Preparing for Your Appointment

Telehealth/Phone visits encompass patient consultations which are not ‘in person’. This includes phone and video conferencing. These are utilized for both new and follow-up appointments. Assume that your appointment will be by phone unless otherwise specified. Phone visits are more convenient for patients, allow us to more quickly assess your needs and minimize traffic in the office. We will schedule you for an in-office appointment if necessary.

Please do your best to be available for your call on the day of your appointment and to accept calls from a blocked number. Appointments are scheduled for specific DAY - not at a specific time.

We have taken this approach to manage expectations. This is especially for those who do not appreciate the convenience of a phone call and that our schedules are complex and inherently unpredictable because of emergencies.

We will attempt to call the number(s) that was provided a minimum of TWO (2) TIMES.

Please be aware that there is a high demand for surgical care and be considerate of other patients by making yourself available. Please review the Office Policies section for information on No-Show fees.

Have someone who can speak English. Ensure there is someone available to translate if you are unable to communicate in English.

Consultations generally take between 5-15 minutes. The length of consultation will depend on the nature of the problem. Your surgeon will have reviewed all or the documentation prior to your visit and then complete a report and any paperwork (e.g. lab requisitions, referrals, operative room booking forms, etc.) after the meeting. Additional appointments will be scheduled as needed. You may be sent additional information or have arrangements for additional testing scheduled at the completion of the consultation.

If you do not hear from us within the call window, do not call the office the SAME day. We value your time. Surgical practice is inherently unpredictable. If the surgeon does not call it means that they been delayed by an emergency. We appreciate your understanding.

We may try and call you later in the day. If you are unavailable, we will prioritize re-booking of your consultation and send you notification.

Feel free to call the next business day if you do not hear from us the day of consultation.

Have the following information available.

Past medical history, allergies, medications.

Email address.

If this is a follow-up, ensure you have completed the reiommended investigations well in advance of your appointment.

DO NOT do the following:

Do not come to the office unless you are scheduled for an in-office appointment.

Do not call the office the day of your appointment if you have not heard from us within the time window. If we are delayed by an emergency, we will try and call you later in the day and if we are unable to reach you will reschedule you.

If you need to cancel, please notify us as soon as possible.

In-office appointments are scheduled when face-to-face discussion or physical examination are necessary.

Please arrive no sooner than 15 minutes prior to your scheduled time.

The duration of the appointment will be between 5-15 minutes depending on the nature of your problem. Your surgeon will have reviewed all or the documentation prior to your visit and then complete a report and any paperwork (e.g. lab requisitions, referrals, operative room booking forms, etc.) after the meeting. Additional appointments will be scheduled as needed. You may be sent additional information or have arrangements for additional testing scheduled at the completion of the consultation.

Every effort is made to be on time. We value your time. However, your wait time may be prolonged if the surgeon is needed to address an emergency. Please let reception know if you are pressed for time so we may expedite your visit or reschedule.

You may be requested to complete a pre-visit questionnaire (see below). Ensure you have a list of your medications and allergies and have a list of your health issues available.

Have someone to translate if you cannot speak English.

Masks are optional.

We prefer that only the patient attends. Exceptions include someone to translate or ONE parent if the patient is under the age of 18. We will consider requests for other individuals on a case by case basis.

Do not come to the office if:

You have symptoms of COVID infection.

Fever, diarrhoea, sore throat, cough or chills

Please be aware that there is a high demand for surgical care and a limited number of in-office appointments. Be considerate of other patients by making yourself available. Please review the Office Policies section for information on No-Show fees.

Some patients are triaged directly for a combined cystoscopy and consultation. In select circumstances thiallow us to provide the most efficient level of care by expediting a diagnosis. Cystoscopy allows us to evaluate the anatomy of the lower urinary tract.

CLICK HERE TO LEARN ABOUT CYSTOSCOPY

This form of evaluation is indispensable in the following situations:

Blood in the urine (hematuria). Cystoscopy is the essential test to check for bladder cancer.

Lower urinary tract dysfunction, especially in cases where the condition has not been responsive to standard treatment.

Assessment of symptoms following any surgery on the lower urinary tract (e.g. radical prostatectomy, TURP, urethral stricture surgery, incontinence surgery).

Complicated urinary tract infections.

There are 3 locations where we perform cystoscopy and we will inform you where to go.

