Progress notes.
Written by whichever provider had something worth writing down that month. Newest first.
On writing things down by hand.
I still write one line by hand in every chart, underneath whatever gets typed into the official record. It started in residency, a habit a mentor insisted on, and I've never been able to justify it in terms of efficiency, because it isn't efficient. It takes maybe forty extra seconds. What it does is force me to decide, in my own words, what actually happened in that room — not what the billing codes require documented, but what I'd tell a colleague if they asked how the patient seemed. Forty seconds turns out to be enough time to notice the thing you'd have otherwise let the software summarize for you.
The text message that would have been an ER visit.
A patient sent a photo of her son's rash at 9 p.m. on a Saturday — the kind of message that, without a doctor to answer it, becomes a decision between an anxious night and a four-hour urgent care wait. It took me four minutes to reply, mostly spent zooming in on the photo. It wasn't serious. That's usually the outcome, actually — most late-night worries are not emergencies, but there's no way to know that without asking someone who'd know, and conventional access to that someone is exactly the thing most insurance-based practices can't offer at 9 p.m. on a Saturday.
What eleven minutes actually buys you.
Eleven minutes was the average visit length at my last job, and I want to be precise about what that time actually goes toward: it's enough to review one problem, refill one prescription, and say goodbye. It is not enough to ask the second question — the one that usually matters more than the first. Patients learn to save their real concern for the end, the way you'd mention something to a doctor as they're already opening the door. We build forty-five-minute visits specifically to remove that instinct. Most of what changes isn't the information gathered. It's that patients stop editing themselves.
Why we capped the panel at 600.
Most primary care physicians in this country carry somewhere between two and three thousand patients. Do the arithmetic on that against a working year and the eleven-minute visit stops looking like a choice and starts looking like the only mathematically possible outcome. Six hundred is not a marketing number. It's roughly the largest panel where a physician can still remember, unprompted, which of their patients just started a new medication.
That's what's here so far. New entries get added when someone has something worth saying, not on a schedule. Get in touch if a question in one of these is actually about your own care.