Download Important Information for Your FIRST Visit

Important Information for Your FIRST Visit with
San Francisco Peninsula Ear, Nose and Throat Associates
If you have recently made your first visit with our office (or are thinking about making
your first visit), we would like to welcome you to the San Francisco-Peninsula Ear,
Nose and Throat Associates. We provide specialty care for complex conditions in the
medical specialty of Otolaryngology – Head and Neck Surgery; this specialty provides
all aspects of medical and surgical care for adults and children for problems involving
the ear, nose, throat and associated structures.
There are many routine and common problems which affect the ear, nose and throat
and which may not need any medical care at all. If you should experience minor
symptoms in this area of your body, it is frequently the result of a common and/or
minor medical condition; there are many safe and effective over-the-counter remedies
for bothersome symptoms associated with simple common health problems. Everyone
is a little different in their response to over-the-counter remedies, so it may take a little
trial and error to find the product that works best for you and for your problems. For
those common problems that do not respond to over-the counter remedies or if you are
concerned about the possible side effects or possible drug interactions of over-thecounter remedies with your other prescription medications, these issues should be
discussed with your primary care physician to determine if referral to a specialist is
indicated.
There are many good places to get information to help you answer these questions; it
is likely that someone else in your family or social group has experienced many of the
common ailments that affect most people, and they may be able to provide reliable
information about products that they have tried and found to be helpful. Your
pharmacist and your family doctor are other excellent sources of information. Some
reputable websites (such as www.WebMD.com and www.entnet.org) provide reliable
healthcare information. One note of caution, you are undoubtedly already aware that
there are many other websites that include claims of health benefits of specific
products but are really just tools for advertising and marketing; as always, caveat
emptor. There is also quite a lot of helpful information on our website,
www.DrKmucha.com. Finally, we have many handouts and brochures available in the
office that discuss many of the more common conditions that we treat.
At San Francisco Peninsula Ear, Nose and Throat Associates, we are dedicated to
providing you with comprehensive medical care that falls within the purview of our
specialty, Otolaryngology - Head and Neck Surgery. Dr. Kmucha is board certified in
Otolaryngology and is also certified in the subspecialty of Otolaryngic Allergy; after a
full 5-year residency in otolaryngology, he completed a fellowship in otology in 1989
followed by a fellowship in otolaryngic (ear, nose and throat) allergy. He served on
the medical school faculty at Yale from 1987-1989 and on the faculty of the Stanford
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Medical School from 1989-1995 where he currently holds an adjunct position as a
consultant to the California Ear Institute at Stanford.
Otolaryngology is the oldest medical specialty in the United States, and board
certification in Otolaryngology has been recognized since 1924. In the United States,
this specialty is often known as Ear, Nose and Throat, but the full scope of the
specialty of otolaryngology is much much broader; in some other countries, this
specialty is known as Otorhinolaryngology; physicians practicing in this specialty in
some countries are then often known as “otorhinos”.
For your initial visit, you will be required to complete a number of forms and to
provide significant personal healthcare information; the forms used in our office are
also available on the website so that you can begin this task before your visit. The
clearer and more detailed the information you provide, the better we can understand
and help you with your problem. Doctors tend to think of medical conditions in
chronological order; please think about your symptoms and be able to describe how
they started, what treatments you or your doctor tried to reduce your symptoms, how
your symptoms changed over time with or without (and not necessarily because of) the
treatments that you have chosen. Remember, physicians often make healthcare
recommendations based on their clinical experience, medical judgment and some
assumptions based on your symptoms and even by the words that you might use to
describe your symptoms. Sometimes these clinical judgments and assumptions are
correct, and sometimes they are not.
You will need to think clearly about your symptoms and to be able to describe them so
that your doctor can understand; if you can not explain your symptoms in a way that
your doctor can understand, the quality of the care you receive may suffer. Many
people use medical terminology is ways different than medical dictionary definitions;
it is always better to describe your symptoms in your own words rather than using
medical terminology that may not be the same as the medical dictionary definition or
different from the use of the medical term by specialist physicians. Be prepared to
explain what you have experienced and what you really mean when you use certain
words such as “vertigo” or “tinnitus”.
You will be asked to think about your medical problems, and you will be asked to try
to learn more about your medical problems. If you prefer not to learn and not to know
about your medical problems, you should probably reconsider whether you are ready
to participate fully in a patient-physician relationship where both parties in the
relationship have significant responsibilities as part of the healthcare team. Any
assumptions that you or your family doctor might have made may also be questioned
and even challenged to assure that the assumptions and the healthcare
recommendations that were made based on these assumptions were indeed correct; if
you are uncomfortable about or feel threatened when your assumptions are challenged,
you may want to reconsider whether your are truly ready to participate fully and
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actively in your own healthcare with a specialty physician. There are many family
remedies, “old wives tails” and myths in healthcare; you should be ready to embrace
new ideas, have some of these myths debunked and learn some new ways of thinking
about your health and your medical problems.
As many medications have side effects and can cause or worsen other medical
symptoms, we expect you to know your medications, the dosages of these medications
and the medical condition for which they have been prescribed. If you have a long list
of medications, we expect you to bring an accurate and current list of all of your
medications to your visit. For your own safety, this list should also be kept in your
wallet or purse at all times in case you might need emergency medical care.
