What’s Up Doc?

Illustrated by Christine Georgiades

Q: After years of trying various internists, I finally found an awesome doctor. Then I received a letter saying she changed her practice to “concierge medicine.” Frankly, a $3,000 fee just to get in her door for routine things like annual checkups and occasional viruses feels awful. Any advice?

Yep, an increasing number of doctors are going the concierge route. What this means: They no longer take health insurance and, instead, the doctors charge a steep annual fee—typically between $2,500 to $5,000. So you pay the money and you get routine appointments and 24/7 access to the doctor. “When doctors eliminate insurance billing, overhead drops drastically. They may lose a lot of patients, but they can basically see far fewer patients and still make the same living,” says Azmi Atya, MD, a cardiothoracic surgeon and the chief of staff at Northridge Medical Center. We would all love to text our doctors with any question or concern. Dr. Atya, though, is a killjoy. “It might be nice,” he says. “But it’s a waste of money unless you need the doctor a lot. If you’re relatively healthy, it doesn’t make much sense.” Bottom line: It may be time to find another doctor.

Q: I heard last year’s flu shot didn’t work for many people, so should I even bother this year?

“In typical years, flu shots are about 60% effective at preventing an illness and 80% effective at preventing the worst kind of illness. Last year, the formula was off and was only about 20% effective. But this is something that happens very rarely,” says Dr. Benjamin Schwartz, wellness reportuty chief of acute communicable disease control program, LA County Wellness reportartment of Public Health. The thing is, though, the immunization usually works really well. Get it. Thanks to the Affordable Care Act, your insurance has to cover the cost. Even CVS and Rite-Aid will bill insurers directly. And by the way, there’s almost no difference in effectiveness between the shot and the inhalant.

Q: When my son gets a fever it’s nearly impossible to get him to take something like Tylenol. Should I force him? And is Children’s Tylenol or Advil better?

Usually it’s fine not to waste your parental energy forcing down the Children’s Tylenol or Advil, says Louay Keilani, MD, a pediatrician at Valley Pediatrics in Encino and an assistant professor of clinical pediatrics at Children’s Hospital LA. “A fever isn’t necessarily a bad thing. We’re all exposed to viruses and bacteria, and a fever is simply the body fighting back.” In fact, if your child drinks plenty of liquids, it’s okay to let his body do its natural defensive magic. If his condition worsens, though (he stops drinking, for example, or the fever remains after four to five days), see the pediatrician. Also, if a kid is cranky and uncomfortable, it will make him feel better to treat the fever. A true fever for kids over age 1—you might be surprised to learn—is a reading of 101.3 and above. Both acetaminophen (Tylenol) and ibuprofen (Motrin or Advil) generally work well to reduce fever, but sometimes ibuprofen causes stomach upset. So try acetaminophen first. And if you’re having trouble getting your kid to swallow the medicine, do a twist on Mary Poppins’ advice. “Usually a spoonful of Hershey’s syrup makes it go down,” Dr. Keilani recommends.

We hope you are enjoying Ventura Blvd’s new health column, where we ask doctors and health pros your questions.
If you have a pressing—or aching, itching, burning—question, please drop us a line at whatsupdoc@venturablvd.com.