Richmond Hospital ambulatory Care

UBC Hospital Bladder Care Centre

Delta Hospital endoscopy clinic

If you are uncomfortable proceeding with cystoscopy/consultation after reviewing the information on cystoscopy, please let our office know. We would be pleased to schedule a Televisit/phone consultation first though this may delay making a diagnosis.

Please review the Office Policies section for information on No-Show fees.

BASIC MALE QUESTIONNAIRE - MUST COMPLETE

Select any of the following that apply to you:

Urinate too frequently during the day or night – voiding diary

Blood in the urine (hematuria)

Kidney stones

Difficulty having children – Infertility

Vasectomy

Vasectomy reversal

Kidney stones

After radical prostatectomyKidney stones

BASIC FEMALE QUESTIONNAIRE - MUST COMPLETE

Select any of the following that apply to you:

Urinate too frequently during the day or night – voiding diary

Blood in the urine (hematuria)

Bladder infections – recurrent UTI

Kidney stones

Basic questionnaire

Voiding diary

Community emergency surgery instructions

Surgical admission RICHMOND Hospital

Surgical admission DELTA Hospital

A referral from a general practitioner or another physician is required by the Medical Services Plan for urological consultation. Your appointment has been scheduled based at the earliest possible time available for your type of consultation. Wait times are an inherent property of the public health care system. You may be re-directed to another urologist within our group if they have a shorter wait time and are able to assess your case or if your problem would be better served by the subspecialty training of another urologist.

Please consult the referring physician if you are a new patient and feel that a more urgent consultation is needed. We would be pleased to review/discuss any concerns with them and welcome correspondence in writing. They have the ability to contact our office.

We take into account the following considerations when triaging requests for consultation.

Practice capacity. This is the primary consideration. We are obligated to assess emergent and then urgent referrals first. Any other type of referral will be scheduled after the more urgent consultations have been addressed. If our capacity to review a consultation within 1-2 years is exceeded, we may decline the request and will advise the referring physicians so that they may seek care for you elsewhere. We will do our best to provide assistance to your physician.

Medical necessity. We have a duty to triage referrals based on need. Need is assessed by the documentation provided by your referring physician. A prolonged wait time is far more likely if the referral is deficient and does not allow us to assess medical necessity. The College of Physician and Surgeons of BC requires referring physicians to include a history, physical examination, past medical history, medications and investigations that would be reasonably expected to be within the scope of practice for a primary care or referring physician. The referral should include a question or problem that merits assessment by a urologist.

Resource availability. This primarily applies to vasectomy referrals. We will not accept consultations that grow our waitlist for surgery to greater than 1-2 years. This permits patients to seek care elsewhere. Note that vasectomy is a core skill for urologists.

Geography/scope of practice. We have a duty to provide care to our community in a timely manner. We may redirect your physician to seek care from a urologist closer to where you live - the exception being subspecialty services that are not available elsewhere.

Second opinions/pre-existing relationships. If your physician has requested a second opinion and you have already been assessed by a urologist, we expect complete medical records from those interactions (consultations, investigations, operative reports). In cases where the patient has been dissatisfied with the care provided we request that those concerns first be brought to the attention of the urologist (either by the patient or their physician) to provide them an opportunity to address those concerns. If you have surgery scheduled with another urologist and desire discussion of what is involved with that surgery we ask that you discuss those concerns with the operating surgeon. The same applies for any complications that may have arisen from surgery. In scheduling second opinions, we will take in to consideration the wait times for those who have not yet received a first opinion.

Patients with emergencies requiring immediate care are directed to call 9-1-1 or proceed to their nearest emergency room.

Patients may call 8-1-1 to receive general health advice.

A urologist is always available through the Richmond Emergency room when after hours care is necessary. The emergency room physician will determine the necessity of after hours urological consultation.

We encourage patients to utilize this website to assist in determining if a peri-operative concern requires immediate care. This advice is not a substitute for sound judgement and patients are advised to follow the advice regarding accessing Emergency Room Services

We adhere to the College of Physicians and Surgeons of BC Medical Practice Standard pertaining to Certificates and Other Third-party Reports . This includes insurance forms (including extended health forms) and letters of absence from work. We also adhere to the CPSBC guidelines on Medical Records Management and Medical Records Documentation.

