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-the- counter 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

1 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

2 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

3 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 non- urgent 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 1- 6pm, 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

4 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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