NOTICE TO OUR PATIENTS

APPOINTMENTS
We are doing our best to keep our patients safe and away from exposure. Effective Monday, 3/23/2020, all appointments will be conducted via telemedicine (over the telephone). Callers should contact us at 512-321-3311 to schedule an appointment. Also, please note that our office hours to answer phone calls until further notice will be from 8:00 AM - 4:30 PM.

We are accepting new patients for virtual (visual) telemedicine appointments via Doxy.me, except for new patients needing controlled substances; the Texas Medical Board only allows telemedicine for established patients needing controlled substances. Patients must have access to a web cam enabled computer or smartphone. No audio telephone visits will be allowed for new patients. Appointments will only be scheduled after receipt of the new patient packet, including insurance information.

Patients will be required to:
Register for our patient portal.
Review via the portal: "HIPAA Notice of Privacy Notices" and "Telemedicine for New Patients" information sheet.
Print off, complete, and return the packet via the portal or fax (512-321-2611), including: "Telemedicine Informed Consent Form" and "New Patient Packet", along with valid proof of identification and proof of insurance.

Upon receipt of all completed documents, staff will contact the patient to schedule a new patient appointment. Appointments are generally scheduled 1-2 days later for insurance verification purposes.

Patients must have a cell phone/computer with a camera to activate voice and camera capabilities at the time of the appointment. Please note that it is the patient's responsibility to ensure that they have appropriate internet connectivity; if there are connectivity issues, we will not be able to conduct the telemedicine visit and the submitted information will be retained on file for when we resume in-person visits.

It is in our patients’ best interest and the best interest of our other patients, many who have chronic conditions, for patients with impaired immune systems, including those with fever, cough/sore throat, and respiratory symptoms to stay home. At any time that a patient’s mild symptoms become more acute or if they experience shortness of breath, that patient should go to the hospital, calling them ahead of time to determine recommended treatment. All of these efforts are attempts to keep spread at a minimum, and hopefully things will be back to normal in a few weeks. 

It is an awesome privilege to serve the medical needs of our community during times of uncertainty.

CORONAVIRUS (COVID-19)
As coronavirus continues to spread across the globe, here is everything you need to know about this virus.
Most coronaviruses cause mild symptoms that patients easily recover from. Senior citizens and those with immune deficiencies or underlying illnesses could have an acute reaction if exposed to the virus.

Many symptoms of COVID-19 and influenza overlap, here’s how to spot the differences.“There is so much overlap in symptoms between flu and COVID-19 but a couple of hallmark differences do exist,” Dr. Caesar Djavaherian, co-founder of Carbon Health. “Influenza tends to cause much more body pain and the COVID-19 virus tends to feel much more like the common cold with fever, cough, runny nose and diarrhea. However, in a small portion of the population with either COVID-19 or influenza, symptoms progress to kidney failure and respiratory failure.”“The differences arise in the very small portion of the population who are at risk because of their lung or heart conditions whose lungs can fill with fluid or go into kidney failure and unfortunately, eventually die, with COVID-19,” Djavaherian said.

One of the most imperative ways to stop the spread, experts say, is to avoid contact with a sick person, and to practice your own good hygiene. Part of that includes staying home when you’re sick and thoroughly washing hands.

“If you are sick, monitor your symptoms daily, and when your common cold turns into a deep unrelenting cough and then shortness of breath, those are the signs that we worry about and the signs that require patients to get medical attention right away,” Djavaherian said. “They may be from pneumonia but in a very, very small group of patients, maybe a COVID-19 infection that has gone into the lungs.”


It’s imperative to call your health care provider ahead of time to share your symptoms and concerns so that they can prepare the appropriate tests and protect others from potential exposure.


“I also recommend using telemedicine, where you can see a doctor via phone or video, to get your questions answered from the comfort and safety of your own home without putting others or yourself at risk,” he said.
 
Person-to-person transmissions are thought to occur when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. Keeping your home and surfaces clean using the correct disinfectants is crucial in preventing its spread. The novel coronavirus may be able to live on surfaces, namely metal, glass or plastic, for up to nine days:
Wash your hands with soap and water for at least 20 seconds  
Avoid touching your eyes, nose and mouth with dirty hands 
Avoid close contact with sick people 

If you are sick, you can protect others by:
Staying home until you are well 
Avoiding close contact with others 
Covering your nose and mouth when sneezing or coughing
Keeping objects and surfaces in your home or workspace clean and disinfected.

