We can do electrocardiograms and check implanted devices such as pacemakers and defibrillators, in the office. Stress tests and echocardiograms are done in a nearby hospital, which has much better equipment than we can afford.

We use an electronic medical record system for our records, and store your outside records on paper. Access to the electronic medical record is protected by industry-standard encryption, firewalling, and role-defined password protection. We do not share our electronic information with outside organizations such as the federal government except as needed for billing.

Our electronic medical record system includes reminders for standard clinical guidelines so that we can easily check that your medicines are correct for you when there are generally accepted guidelines for treatment. If you like, we can print out copies of the visit record for you to take with you at the end of your visit, and we can fax it to your other physicians also if you wish.

Parking is in an adjacent commercial garage. We do not pay parking at this time. Fees for parking range from $1 to $6.

1. You are the important one here. Ты самый важный здесь. Tú eres lo más importante aquí. Vous êtes ici le plus important.
2. Your appointment with the physician begins on time, or we pay you! (see Fine Print for details).
   Fine Print Payment is prorated and is based on the then-current fee schedule. For example, if the payment is $25 per hour in 15-min blocks for each hour your appointment is late 15 minutes or more, you would receive $6.25 if the appointment starts 15 to 29 minutes late, $12.50 if it starts 30-44 min late, and so forth. If you feel that these amounts are too little, let us know. Even the lowest amount will pay for your parking, though.
   The late-appointment payment does not apply if we notify you at least 24 hours in advance that the appointment cannot be kept or if the contact information we had on file did not allow us to notify you at least 24 hours in advance, and is set at a flat fee of $25 if we notify you at least an hour in advance of the appointment that it cannot be kept. Please note that we cannot use email or text messaging to communicate with you, per State law, without written permission prior to that particular communication, which means we cannot use those methods in this case. In the future, we plan to allow you to check the current status of your appointment time on our secure web site but this feature is not available at this time.
   There is a cap on the payment of two hours at the then-current rate. Thus, if the physician is called away for an emergency that lasts all day, our liability to you is capped at two hours at the late-payment rate. We would hope you would forgive us in case of an emergency involving another patient, but this would be your option since we could never give you details that you could use to verify that an emergency actually existed.
   The appointment start time for purposes of determining the payment due you if we are late is the time the physician greets you and is ready to see you. Sometimes we bring a patient into an exam room to measure the blood pressure, weight, and so forth, before the physician is available; this does not count for this purpose unless the physician is also available. Most of the time, however, the physician will greet you as you are brought from the waiting room. The start of the appointment for billing purposes (that is, determining how much you pay us) begins when the physician begins to discuss your case with you and/or your designated representative(s) and/or your permitted other individual(s). For example, "So, Ms. Doe, how has your husband John been doing?"
   Finally, payment is not payable if you are late for your appointment or during an Act of God as defined in law.
   Please let us know if you can think of any exceptions we have not mentioned here, or if you feel these conditions are unfair.
3. You can meet with the physician for an hour or more to discuss your situation and ask questions.
   The reason this is possible is that our fees are based on the time the physician spends on your case in person, on the telephone, in reviewing records, and so forth. This approach is the same as is used by many kinds of professionals: lawyers, accountants, financial planners, and consultants of all kinds. The reason physicians do not charge this way any more is that the insurance companies have required payment "by service" rather than "by time". The result, predictably, is that physicians under pressure to see more and more patients by reduced payments and, more often now, by the administrators for whom they work and by whom they are paid, reduce the amount of time they are able to give each patient. Fortunately, the insurance companies have driven down payments to physicians so low that many patients can afford an hour or two of the time of a high-trained physician for about the same as they would pay for an accountant or a low-priced lawyer. Why spend hours waiting for a rushed 5 to 15 minute visit when you have many questions and would gladly pay out of pocket if only there were someone you could pay to answer them? Now there is!
4. Follow up visits with the physician available by telephone or on our secure Web portal (currently in development) at no extra charge, saving you time and travel expenses.
   The reason that physicians often require patients to come to the office to renew prescriptions, receive test results even if they are normal, and to discuss issues that do not require physical contact, is simple: the insurance companies refuse to pay for such services unless the physician is face-to-face with the patient. Why? Ask them. So, the patient has to take time off from work or the home, face congested traffic and bad weather, find a parking place in a crowded garage risking collision with drivers who are distracted perhaps by their own health problems, wait for the physician, and then pay a co-pay. Instead, why not stay home or at work, find a comfortable place to sit, and either log onto a computer to leave an email and then later to review the response(s), or speak with the physician during a scheduled telephone visit? The fee is the same as it would be if you came to the office, but you save all the other headaches and expenses.
5. We can visit you at home and accompany you to your visits with other health care providers.
   Sometimes it is physically very difficult for a patient to travel, yet the matter of concern can be diagnosed and treated without the high-technology tools available in the office. Especially if transportation by ambulance is necessary, would it not be cheaper to bring the physician to the patient? This was the customary way things were done until the insurance companies set rates so that physicians could not afford to make home visits.

1. The Personalized Medical Office System is available currently only to patients who pay directly for service.
2. Out of state and International patients are welcome! However, all medical services are performed only in Texas. Our physician speaks English very well, and other languages not nearly as well (Spanish, French, Russian). Since clarity of communication is vital for good medical care, it would be wise to bring someone whom the patient trusts to serve as a translator if the patient cannot communicate well in English.