Clinic Policies

Dear Patient,

Welcome to Vivo Family Medicine and to my practice. A bit about me: I am a newly graduated family physician from the University of Toronto residency program (June, 2018). I finished my medical school at the University of Ottawa. Prior to my medical studies, I completed an undergraduate degree in Health Sciences at McMaster University and a Master's degree in Epidemiology at Queen's University.

I am committed to providing excellent primary patient care. My special interest is in optimizing patient experience through continuous improvement of the practice. As a result, our clinic policies below will change based on our shared experience and feedback from staff and patients.  

My philosophy of providing care is based on the principles of family medicine: https://www.cfpc.ca/Principles/

I truly believe that the physician-patient relationship is central to my role as your family doctor. I look forward to serving you and providing you with the best possible care.

Best regards,

Dr. Amjed Kadhim-Saleh, MD CCFP

 

Booking an appointment

Please call our office to book an appointment as needed. Also, you can book your follow-up appointment at the end of your visit based on your discussion with the doctor. When you book the appointment, our Patient Services Associate will ask about reason for visit. Please note that this is very important to help us in the planning process, which will reduce your wait time. For example, if we know that you are coming in with urinary symptoms, we can process the urine sample prior to seeing the doctor, which will make your visit quicker and also informative in making the right diagnosis. Another example would be if you are coming in with high blood pressure, the doctor will review your blood work prior to your visit and arrange for additional testing so that we make the most out of your visit.

What to bring for your appointment

1. Your OHIP card (Ontario Health Insurance Plan; green health card). Please note that without this card, we would have to charge for the visit.

1. List of your medications (you can get this from your pharmacy) or alternatively your medication bottles. This list is crucial in ensuring your safety and would allow your doctor to prescribe the correct medication.

1. Your medical information. For example, you may have received a Hospital Discharge Report if you have been hospitalized recently. This information is quite useful for the doctor to know as it will guide your care.

1. List of your specialists. This list can be quite helpful because we can refer to the same specialist if needed.

Checking in

Please arrive 10-15 minutes earlier than your scheduled appointment. Our Patient Services Associate will verify your OHIP (Ontario Health Insurance Plan) coverage as well as your contact information. She will then escort you into the waiting room. Prior to seeing the doctor, you may be asked to fill out a health questionnaire or provide further information, based on the reason for your visit. We will guide you in every step of the way. Please note that if you are more than a few minutes late, we may ask you to reschedule.

Your visit

Sometimes we will not be able to address all your health concerns in one visit. We appreciate that you likely have not had a family physician in some time and that this presents many challenges.  Your intake visit is scheduled to be long enough that we should at least be able to triage your concerns and begin to address them. In some instances, follow-up appointments will be necessary, which if nothing else will allow us to get to know one another better.

We believe that it is important to have a thorough assessment for each health concern. As a result, we do ask to focus each visit on the main issue that brought you to clinic that day. You may feel that another issue can be addressed quickly because it seems like a simple request. However, your doctor does not wish to provide you with a quick answer without actually providing a full assessment. This is important for your safety. Therefore, we do ask to please focus on the one issue per visit. We thank you for your understanding.

Prescription Renewals

Your doctor will always try to prescribe enough medication to last until your next appointment. Your doctor will also aim to “line up” long-term medications so that the prescriptions expire at the same time.  It is important that your doctor sees you again in clinic before renewing medications, as this is usually at an appropriate interval to re-evaluate your health. Please pay attention to your medications and plan ahead so that you do not run out. Bringing all your medications to your appointment (or list of your medications) is always a good idea. Please note that renewing your medications remotely (i.e. without having you come to clinic) is considered an uninsured service, and as a result, there is a charge for this service.

Requests for referrals

Please note that your family doctor is an expert in providing primary care services. Referrals to specialists will, of course, be used if deemed appropriate. However, your family doctor may feel that the issue you are presenting with is something that does not require involving a specialist and can instead be managed at our clinic. For example, some patients request a referral to a dermatologist for moles that appear to be quite benign. Your doctor may provide a different plan instead of pursuing a referral right away. We ask to please keep an open mind. Also, some referral cannot be made without doing the initial investigations first, such as bloodwork and imaging. These investigations would provide a more thorough assessment that makes a referral request more complete and would actually expedite the process. It may also uncover issues that need to be dealt with sooner.  