How to safely care for a sick relative:
Health officials are urging anyone who feels ill to isolate and stay home. Even if the patient does test positive, it can be considered safe to continue supporting them with some extra precautions. Make sure the patient is following their healthcare provider’s instructions for medication and care, Help them with getting groceries or prescriptions and help to monitor their symptoms for any signs of worsening illness.  Household members should wear a facemask around the patient and stay in a separate room and be separated as much as possible. Visitors should also be prohibited in the home, and patients should not care for household pets while sick.  According to the CDC, those include washing hands with soap and water for at least 20 seconds or using an alcohol-based hand sanitizer with at least 60 percent alcohol, avoiding touching your eyes, nose and mouth, and covering your cough or sneeze with a tissue. It’s also advised to practice cleaning and disinfecting frequently touched objects and surfaces.  Once the patient has begun to improve, it’s still important to take steps in minimizing secondary transmission.

“The decision to discontinue home isolation precautions should be made on a case-by-case basis in consultation with healthcare providers,” Guzman said. “If you are living under the same roof as a family member with confirmed COVID-19 it is best to continue to follow distance precautions as mentioned above by the CDC.”
Before being tested for the COVID-19, patients must first answer a series of questions, including where they have been and if they are experiencing shortness of breath, or have been exposed to someone with the virus, 
If a doctor determines a patient to be “a person under suspicion” for the virus, a nasal or throat swab is then performed to obtain a sample.

Infected patients should treat symptoms the same way they would a cold -- with rest, pain or fever medication and plenty of fluids.

Learn how we can care for you...

Our team of medical professionals have served Texas families for more than 20 years. We are dedicated to offering same-day appointments with our highly experienced providers in an effort to minimize wait time. Our focus on personalized relationship driven service for the entire family motivates us to share in an exceptional patient experience every single visit. Please take our patient survey and let us know if we are meeting this goal.

The Case for Having a Primary Care Physician

"You’re young, you’re healthy, and you’re very, very busy. Do you really need a primary care physician? The short answer is, “Yes, you do.”

If you’re satisfied with that response, you probably already have one. But maybe you–or your best friend or your kid brother–are not yet convinced. I can practically hear your voice rising two octaves in protest: You’re perfectly healthy and you always have been with the exception of that broken arm in third grade, the surgery on your wisdom teeth, and the occasional cold.

So, why should you get yourself a primary care physician? Is it because you need lots of tests and blood labs and all that jazz to make sure you don’t have a hidden cancer? No. You can breathe a sigh of relief – that is not the reason.

Put simply, having a primary care physician will keep you healthier as you age. Studies in numerous medical journals have confirmed this, including one in International Journal of Health Services which revealed that states with more primary care physicians per capita have better health outcomes, including fewer deaths from cancer, heart disease, or stroke. A separate study in the same journal suggests that an ample supply of primary care physicians is associated with a longer life span–if you add more primary care physicians to a community, the result is fewer premature deaths.

How is it that a primary care physician could have such a big impact on your health, you ask? The key is what’s known in the medical community as “continuity of care.” Continuity of care means that you establish a relationship with a health care provider and you enhance that relationship year after year. This provider gets to know you and your health goals, and helps you manage your overall progress. Continuity provides tangible benefits that have been proven to add up to better health. Here are just a few:

Someone to Watch Over You

In the short term, continuity of care dramatically increases the likelihood that you’ll receive a correct diagnosis and appropriate treatment. “The best diagnostic test available to a doctor is the test of time,” says One Medical Group physician Andrew Diamond. “Your primary care physician gains valuable information from tracking a problem over time –whether for a week, two weeks, or a month–and can make treatment decisions accordingly.” Think of the other extreme: If you go to the ER with a problem, the providers don’t expect they’ll ever see you again, so they’re likely to order extra tests and treatments to cover all the possible bases at once.

Over the long term, a provider who knows your health history, your habits, and your personality can more easily recognize signs that indicate a potential change in your health. For example, if you complain of fatigue to a doctor who doesn’t know you, you might not be taken seriously – but your primary care doctor will be able to see that you aren’t your usual self. On the flip side, that same provider will be able to reassure you when you’re not sick–they’ll know that the mole you’re worried about on your back isn’t a problem because it hasn’t changed in the six years they’ve observed it.

One Point Person

If you need to see a specialist, a skillful primary care physician will refer you to someone they know and with whom they have a collaborative relationship. If you have concerns about getting different suggestions from different specialists, your primary care physician can help you sort through and prioritize which suggestions to act on first. “This is the concept that’s known as the ‘medical home,'” says Richard Madden, MD, a family physician who serves on the board of directors of the American Academy of Family Physicians. “Your primary care physician has a working relationship with their referrals and keeps track of your care with them.”

