It’s time for your flu vaccine

Flu season is on the way! One of the best ways to protect your family is to follow the CDC’s recommendation: everyone 6 months and older should get an influenza vaccine every year.

For the traditional flu “shot” or injection, the only stock we’re carrying is the quadrivalent formulation in preservative-free vials. This helps protect against 4 strains of influenza.

This year, a reformulated “Flumist” nasal spray has been re-introduced. According to the experts who’ve reviewed the data for the CDC, it’s expected to be about equivalent in effectiveness as the injected form. Flumist has not yet been shipped — we don’t have it yet, but we will, hopefully in the coming weeks. It can only be used from age 2 through 49, and people with immune problems or chronic heart or lung disease, including asthma, should get the shot instead.

We’re happy to offer these vaccines to our patients and their parents. For parents, we can file for payment from your insurance company (make sure your insurance does not insist that you visit your own PCP for vaccines), or you can pay a cash price of $35 for the flu vaccine.

You can book an appointment for your family by using the portal or by calling on the phone. Either way, we hope to see to you soon to help get your family protected!

More info: CDC’s flu information



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Limiting Media/Screen Time

“Media Time” includes time spent in front of a computer, tablet, television, smart phone, or another screen. It can be difficult to balance Media Time with other activities, but it’s important to have common-sense rules for your family to prevent media overuse and to make sure your child has time for other activities.

The American Academy of Pediatrics has created a site to make it easy for you to make your own, personalized “Family Media Plan.”

At the website, you can use a “media time calculator” that’s already filled in with sleep needs and other information based on your child’s age. You’ll put in the other activities and times, and you can see how media time fits into their day.

There’s also a section, “create your family media plan”, where as a family you can choose the guidelines and suggestions that are most important to you. The plan accommodates children of all ages, and creates rules that everyone can agree on to cut down on fighting and arguing over screens. To help make this successful, ensure that your whole family participates in creating the plan. It’s a great way to help you and your children balance your online and off-line lives.

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Stay in touch

We want all of our patients and families to be able to reach us – and we’ve now got more ways than ever to stay in touch!

Our portal allows you to send non-urgent messages directly to your favorite doctor, or to our nursing, scheduling, or office staff. You can also review notes from your visits or upload documents to us via a link above the messaging section. We also routinely send normal and negative lab results to families via the portal, to make it quicker and easier for families to get results. Signing up for the portal is free – check it out!

You can also schedule sick visits either via the portal, or via the links on the front page of our website (even if you don’t yet have a portal account!) Try it especially on evenings or weekends to get your child a sick appointment for the next day. For well appointments (checkups), please call our office during regular hours. We hope to have well appointments available for all patients from the portal soon.

Keep in mind that portal messages aren’t monitored while we’re closed. For emergencies or urgent medical questions, it’s best to call us on the phone. Just call our regular office numbers, 24/7. The operator will connect you with a nurse or physician. If for any reason you don’t hear back soon, call again. We try to return urgent calls quickly.

Very rarely, we’ve had issues with phone service. If that happens, try to reach us through the portal, or via a backup line to our answering service: 770-928-5214.

We also post news and practice information here on our practice website and on our Facebook page (stop by and Like us!). Lately, we’ve been getting a lot of reviews on Google and other sites – and we want you to know we look at all of them, and we appreciate both your kind support and the occasional post that tells us how we need to improve!

As always, thanks for all of your support and trust. Stay in touch!

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Thanks for choosing us as “mom-approved pediatricians” in Atlanta Parent magazine!

See the article here!

Benaroch, Roy, MD
“Dr. Roy is just fantastic! He has a gentle and very friendly approach. He walks into the room always smiling, immediately noticing my sons and asking them how they are. His advice is always on point.” -T. L., Roswell

Bien, Elizabeth, MD
“She always takes the time to address all your questions and concerns.” -Stacey K., Roswell

Biggs, Jennie, MD
“She has been seeing my children since they were babies and they are now teenage boys. She is so caring and listens to them and understands our concerns! She is the best!” -Carrie B., Roswell

Green, Lindsay, MD
“Punctual, kind and caring, great bedside manner, takes the time to answer all of your questions every time.” -Ashley T., Roswell

Stebbins, Stanton, MD
“Dr. Stan is so knowledgeable about kid’s illnesses. He stays up to date on current research and he is so great with kids!” -Ashley S., Roswell

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Your children deserve better than telephone medicine

Someday we may miss the quaint idea of our children having their own doctors – doctors who actually get to know their patients and families. We keep all of your records, we know how many ear infections your child has had, we make sure they’re protected with vaccines and we monitor their growth and development – you know, the important, big picture things. The things you just can’t get with a quick phone call to an anonymous telephone doc. Can a phone call substitute for an in-person visit with a doctor who knows your child?