In addition to the guidelines from the CPSBC on medical records documentation and management, your information is also subject to the Personal Information Protection Act (PIPA).

Completion of forms and transfer of records require a patient’s valid and documented written consent.

Requests will be completed in a reasonable time frame. This is usually considered to be within 30 business days of the request but may be sooner.

Completion of forms and provision of test results is not a service insured service by the Medical Service Plan. Fees will apply for completion of forms, transfer of records and any discussion necessary to accomplish such requests.

We cannot conceal or withhold relevant information with the exception of that allowed in specific circumstances by legislation (e.g. genetic test results).

Management of patients is holistic (we treat ‘people who happen to have illness’, not ‘just diseases’). As a consequence, your record will contain information provided by the referring physician and may include information provided by other physicians involved in your care or information from a public health care facility that you may have attended (e.g., a hospital). Our records may contain a significant amount of information.

The information in your medical record includes, but is not limited to, the following: contact information, your history, physical exam findings, past medical history, past surgical history, allergies, medications, personal habits, marital status, and investigations. Investigations may include but are not limited to laboratory investigations, imaging results, surgical reports and pathology reports.

Safe and competent surgical care requires comprehensive knowledge of the entire patient’s condition. This documentation may include sensitive information including any psychiatric issues and substance abuse disclosed by you and/or by your other health-care providers. These impact on the care of patients including the safe conduct of surgery and anesthesia including peri-operative care. We encourage patients to be forthright and honest about those issues to avoid undesirable outcomes.

The College of Physicians and Surgeons of BC recognizes and requires communication between treating physicians with the purpose of providing care. Patient consent for transfer or records between registrants or other health-care physicians is deemed to be implicit with few exceptions. Our records may contain documentation from other physicians or health-care providers.

Please make your urologist aware if you have questions regarding the content of your medical records, the scope, purpose, and likely consequences of disclosure of your personal health information. We will do our best to answer those questions and would be pleased to review your medical record with you personally or conversely provide a copy for your review. Fees will apply.

Fees for Non-Insured Services

Fees are charged in accordance with the Doctors of BC guidelines. Note that there are no fees when the transfer of records if required for direct care of the patient and those records are transferred to recognized health care providers within the patient’s circle of care. The patient’s circle of care does not include friends or relatives who may happen to be health care professionals.

Copies or transfer of the entire chart for the patient when accompanying a form (e.g., when required for completion of insurance or disability forms) OR when requested by the patient: $30 for electronic transfer by email; photocopying, printing or faxing $1/page for the first 10 pages and $0.30/page for subsequent pages. Fees are charged for each individual request or form. Additional fees to complete forms may apply. Requests for individual results are charged differently.

Written certificates, including time loss benefit forms, insurance forms, critical illness forms, etc.: $50 for completion of each form; additional fees for copies or transfer or chart when required.

Requests for individual results/reports by the patient (electronic or printed results): $10 for each result/report and $2 for each additional result/report to include either printing or electronic transfer by email. Additional fees to mail results.

Transfer of patient records to another physician (basic): $35

Review of records for medicolegal purposes or when review is required prior to transfer of records: $125 per 15 minutes or portion thereof; additional fees for copies or transfer of the chart.

Prescription renewal by telephone: $30

If you do not carry insurance through the Medical Services Plan or request an uninsured service we will provide you a quote prior to providing the service or scheduling an appointment.

You may be able to retrieve copies of lab results by setting up a client account through Life Labs.

At the present time, our electronic medical records vendor does not have a ‘patient portal’ that will allow you to retrieve results.

Consent for Release of Records to Third Parties

Failure to attend for appointments will result in the assessment of a fee. This is meant to deter abuse of the health care system which is a shared, publicly funded, and limited resource. Failure to attend for appointments deprives other patients from care wastes precious heath care funding.

Fees will be assessed on a case-by-case basis. For cancellation or rescheduling, please provide at least:

10 business days notification for surgery (including vasectomy).

5 business days notification for cystoscopy.

2 business days notification for all other types of appointments.

Televisit/phone no-show/late cancellation: $50

In-office no-show/late cancellation: $100

Cystoscopy no-show/late cancellation: $100

Vasectomy no-show/late cancellation: $150

Surgery no-show/late cancellation: $300

Notes: Notification times were chosen to allow enough time to schedule a replacement patient into the appointment.

Hospitals require a minimum of one (1) month advance confirmation for surgery bookings.

