Our differential.
In a chart, a differential is a ranked list of what could be causing a problem, most likely first. This is ours, for primary care in general.
The appointment slot became the unit of care, not the patient.
Scheduling systems are built to fill eleven-minute slots efficiently, which is a genuinely different goal than caring for a specific person well. Once the slot is the unit being optimized, the patient becomes the thing that has to fit inside it.
Documentation started serving the insurer, not the patient.
A chart note today has to satisfy billing codes before it has to be useful to the next doctor who reads it. We've seen notes so dense with required billing language that the actual clinical picture is buried in the third paragraph.
Panel sizes grew until relationships became structurally impossible.
You cannot know three thousand people. At some point, panel size stops being a business decision and starts being a description of how much of "knowing your doctor" is actually still possible.
Access became something you had to earn by getting sicker first.
A three-week wait for a routine visit means the questions that could have been answered early get answered in an urgent care waiting room instead, after they've become bigger questions.
None of this is a complaint about any individual doctor working inside that system — most of them are doing careful work under genuinely difficult constraints. It's a complaint about the constraints. Here's what we built instead.