Office Hours

Our office hours are currently Mondays - Fridays from 9 AM to 5 PM, with the exception of Wednesdays from 12 PM to 8 PM to allow for after hours coverage. These hours may change in the future. For vacations and other leaves, we may have another physician (called “Locum”) who would cover for the family doctor on leave.

Same Day Urgency

Your family doctor will keep same day appointments available in order to ensure you have good access to our clinic. Please note that these appointments are meant for urgent issues only.  Please respect your fellow patients by not booking at the last minute for a non-urgent issue.
 
Medical Education

Your doctor may participate in medical education by supervising medical students or resident physicians. They are members of our health care team and will all be supervised appropriately.  You always have the option of declining to be seen by one of these providers; however, these providers are excellent at being thorough and may actually bring a fresh eye to your health concern. As a result, this may be a good opportunity to help these trainees along their medical education journey and also ensure that you are receiving the best possible care.

Antibiotics

At Vivo Family Medicine, our philosophy is to provide evidence-based medicine. Your doctor will certainly prescribe antibiotics if deemed appropriate, such as if you are having a skin infection or pneumonia or a UTI. However, antibiotics would not be appropriate for certain infections, and in fact, may actually cause harm such as upset stomach, diarrhea, rash, and possible allergic reaction. For example, the common cold is caused by viruses that cause symptoms of a sore throat, cough, runny nose, and chest congestion. Antibiotics kill bacteria but not viruses and thus do not treat the common cold. Your doctor will prescribe other treatments to help you manage those symptoms. Your doctor will also counsel you on what to expect in terms of recovery and when to return if you are not getting better.

Opioid and Sedative Medications

Narcotics such as percocet, oxycodone, hydromorphone, morphine, Tylenol #3, tramadol, etc., are only meant to be used for acute issues (such as severe trauma). When used for long-term periods, these medications have a high risk of side effects. Your doctor may feel that it would be inappropriate to continue taking these medications and, in that case, would not prescribe them. However, if you have already been taking these medications chronically, your doctor may need to taper you off these medications gradually and safely.  

If a doctor does prescribe these medications, you will need to sign a contract and participate in regular urine drug testing. Any breach of the contract would result in these medications being reduced, more tightly controlled, or stopped altogether.

The same stipulations apply to two major classes of sedative medications: benzodiazepines (lorazepam, diazepam, oxazepam, etc.) and the “Z-drugs” (zopiclone, zolpidem, etc.).  There are significant consequences to long-term use of these medications and the circumstances that warrant this are exceedingly rare. If you are experiencing difficulties with sleep or anxiety, your doctor would be happy to discuss this with you and find another solution.

Your Past Medical Records

It is helpful to obtain copies of your past medical records, especially if you have any significant medical issues. This can be done by completing an authorization to release information form at the front desk. The Patient Services Representative will then send the form to your previous doctor(s) and/or hospital(s) to request the information. Sometimes your past doctor(s) and/or hospital(s) charge a fee to you for this service. You are responsible for paying this fee. However, this information can be important to your health care.

Non-Insured Services

Medicare covers most, but not all, medical treatments and services. Some common examples of services which are not covered include forms for school, work or insurance purposes, Driver’s Physicals, cosmetic procedures (e.g. skin tag removal, some wart treatments), TB skin testing, and some vaccinations. You are responsible for the payment of these services. We have a list of these services with the pricing for each item. You can ask your Patient Services Representative for a copy.

Forms

If you have a form to be filled out, please let the staff know when you book your appointment. Please make sure that you fill out all the sections that are “to be filled out by the applicant.” Some forms are quite simple, but others cannot be filled out at the time of the visit. Usually, forms can be filled out within 1-2 weeks, but it depends on the form. Please allow plenty of time for your doctor to complete your forms. In rare occasions, your doctor may feel that further information (such as testing or a specialist opinion) is needed before completing the form.

I look forward to getting to know you and your family, and to promoting your health.  Welcome!

Sincerely,
Dr. Amjed Kadhim-Saleh, MD, CCFP