No cancellation fee will be assessed if the surgery is cancelled or rebooked at the direction of our office - this typically occurs if the hospital cancels or restricts an operative day. In this case, neither patient nor surgeon are compensated.

We adhere to the College of Physicians and Surgeons Practice Standard pertaining to Medical Records, Data Stewardship and Confidentiality of Personal Health Information .

Patents are entitled to examine and/or receive a copy of their medical record, which includes any records created by other registrants, upon request. Practice standards specify a response to a patient’s request for such information within 30 business days.

Transfer of records and providing copies of reports/results is not an insured service and fees may apply (see Forms, Copies of Reports & Non-Insured Services).

Please note that we may, at our discretion and on a case by case basis, provide copes of results either in paper or by email at no charge. Requests for records is time consuming and a reasonable fee may be assessed. For many types of results, you can set up an account at LifeLabs or via the BC government website.

The patient-physician relationship may come to an end for many reasons.

No ongoing need for specialist care.

Many patients do not require ongoing specialty care. This allows us to assess patients who need our specialized skills. We will send instructions on any ongoing monitoring or prescription renewals to your family physician. They may refer you back to us if there is a change in your condition or if they are not comfortable managing your condition.

You (the patient) does not feel that ongoing care is necessary.

You are free to end your relationship with your urologist. We’re sorry to see you go and recommend that if you have concerns regarding your care you approach your urologist about those concerns. We’re happy to receive complaints in writing if that is preferable to you. In selecting this option, you acknowledge that you understand the following:

We strongly recommend that you discuss the nature of your condition with your urologist or family physician if you are unsure if it is safe to terminate urological care.

You understand that your referring physician or your urologist believe that ongoing care is necessary to address your medical condition.

You understand that in certain circumstances (for example, cancer care, cancer screening or urinary tract obstruction) that failure to follow the advice of your physicians may lead to undesirable outcomes including but not limited to a worse prognosis or death.

We will make no further attempt to contact you.

We will not schedule additional appointments without a repeat referral.

We will send notification of your decision to terminate the relationship to the referring physician.

We remain available to address any emergent or urgent conditions at the request of another physician.

At any time, you may ask your family physician or other physician to:

Make a referral back to the same urologist or another urologist in our office. For referral to another urologist in our office we recommend that you review the information on second opinions in the ‘Office Policy’ section.

Refer you to another urologist in a different practice group.

We (the urologist) do not feel that an effective therapeutic relationship exists.

Not every patient and urologist is the right match. Sometimes the patient does not require specialized care (but the patient prefers to continue with that care). Whatever the reason, we acknowledge that the relationship is based on honesty, respect and trust and if these cannot be established then the patient may be better off seeking care elsewhere. We follow the BC College of Physicians and Surgeons Practice Standards in ending the patient-physician relationship.

We will do our best to resolve any concerns and remain available for emergency care.

Second Opinions

Your health, your choice. At any time, you may request a second opinion on your condition either from your family physician or your urologist. We are here to provide advice and understand that sometimes patients may wish to determine if there are other options available or are dissatisfied with the advice they have received. We recommend first addressing any concerns you might have with your urologist to clarify the situation.

If you have a particular procedure in mind, we will endeavour to refer you to someone who is able to provide that service. In cases where the desired service is out of country, it is often best that the patient approach the care provider directly and we are happy to provide copies of medical records to the patient or transfer to that provider if the patient provides contact information and a signed release form (fees will apply).

Patients interested in a clinical trial available locally can request referral for this though in most cases your urologist will be aware of trials that are accusing patients and offer your this option and a consultation with the trial physician.

For experimental procedures or those which are not considered a standard of care, we will provide appropriate guidance. Patients may learn about treatments from reading the internet and in many cases those treatments are unproven, harmful, may delay appropriate treatment and are frequently non-insured and expensive. We advise patients to exercise caution regarding advertisements for medical treatments available in print, radio, television or online.

Physicians are not obligated to refer a patient for interventions which do not have an established tract record, are not considered a standard of care or experimental treatments that are not available in the context of a clinical trial (with institutional review board oversight and appropriate patient consent). Patients may request copies of their medical records and may seek such investigational or experimental treatment on their own but the professional and ethical obligations of their urologist may preclude any participation in ongoing care in which the treatments are inappropriate.