March 2016

A Q&A with OCFP CPD Faculty Member Dr. Jose Silveira

Dr. Jose Silveira, is the Psychiatrist-in-Chief at St. Joseph's Health Centre in Toronto, Co-Chair of the OCFP's Collaborative Mentoring Networks (CMHN/MMAP) and an OCFP CPD Faculty member who teaches the Mainpro-C accredited Managing Uncertainty. Through this workshop, he helps family physicians approach mental health care with confidence, even when diagnosis isn't clear. 
Photo of Dr Jose Silveira

What can physicians expect to take away from the Managing Uncertainty: A Novel Approach to Undifferentiated Mental Disorders course?

JS: Firstly, that the long-term nature of family medicine is perfectly suited to the assessment and management of mental disorders.  Secondly, a clear approach to identifying risks related to the presenting mental disorder regardless of diagnostic clarity.  The identification of risk allows the clinician to relax in their ongoing management of patients.

Why is it important for physicians to learn more about this topic?

JS: Family physicians as a group provide more mental health and addictions care to more Canadians than any other profession or specialty.  They have the unique advantage of following patients from cradle to grave and seeing patients in the early stages of illness.  Anxiety in managing mental disorders often arises from the uncertainty in the presentation and concern that, "I might miss something serious."  It is important that physicians be given a clear approach to identifying risks so that they can confidently follow their patients knowing that they have ruled out risks and mitigating risks that are present.


What do you think is the most useful practice-impacting insight from this course?

JS: That the challenge that most physicians experience in disentangling risks and diagnoses in patients presenting with mental disorders does not reflect on the physicians' knowledge and skill.  The challenge is inherent to the ambiguity of how patients present, the absence of objective measures and the abstract nature of the phenomena.

Tell us a bit about your professional history with this topic:

JS: As a psychiatrist working with family physicians for the past 18 years I have learned an enormous amount, especially by virtue of the questions that I have been asked.  Professionally, I have always struggled with the lack of prioritization in approaches to assessing mental disorders in conjunction with the absence of clear targets that are useful in primary care where most patients present and are managed.  I shared an approach for identifying risks related to presenting mental disorders that I found useful with a family physician peer one day, and I was surprised to hear that they found it useful. 

This approach is independent of diagnostic clarity and has three simple elements:

  1. Categories of risk to consider
  2. Areas of function that are commonly compromised in mental disorders
  3. Symptoms that one needs to worry about
Over the past eight years I have worked with Dr. Patricia Rockman, a family physician, to refine this approach based on the literature and through testing with practicing physicians.  Through combining medical decision making and the use of related literature, we have the current version of the approach, which is discussed in the Managing Uncertainty CPD course.


Dr. Jose Silveira is an Assistant Professor in the Department of Psychiatry at the University of Toronto; Psychiatrist-in-Chief at St. Joseph’s Health Centre in Toronto, as well as the Medical Director of Mental Health and Addiction Programs. He works closely with primary care physicians and co-chairs the OCFP's Collaborative Mentoring Networks (CMHN/MMAP).

In addition, Dr. Silveira has served as a psychiatrist providing shared care with numerous Community Health Centres and Family Health Teams throughout his career.

Dr. Silveira’s workshops and seminars are designed to be practical and assist family physicians with comprehensive primary care practices and manage undifferentiated mental disorders, including addictions.

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