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Clinical FAQ

What do you think about antibiotics?
There are three possible situations involving antibiotics:
  1. There are illnesses in which antibiotics are totally useless – flu, stomach virus, allergy, etc. We will not prescribe antibiotics for children who have these illnesses. On occasion, we may prescribe an antibiotic to treat a COMPLICATION of such illness, but it is rarely appropriate to prescribe an antibiotic before such complication occurs, even with high fever or severe cough as symptoms.
  2. There are illnesses in which an antibiotic is essential, and serious consequences are likely to occur in children who are not treated with an antibiotic. Severe strep throat and pneumonia are examples of such. Antibiotic injections may be offered for children with such illnesses if they are unable to take antibiotics by mouth.
  3. More commonly, we see children who will probably recover without antibiotics but for whom antibiotics will reduce illness duration and discomfort, and/or prevent rare complications. We will generally offer antibiotics to such children, or watchful waiting as an alternative if the family so wishes. Bronchitis, sinusitis and mild ear infection are examples of such conditions.
What do you think about circumcision?
  1. The two illnesses that circumcision appears to protect against are urinary tract infection and cancer of the penis. Penile cancer is infrequent, but more common than serious complications of circumcision (see »this article for a "trade-off analysis").
  2. Circumcision also has a protective effect against HIV acquisition and other STDs, but as it if far less effective than safe practices it cannot be recommended as a substitute.
  3. Circumcision remains a personal decision, incorporating cultural and religious factors, and its use is not without medical indications. It is particularly indicated for boys with »phimosis but its risk/benefit ratio does not justify its use in all male infants.
What do you think about alternative medicine?
"Alternative" is a wastebasket term, meaning all kinds of interventions without proven benefit. The moment an alternative treatment is shown to be effective, it stops being alternative and becomes part of real medicine. This happened with melatonin for insomnia and St John’s wart for depression, as well as "duct tape" for warts.

For guidance on alternative therapies, see »National Library of Medicine page of alternative and complementary medicine.
What do you think of naturopathic medicine?
"Natural" and "good" are not synonyms. Of the top ten carcinogens worldwide, eight deadliest -- tobacco, Hepatitis B and C viruses, Helicobacter pylori, aflatoxin, sunlight, asbestos, and radon – are 100% natural. Natural formulations of ephedra and foxglove are more toxic than their medicinal equivalents, and no natural substitutions exist for most antibiotic and anticancer agents. Naturopathic treatment is, however, effective 90% of the time, as 90% of all illnesses will go away by themselves eventually. For a systematic review of natural remedies, see »National Library of Medicine review of herbal remedies and supplements.
Why do you rely so much on in-office testing?
Since we are open 365 days a year, and are able to see any patient who becomes ill the same or the next day, we see each sick child very early in the course of their illness. No matter how experienced a doctor is, he or she will not be able to see signs that have not yet appeared. Lab and ancillary testing may reveal, or hint at, the true diagnosis long before it becomes detectable by examination.
Can you recommend a good source of pediatric advice?
  1. »University of Michigan C S Mott Children's Hospital Pediatric Advice Page.
  2. »National Library of Medicine review of herbal remedies and supplements (excellent!).
  3. »National Library of Medicine Medical Encyclopedia.
  4. »Medical Information in Spanish.
  5. <<liAsthma Totally Explained
  6. »Well Child Care 0-6 months (PDF)
  7. »Well Child Care 6-24 months (PDF)

Financial FAQ

Are you open on the weekends?
The Brooklyn (Brighton) office is open all weekends, all holidays, and in all weather conditions. On major holidays we may open earlier and/or close later, but at least one of our Board-certified doctors is available on any day of the year. The Staten Island office is open 6 days a week, and is closed on major holidays. Staten Island patients are always welcome at the Brighton office.
Do you accept Medicaid?
We accept Medicaid. Many people have been changed from Medicaid to other insurances without their knowledge or consent. We accept some, but not all, of these insurances. Some of these insurances are HMOs, and one of our doctors must be listed as PCP in order for you to be seen here.
Do you accept HMOs?
We accept many (but not all) HMOs. One of our doctors must be listed as PCP in order for you to be seen here. We have to verify PCP for each visit to our office, and apologize in advance for any delay this may cause. If you have another PCP listed with your HMO, you can only be seen after you change your PCP to one of our doctors, and this may not always be possible on the same day, depending on your HMOs policies and their availability by phone. Patients with other PCP’s can only be seen on a self-pay basis.
(PCP: primary care provider)
Do you accept my insurance?
If we do NOT accept your insurance, it is either (a) because it is very rarely seen in the areas we cover, or (b) because it endangers the health of the patients it covers by making essential services difficult to obtain. Click here for a partial listing of insurances we accept.

We do collect copays as required by our contracts with insurance companies. If a deductible exists, it must be satisfied before we can accept the insurance.
Does access to vaccinations depend on patient's insurance?
Unfortunately, it does.

Immunizations for some insurances can only be given from the VFC stockpile, and cannot be "borrowed" and "replaced". It is unfortunate that the program designed to improve access to vaccines serves to create "second class citizens" in VFC-eligible children. The difference in availability between VFC and private suppliers can be weeks to months, in spite of what the VFC web site says. I am told the VFC vaccines are shipped first to hospital clinics, suggesting that the program also considers community pediatricians "second class doctors"..

What is the charge for self-pay patients?
New PatientOld Patient
Sick Visit $80 $60 Includes in-office tests
Well Visit $110 $80 Includes in-office tests and forms (school, WIC, etc)

Med Plus Articles

Introduction: Why is this here?

This section is unusual: as other pages tell you WHERE (our offices), WHAT and HOW (our services), WHO (our doctors) and WHEN (our schedules), here we will try to post some answers as to WHY.

WHY do we do what we do, WHY do we think we know what we think we know, and WHY do we think what we do works?

The gold standard is the randomized controlled double blind study.

Say you have one hundred children with hiccups. You separate them into two groups of 50, randomly; you treat 50 by jumping out and yelling Boo! (that's your experimental group), and you leave 50 alone (that's the control group). Then a researcher who does not know what child got what treatment (that's double blind) times the duration of hiccups on a stopwatch.

Then you calculate average hiccup times for the treated and control groups, and in comparing them you determine the efficacy of the Boo treatment.

To the best of our knowledge, every treatment we suggest, for every condition, is based on a big difference in outcomes of this condition in treated vs control groups. On this page, some of the studies that led to our treatments are presented as summary abstracts. Something to consider for a rainy afternoon...

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