Dear friends and patients of the Family Doctors of Belleview,

As we at FDB continue to strive to improve our practice and the care we are able to provide our patients, we review many issues/areas that impact that care in the hope that impediments can be identified and eliminated. We observe that there may be some confusion about how appointments are scheduled. Although, we do not advertise "specific visit types," we do think of patient encounters as existing in several forms which require different preparation and different amounts of time allotted for the visits:

• Get established visits
• Routine follow-up visit
• Specific problem visit
• Specific follow-up visit
• Hospital follow-up visit
• Annual physical exam/preventative care visit

The Get established visits are scheduled soon after a patient decides to become an established patient at FDB. It usually entails 2 visits, the first to provide an extensive history --the most important information that any health care provider can have-- and the second to perform an extensive physical examination. It is at these visits that the recommendations might be made for further testing--laboratory studies, EKGs, X-rays, etc.----all based on the information obtained by completing the history and physical examination. The amount of time allotted for these visits is usually between 30-45 minutes. Refills of medications and prescriptions for new medicines may be provided. Probably most importantly, recommendations can be made and a plan devised for the best way to manage medical problems that already exist and prevent undesirable ones (such as heart attacks, strokes, and cancer) from happening in the near future! You are now on your way to better health!

Once you have become an established patient at FDB, your health provider may suggest that you return periodically for routine follow-up visits. These visits may be scheduled as frequently as every 3 months or as infrequently as once a year depending on the complexity of your health care. These visits may be preceded by a trip to the laboratory for phlebotomy ("blood drawing") one week prior to the visit. This will allow us to review your labs with you and allow us to discuss any problems and answer any questions. Since most people grow up with the idea that one goes to the doctor "only when sick or needing medicine," the idea of a routine follow-up visit may be a bit foreign to you! The agenda is usually set by the provider-he/she knows why he is requesting the visit and presumes that the content of the visit will reflect the need to follow those problems previously identified. The amount of time allotted for these visits may vary between 15 and 30 minutes depending on the complexity of the problems to be reviewed and managed. Please understand that it is usually not possible to review every problem at these visits, and it is assumed that no new problems will be managed.

If a new problem has developed since your previous visit, we hope that you will schedule a specific problem visit. We certainly do not discourage you from expressing your concerns about a new problem as long as you understand that the provider may request that you schedule another visit in the near future to manage that problem. Sometimes the new problem is serious enough to require attention at that visit. If so, your provider will do all he/she can to manage the problem at that time. He/she may then ask you to reschedule for a routine visit-----in effect simply substituting a specific problem visit for a routine follow-up visit! Please understand that time and scheduling simply do not allow both types of visits to be performed at the same time! Patients with very complex medical problems will obviously require more attention from the provider and more frequent visits for appropriate care.

Establishing as a patient with The Family Doctors of Belleview offers you the opportunity to take advantage of all the services we have made available to provide great care to our patients. Although we believe that maintaining health should be one of our most vital mutual goals, you obviously will also need care when you become sick! We are very capable and happy to manage that area of you health care too! The specific problem visit is the venue for receiving that care. The office staff with whom you communicate initially will ask a few basic questions and then help you make the appointment. These appointments may vary between 10-20 minutes, and may include tests that the provider feels are necessary to "get the answers" that lead to appropriate diagnosis and treatment. Medications may be prescribed and referrals to consultant specialist may be arranged. Arrangements for admission to a hospital - - may be made if needed! If your provider is not available because of meetings, vacation, or a very full schedule, your visit may be scheduled with another provider from our office.

After your provider has evaluated and treated you for a specific problem, he/she may ask you to return for a specific follow-up visit to monitor the progress of the intervention started at the initial visit and to assure that the healing process is proceeding as expected.. You may be asked to schedule such a visit to re-evaluate a wound and/or remove sutures. Sometimes the initial intervention may not be working as well as was hoped, and a referral to a consultant/specialist may be arranged. These follow-up visits are often scheduled with your usual provider to allow him/her to review care that may have been rendered by someone else at the previous visit. These visits tend be a bit shorter and quicker than other visits, usually 5-1 5 minutes, and the agenda is specific---following the progress of that specific problem for which it was scheduled. If you do need to mention another problem, please understand that another visit may be scheduled to manage that problem.  BUT it is very important for you to understand this: your provider remains aware of your entire medical history and takes that into consideration when decisions are made about any new problems! So, the provider may mention your weight or blood pressure or an abnormal lab or other aspect of your routine care at the visit as part of his/her commitment to you to provide the best care possible in the most efficient and expedient manner.

Becoming sick enough to require hospitalization is a reality that we all hope to avoid. After you leave the hospital, you will be asked to make a hospital follow-up visit with your provider. The purpose of this visit is to help the patient understand the hospital experience---what happened, what was done, explain test results, interpret information provided by other physicians in the hospital that might have been confusing, and to review the patient's progress during the recovery period. Usually 15-30 minutes are allotted for this visit. It may be necessary to obtain additional information (lab tests, x-rays, etc.) at the visit, and review and adjustment of medications is quite commonly required.

Finally, it is often beneficial to dedicate a visit to a general and broad review of your health and to provide preventative services such as cancer screenings, cholesterol screening, osteoporosis screening, etc. This is accomplished at an annual physical examination/preventative care visit. For children, these visits are recommended and performed very often in the first 2 years (2 weeks, 2-4-6-9-12-15-18-24 months and then annually through age 11) because children are growing and changing so rapidly, and monitoring development is so important. In adults, these visits may not be recommended every 1-3 years-perhaps even less often in a healthy individual who has been followed regularly through routine visits. The agenda for these visits is to review all the care that has occurred in the past few years, identify any problems that may not be obvious by performing an updated history and physical examination and performing appropriate testing, to screen for common problems and initiate intervention if identified. It is also an opportunity to receive information that may be valuable to the patient to maintain a healthy lifestyle, such as information on available vaccinations, new medical research findings, services available in the community for specific problems, etc. Medications may be adjusted, renewed, or changed, and particular concerns that a patient may have about medications may be discussed. Time allotted for these visits is usually 40-60 minutes.

We understand that you are concerned about your health, and we are honored that you have chosen The Family Doctors of Belleview as your medical home. We take your trust very seriously, and believe that at the core of everything we do at FDB should be the recognition of our responsibility to provide the very best health care we can to our patients. Our pledge to you is to continue to explore and create ways to make that possible. Together, we believe that we can make it work and keep you as healthy as you hope to be!