Save Time Down the Line

Setting up a relationship with a consistent provider can help you get care more quickly should you get sick in the future–whether it’s a pesky sinus infection or something more serious. “When you’ve established care and set up that relationship, it’s much easier for us to help you down the line,” says One Medical Family and Nurse Practitioner Meg Scott. “We know your history, we know more about you, we can even help you resolve things over the phone or via email sometimes.”

Prevent Future Illness

And finally, if you come in for regular physicals instead of only coming in when you’re sick, your primary provider can help educate you about your health and prevent chronic illnesses down the line. “When we do a physical, we do a lot of routine, basic checks. But coming in regularly can be very valuable to your long-term health,” says Scott. She says she covers a lot of ground in a yearly physical, dispensing information tailored to the unique needs and goals of each patient. The range of topics may include education about high blood pressure, weight loss, STD prevention, alcohol and tobacco use, or stress and anxiety. “It’s proactive and preventive at the same time,” she says.

The Problem with Self Referrals

Still not convinced you need a point person to help you manage your health? Think it saves you time to go directly to a specialist when you sense something is wrong? Think again. When you refer yourself to a specialist without seeing a primary care physician first, says Madden, “You’ve already identified a certain part of your body as the source of the problem and chosen a specialist based on that.” Sometimes the problem is fairly obvious: You’re having a skin problem, so you go to a dermatologist. But what happens when you have chest pain? You might decide that you need to see a cardiologist, who will evaluate your problem through a cardiologist’s lens, looking for cardiac explanations and ordering tests of your cardiac function.

But what if those tests are inconclusive? Will you seek out a different cardiologist who will repeat the same tests, hoping for an answer this time? What if your chest pain isn’t caused by a cardiac problem? What if it’s coming from your gastrointestinal system, or from your lungs? Will you take yourself to a gastroenterologist, or a pulmonologist, and go through all the specialized tests they recommend, too?

All those visits take time, delaying your diagnosis. And all that testing can be dangerous. “There can be harm in overtesting,” says Madden. “There can be complications or pain, and lots of costs that could have been avoided.” Diamond agrees, “Many tests involve radiation, toxins, or invasive procedures that carry significant risks. Tests can give ‘false positive’ results, prompting treatment for an illness that you don’t have. And tests can detect miscellaneous irregularities unrelated to your complaint – leaving you stuck with even more testing to prove those are benign.”

In contrast, when you go to a primary care physician whose goal is to consider the whole of the person, says Madden, “You avoid a narrow approach to your problem and the unnecessary tests that go with that.”

The Big Picture

The point Madden makes is key: Everyone should have a provider who can step back and look at the “big picture” of their health–especially during times when a diagnosis is needed. This is what primary care physicians are trained to do. In medical terms this approach is called a “a broad differential diagnosis.” As Diamond explains it, “Any set of symptoms can have a lot of possible explanations. A primary care physician has to have an open mind, listen carefully, and consider all the possibilities.”

What to Look For

What should you look for in a primary care provider? Along with feeling a sense of safety, rapport, and trust, Madden recommends finding a practitioner who conveys a sense of thoroughness and a depth of knowledge. He also recommends finding a provider who values your input and opinion. “You want to feel like you’re involved in the process of decision-making.” For example, if your doctor recommends tests she might then ask, ‘How do you feel about that? Is this what you’re looking for? Does it seem reasonable? Is it affordable?’ Meg Scott agrees. “It’s not a one-directional relationship, it’s bi-directional,” she says. “The goal of each visit should be to have a level playing field, where you can voice your concerns openly and you walk out the door feeling like you were really listened to and you’ve got a plan that’s going to work for you.”"

My latest visit was one of the best doctor visits I have ever had.
I had several issues to deal with, and they were all handled thoroughly and thoughtfully.
I highly recommend Dr. Lerma's clinic!
I have been a patient of Dr. Lerma for about 6 years.
I drive 2 hours for my visits because he has been my Doctor for so long and I fell very comfortable with him. He takes his time and asks me questions to where I fell that he cares about my health. The staff are always so helpful when I have trouble with my insurance or need to change my appointment.
In being a long term patient,I have always been satisfied with all staff here.
I've been going  to Dr. Lerma for over 10 years.
He has a heart of gold and is the best doctor I've ever been to.
Office staff is always very attentive and helpful.
Appointments are scheduled quickly and within a day or two. Immediately if necessary.