Every once in a while my clinic goes through a lull where people don’t show up for their appointments. These are called “no-shows”; all doctors get them. Lately we’ve had a run of them, and my roster looks like swiss cheese. It was only a month ago I was so swamped I was cramming patients in on my lunch hour or before opening.

These feast or famine periods come and go. It is an ill wind that blows nobody good. When in a ‘famine‘ time, I am not so stressed and I can do chart reviews.

When patient charts get thick, or contain many changes, it is easy to get lost what has happened. It is like watching a long opera only to discover you are in Act III and can’t recall how we got here.

I announce to the patient I will be taking their chart home and conduct a review for ‘what to do next’.  I start on page one; “I am born”. Being a Dickens fan, long wordy novels aren’t difficult for me to read. Indeed, many of my charts resemble Dickens novels (or Stephen King). As I read, I slowly compose timelines onto a blue sheet of paper. Blue is chosen so I can find later on, when it resides within inches of white sheets.

At the end of the review, I get sit back and see ‘everything’ on one page. It never fails to give me vision of what I need to do/where next to go.

I call these blue-paper summaries  ‘Hari Seldons”.

Curiously, patients often get better on their own between the announcement and the follow up appointment.  How does this happen?  I sense patients ‘relax’ knowing I will ‘have a plan’ ready for them; they feel in good hands I suppose.

I’ve become superstitious. If I have a difficult patient I do a Hari Seldon plan sooner than not, hoping they will improve just for having doing one.

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