Dear Dr. Roach: Two years ago, my doctor (whose patient I had been for many years) decided to switch to a concierge practice. He charged $2,000 annually per patient. Neither my husband nor I chose to participate. We found a new doctor who we have been very happy with for the past two years. Now he has decided to go concierge as well.

He is charging $2,000 annually or offering patients who do not wish to participate in a concierge practice an opportunity to pay an “administrative” fee of $500 annually to continue as one of his patients. Both my husband and I have very good insurance that covers 100% of our medical costs, and I saw my doctor three times last year. I told him that paying an additional payment of over $150 per visit is ridiculous. So, once again, we are looking for another physician.

This appears to be occurring quite often in my area. My question to you is, do you think this is right?

— P.E.

Answer: In my opinion, concierge medicine can be done ethically, but I have real questions about the way your physician is moving to a concierge or “retainer” medicine practice. If a physician chooses to move to a concierge model, which by itself is not unethical, they ought to help their existing patients find care and aid with the transition.

I don’t agree with the $500 “administrative fee” per year, which sounds like a charge solely to remain as his patient and get no additional service. I understand the benefits of a concierge practice to a physician, and for those who can afford it, there are advantages for the patient, too. But it is my personal opinion that we physicians have an obligation to provide care. I have known concierge physicians who volunteer at free clinics as a way of fulfilling their professional obligations.

Dear Dr. Roach: I first heard about a disease called “sweating sickness” while watching a television series. Do people still get sweating sickness under a different name?

— J.S.B.

Answer: Sweating sickness was a disease that was found in England between 1485-1581 but wasn’t seen again. The major symptoms were a rapid onset of a high fever with sweating, then death following in hours or days. The details of the described cases at the time have led medical historians to suspect that the disease was a very dangerous virus such as a hantavirus, which causes a hemorrhagic fever in Europe and Asia and a heart/lung syndrome in the Americas.

Hantaviruses normally exist in rodents but can occasionally cross over into humans. Less than 1,000 cases of hantavirus cardiopulmonary syndrome have been reported in the United States as of 2021, but a prominent actor’s wife recently died of hantavirus pulmonary syndrome.

Other authorities suspect that sweating sickness was caused by an enterovirus (a large family of viruses that is responsible for many diseases, including polio), which is the suspected cause in a condition called acute flaccid myelitis. But we can only guess at the cause of this mysterious illness.

Highly virulent germs (those that kill their hosts) often die out quickly as they kill their hosts before many people get infected. However, some diseases become less virulent over time since the germs that don’t kill people have more time to spread to others.

Syphilis, for example, was a rapidly fatal disease in Europe during the 16th century, but by the 18th century, it had become a much more indolent disease. The main barrier to syphilis treatment now is getting people diagnosed.

Contact Dr. Roach at ToYourGoodHealth@med.cornell.edu.