minced
4 tablespoons green chiles
Oil spray
Salt and pepper to taste
4 eggs
1 cup shredded lettuce
1 tablespoon cumin
1 oz Mexican cheese, shredded
2 teaspoon cilantro, chopped
1 (15 oz) can refried beans
1 (13 oz) package Tostadas
1 tablespoon lime juice
1 avocado, thinly sliced

Instructions

1) Set oven to 400 degrees F
2) Spray baking pan with oil spray. Place tostadas on baking pan,  Drizzle lime juice and add salt to taste. Cook for 2-3 minutes
3)  Add vegetable oil to fry pan, sauté onion.
4) To pan with onion, add tomatoes, green chiles salt, pepper, and cumin
5) Heat refried beans in microwave until warm
6) In a separate pan, cook eggs over easy
7) Top heated tortillas with heated beans, add second tostada, then top in order with cheese, tomato sauce mixture, lettuce, eggs, avocado, and cilantro.

Hi, thank you for reading! My name is Dr. Jeff O’Boyle. I am a board certified family medicine physician. My clinic, Beyond Primary Care is located in Ann Arbor, Michigan. In this post I am answering a common question that I receive, and that is how does Direct Primary Care (DPC) keep medications costs low for it’s members? Offering low priced medications is a key feature of virtually all DPC practices, and is something that is done to increase the value of a membership. Just how low? Many DPC practices do in-clinic dispensing and can provide hundreds of medications to their patients at a tenth of the costs that many national retailers can provide.

How DPC Practices Keep Medication Costs Low

DPC practices, like pharmacy retailers have applied for and obtained their medication dispensing license from their respective states. This allows a DPC provider to contract with pharmaceutical wholesalers of medications, the same wholesalers who retail pharmacies such as RiteAid, Walgreens, or CVS may use.  My clinic, Beyond Primary Care, uses two wholesalers of medications, AndaMeds and Bonita Pharmaceuticals. 

These wholesale companies sell the medications, often in large quantities to the DPC practice. However, unlike hospitals and retail pharmacies where selling medications IS their business – resulting in the expected mark-ups (250%!) and high-prices as noted by the American Journal of Pharmacy Benefits– DPC practices turn around and sell the exact same mediations to their patients at those near-wholesale prices. As noted, DPC sell the medications to their members in this innovative manner because our primary business is taking care of you and NOT being just a pharmacy. Your membership for care to a DPC practice allows for this innovation. 

Savings from Medication Costs

You may be or may know some people who take multiple medications. Medications for blood pressure, diabetes, urinary incontinence, anxiety, heart conditions, COPD, or erectile dysfunction may add up to hundreds of dollars a month you are paying out of your pocket. Compare this to the costs I charge my members for the exact same medications. Often times the money saved in medication costs alone pay for a DPC membership! Don’t see your medication on my sample list? Don’t worry, I may still stock it or I can order it too!

* Prices are subject to change without notice, one month supply listed unless noted

Did I Mention In-Clinic Dispensing?

Many DPC practices do in-clinic dispensing of medications. Once the doctor evaluates you and discusses the best course of treatment, that provider can have the necessary medications dispensed to you before you leave the office. In urgent situations, this saves you time, energy, and of course MONEY, something that rarely happens in fee-for-service medical offices. 

Obtaining Specialty or Brand Name Medications

As I mentioned in my earlier post, there are times a member needs or would benefit from a certain medication that is brand name only (very expensive) and would be best obtained through insurance that requires a prior-authorization (what is prior authorization) from the insurance company.

In this scenario, we will work to fill out the necessary paperwork to get your needed medications at reduced costs or even reach out to the pharmaceutical companies seeking a reimbursement or free supplies on your behalf. A great example is we got one of our members Vivitrol, a vital medication for Medication Assisted Therapy in Addiction Medicine. This medication costs over $1,000 on the market, but we worked to get our member the medication FREE of charge with their insurance. Did I mention the office visit and the injection itself were included with the membership? So the patient literally paid $0. Saving money for our patients gets me so excited! 

Dr. Jeff O’Boyle will host a Meet and Greet at Beyond Primary Care Thursday, December 6th from 5:30 pm until 8 pm. 

Meet Dr. Jeff O’Boyle, check out the personal and all-in-one clinic, and learn what Direct Primary Care offers.

Topics include:

• How Direct Primary Care works with health insurance
• What kind of insurance works best with Direct Primary Care
• How obtaining your medications works with Direct Primary Care
• How obtaining labs and imaging works with Direct Primary Care
• How hospitalization works with Direct Primary Care
• How referrals work with Direct Primary Care
• Comparing the actual costs of services and products in a fee-for-service system versus Direct Primary Care
• Dr. O’Boyle will answer any questions you have

Hello and thank you reading my blog at Beyond Primary Care and trying the BPC Good Eats recipes. This featured recipe is a Cheesy Skillet Pizza. These recipes are my attempt, in a way, to bridge that Doctor’s adage of “Eat Better & Exercise More.” In this post, I will showcase a healthy meal made on a budget, my pictures are pretty decent, and that is how I got into this food endeavor.

Cheesy Skillet Pizza Pasta
Prep Time: 15 minutes
Total Time: 40 minutes
Adapted from: The Comfort of Cooking

Ingredients:
1 tbsp olive oil
8 oz spicy or mild Italian sausage, casing removed
½ cup mini pepperoni, divided
2 (15oz) cans tomato sauce
½ tsp dried oregano
½ tsp dried basil
¼ tsp garlic powder
8 oz. rotini pasta
Salt and Pepper to taste
1 cup mozzarella cheese, shredded
½ cup parmesan cheese, shredded
2 tbsp fresh parsley, chopped

Instructions:
1) Preheat oven to boil
2) In a large cast iron skillet set to medium-high heat, add olive oil.
3) Once oil is hot, add Italian sausage and cook until browned. Drain excess fat.
4) Stir in ¼ cup pepperoni to skillet with sausage and cook 1 additional minute.
5) Stir in tomato sauce, oregano, basil, garlic powder, pasta, and 1 ½ cups water.
6) Bring to a boil. Cover and reduce heat simmering until pasta is cooked through, about 12-14 minutes.
7) Remove from heat, sprinkle with mozzarella, parmesan, and remaining ¼ cup pepperoni.
8) Place under broiler and cook until melted and golden brown, 1-2 minutes, watching to avoid burning.
9) Garnish with fresh parsley, serve