If you have had medical treatment or tests (biopsies, ultrasounds, x-rays, CT scans,
MRIs, PET scans etc.) performed for the medical condition for which you are planning
to visit our practice, we expect you to either bring them to your first visit or to assure
that your other doctors have sent those records to us and that we have received the
records that you have requested your doctors to send to us. This is especially important
with respect to abnormal blood tests, abnormal imaging studies, abnormal sleep
studies, balance tests, hearing tests, etc. Assuring that these test results are available
for your visit will improve the quality of the visit, the quality of care that you receive
and will obviously make it more likely that your problem can be addressed more
efficiently; any delay in obtaining records only delays treatment. You may be
questioned about what you understand about the tests that you have already consented
to undergo. You may be questioned about your choice to accept and implement the
treatments that you have already completed prior to your first visit in our office.
As a fully participating patient in the informed consent process, with full
communication between you and your doctors and with your own active involvement
in your care, you will understand that your doctors only make recommendations and
that you as the patient have the choice to accept or ignore any of these
recommendations. We know that there are often many choices to be made about each
medical treatment and that some of these decisions are complicated and difficult; but
we also know that, ultimately, it is the final decision of the patient whether or not to
accept these medical recommendations and to choose to adhere to them. All medical
treatments come with some benefit and some risk; you will need to determine how you
balance those benefits and risks and participate in decisions about various treatment
options based on your own decisions about potential benefits and risks.
Ideally, before every patient accepts any physician’s recommendations, the patient
should understand the potential benefits and potential risks of accepting that
recommendation, as well as the potential risks of not accepting the medical
recommendation; informed refusal of medical recommendations is a very real and
reasonable option as long as you are fully informed and fully involved in the decision
making process. In our practice, you must participate fully in the decision making
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process; our doctors will not make these decisions for you. If you choose to refuse to
follow medical recommendations, this decision will be documented in the medical
record, and you will be asked to sign a form documenting your “informed refusal.”
Many patients without insurance receive care in our office; we accept cash, checks,
VISA, Mastercard and Discover card. If you have insurance that is effective for the
dates of services on which you receive care in our office and if you wish to have the
charges for these services submitted to your insurance, you will be required to provide
appropriate documentation of your insurance coverage. If you do not wish us to
submit claims to your insurance for certain services or if a certain service that you
choose to receive is not a covered benefit of your insurance, you will be required to
pay for these services at the time that you receive this care; if the charges are higher
than your budget allows, we will try to arrange a payment plan, but this is not always
an option. Once you have received medical services, payment is due – either by your
insurance or by you. For your privacy and the security of your personal healthcare
information, you will also be required to provide other items of personal identification.
We provide many types of testing and other specialized services including middle ear
testing, hearing testing, hearing aid fitting, allergy testing, allergy treatment, taste and
smell testing, Botox injections, chemical peels, minor surgical procedures, etc. With
the exception of allergy treatment, all such services require an appointment and may
also require pre-authorization from your insurance plan if you choose to have your
insurance plan participate in the payment process for the services which you choose to
receive.
For any follow-up visits, testing, treatment or procedure performed in our office, you
will be provided with a written appointment reminder when you leave the office at the
visit prior to this new appointment. You will also be contacted 2-3 business days prior
to any and all scheduled appointments as a reminder about that appointment. Please be
sure that we have the correct and preferred contact numbers. We care for a large
number of people, many of whom need to be seen urgently, and appointments which
go unused could have been utilized by those in need. In case of an emergency, illness
or other urgent problem, please contact our office to reschedule your appointment. If
for any reason you are unable to keep your scheduled appointment as a result of a nonurgent matter, please contact our office as early as possible to reschedule; with the
exception of urgent and emergent reasons, a $50 service charge will be added to your
account if you fail to keep any appointment (with the physician, with the allergy nurse,
with the audiologist, etc.) or if you fail to cancel your appointment with 24 hours of
the scheduled appointment time.
Allergy injections do NOT require an appointment and are available in our Daly City
office on Monday and Tuesday 9am-12 and 1-530pm, on Wednesday 9am-12 and 16pm, on Thursday from 9am-12 and 1:30-5:30pm and on Friday from 9am-12 and
1:30-4:30pm. Please ask for a pocket reminder card of these hours. We also maintain
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an allergy email list, so if you wish to be notified each month of any potential changes
to the allergy injection schedule and/or availability of allergy injections, please
provide us with your current email address so that you can be added to the list. Please
call if you wish to confirm an appointment, office hours, availability of services, etc.
If you have received a prescription from our office, routine refills of prescriptions
should be addressed during your face-to-face visits with your doctor. If you do not
have or do not need a visit with the doctor, routine prescription refills will only be
addressed during regular office hours when medical records are available. If you have
had a procedure or surgery and believe that you will require medications (especially
outside of normal office hours), plan accordingly and request sufficient medications to
address your needs when the office might be closed. Pain medications prescribed by
another physician will not be refilled at any time unless the originally prescribing
physician has communicated with our office in advance about your likely need for
these controlled substances.
We look forward to participating and sharing in your care; we encourage your full
participation. Please be as prepared as possible for each and every visit. Please call our
office if you should have any questions, if you should require assistance in
determining if you should make an appointment, if you should require assistance in
determining the type of testing appropriate for your problem or if you should require
assistance in determining when your insurance will cover your visits or services in our
office.
If you are not prepared to explain your symptoms clearly and in detail, if you are not
prepared to thinking critically about and learn more about your problem, or if you are
not prepared to participate fully in the decisions required to address your medical
concerns, it would seem reasonable to postpone making an appointment until you are
indeed ready to participate fully in these aspects of your healthcare.
5/1/2009
Steven T Kmucha MD JD FACS
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