Apparently at least one huge insurance company thinks so. My own family’s health insurance comes from Aetna Healthcare (the letters of which can be rearranged to spell “At Heartache Lane”.) They’re really pushing me to try out “Teladoc” (which, ironically, can be rearranged to spell “late doc” or “eat clod” or “del taco.”) One of the many promo brochures they sent shows a sad-looking child in the background, with an app open on mom’s phone in the front. “How would you like to talk to the doctor?”, it says, in big friendly letters. Holly, presumably the child’s mom, is quoted “One night my child was running a high fever. I called Teladoc & the doctor prescribed a medication & plenty of fluids. Glad I avoided the time and expense of the ER.”

What Holly’s mom should have done was called her own child’s doc. Depending on the kid’s age, health history, and symptoms, it would have been appropriate to either: (1) stay home and give a fever medicine, then come in for an exam in the next few days if still feeling poor; or (2) if there was chance of a genuinely serious medical issue, to go get evaluated right away. The child could have had meningitis, pneumonia, or a viral infection, or one of a thousand other things. But there could have been no way to know a diagnosis over the phone. What was needed was a risk assessment, not a prescription. Holly’s story, to a pediatrician, makes no sense. It doesn’t represent anything close to good or even reasonable medical care. A high fever does not mean someone should “call in a prescription”? That’s completely, utterly, and despicably wrong.

Why is Aetna pushing Teladoc? It’s cheap. Aetna’s payout to the telemedicine company is far less than what they’d pay for an urgent care or emergency room visit. Insurance companies aren’t eager to spend money for people to see doctors. Cheap is good for insurance companies, but is it good for your children?

I couldn’t find any studies in pediatric patients looking at the accuracy of this kind of service for making a diagnosis or the outcomes of prescribing medicine for acute problems over the phone. I emailed the Teladoc people, introducing myself as a physician whose patients might use their services. Do they track their accuracy or outcomes? Do they have any data showing that what they’re doing is even close to good care? I got no response.

Though there are zero pediatric studies, I found one good study in adults,  reviewed here. Researchers contacted 16 different telemedicine companies specifically about rashes. They uploaded photos and basically “posed” as patients. The results were abysmal – there were all sorts of crazy misdiagnoses, and many of the telephone clinicians failed to ask even basic questions to help determine what was going on. Two sites linked to unlicensed overseas docs, and very few of the services even asked for contact info for a patients’ primary care doc to send a copy of the record.

I think I know why telemed companies don’t bother to send records to primary care docs. I have gotten just a handful of telemedine records in the last few years, and they’re frankly embarrassing. One was about an 8 year old with a sore throat (who wasn’t even asked about fever). It says the mom “looked at the throat and saw it was pink without exudate.” (Let me mention here that throats are always pink. That’s the normal color of a throat.) Amoxicillin, in an incorrect dose, was called in for “possible strep throat.” This is terrible medicine that contradicts every published guideline for evaluating sore throats in children. I’ve also got records from kids treated with three days of antibiotics for a sinus infection, and urinary tract infections being treated without any testing of the urine (again, these examples completely contradict evidence-based care guidelines) If this is the kind of Krappy Kare we’ve decided we want for our children, we ought to just make antibiotics over-the-counter and skip the pretending over the phone.

There can be a role for telemedicine. I see it as a useful tool for follow-ups, especially for psychiatric or behavioral care where a detailed physical exam isn’t needed. Telemedicine can also be a great way for physicians in isolated or rural areas to get help from a specialist for complex cases. And telemedicine technology is already being used successfully to allow expert-level interpretation of objective tests, like pediatric EKGs and echocardiograms.

But current available technology (like this Teladoc service) doesn’t allow a clinician to really examine a patient, look in their ears, or even assess whether their vital signs are normal. They cannot help decide whether a child is genuinely ill or just a little sick – and that, really, is what parents need to know in the middle of the night. Calling in unnecessary antibiotics is cheap and easy – and that’s why this kind of care is being pushed by insurance companies. But it’s no substitute for genuine medical care from your own child’s doctor. Your children deserve better care than pretend medicine over the phone.


The Pediatric Insider

© 2018 Roy Benaroch, MD

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