Thursday 16 April
Good afternoon, Dr John Dolittle.
Today's clinic, plus patients I'd raise with you this week.
Practice Population
Practice trajectory is
worsening
+15.1%
2
improving
5
stable
9
worsening
16 registered
Today
19
· Sorted by who needs you most
Register walk-in
Day brief
Sketch note
Morning Impromptu Clinic / Walk-ins
8 booked
Walk-ins
30/30m
0m free
Afternoon Proactive Clinic / Walk-ins
8 booked
Walk-ins
15/30m
15m free
Dr John Dolittle
08:30
20m · Phone
Margaret Chen
67F · SH-10284
Positive
Initiate SGLT2 (empagliflozin 10mg) — cardiorenal protection, not glycaemic control
Positive zone
08:55
30m · F2F
Eleanor Shaw
81F · SH-10372
Positive
Reinforce daily weights and symptom diary
Positive zone
09:30
20m · F2F
Oliver Bennett
72M · SH-10389
Positive
Check U&E + eGFR; adjust apixaban if needed
Positive zone
09:55
30m · F2F
Priya Ramanathan
59F · SH-10326
Positive
Check adherence and side-effect burden
Positive zone
10:30
10m · F2F
Robert Calloway
62M · SH-10351
Gray zone
Inhaler technique review in clinic
Gray zone · pattern emerging
10:45
20m · Phone
Helena Voss
48F · SH-10359
Positive
Add third antihypertensive (amlodipine)
Positive zone
11:05
10m · F2F
Linda Prescott
72F · SH-10302
Gray zone
Order NT-proBNP + ferritin/TSAT today
Gray zone · pattern emerging
11:20
30m · F2F
Greta Larsen
59F · SH-10384
Gray zone
Invite for cardio-oncology surveillance review
Gray zone · pattern emerging
12:00
Walk-in
Priya Ramanathan
urgent
Buffer
Acute injury
· Promised by 10:37 · overdue
match 89%
12:15
Walk-in
Walk-in · F, ~50s
routine
Buffer
Acute presentation
· Promised by 09:12 · overdue
14:00
Afternoon Proactive Clinic / Walk-ins
14:00
10m · F2F
James Wright
41M · SH-10318
Negative
Reassure — rule-out is robust
Low zone
14:15
30m · F2F
Marcus Lindsay
28M · SH-10367
Gray zone
Book SMI physical health check (QOF MH003)
Gray zone · pattern emerging
14:50
15m · Phone
Aisha Khan
34F · SH-10344
Gray zone
Invite for structured health check
Gray zone · pattern emerging
15:05
20m · Phone
David Okafor
54M · SH-10291
Gray zone
Share trajectory visually — framing as reversible pre-diabetes
Gray zone · pattern emerging
15:25
30m · Video
Nikhil Menon
45M · SH-10378
Negative
Reassure — communicate the rule-out
Low zone
15:55
10m · Phone
Sofia Ramirez
26F · SH-10394
Gray zone
Dietary advice now — don't wait for OGTT
Gray zone · pattern emerging
16:10
15m · F2F
Thomas Brennan
78M · SH-10331
Gray zone
Structured medication review — deprescribe where appropriate
Gray zone · pattern emerging
16:30
30m · F2F
Carlos Hirano
55M · SH-10402
Gray zone
Discuss hepatology referral vs primary-care acceleration
Gray zone · pattern emerging
16:40 · Now
17:00
Walk-in
Walk-in · M, ~40s
urgent
Buffer
Social / safeguarding
· Promised by 15:38 · overdue
I'd raise with you this week
4
· no consult booked yet
Marcus Lindsay
28M · SH-10367
Mental health + cardiometabolic drift
Gray zone
Antipsychotic metabolic effects visible in the trajectory. Physical health check 11 months overdue.
Gray zone · pattern emerging
Lifestyle programme → −52% (BMI)
Carlos Hirano
55M · SH-10402
MASLD (moderate fibrosis risk)
Gray zone
FIB-4 intermediate + metabolic drift. Referral decision is today's task.
Gray zone · pattern emerging
Lifestyle programme → −88% (BMI)
Aisha Khan
34F · SH-10344
Metabolic (early pre-clinical)
Gray zone
Not on any register. Trajectory says she should be on prevention pathway now.
Gray zone · pattern emerging
Lifestyle programme → −62% (BMI)
Greta Larsen
59F · SH-10384
Cancer survivor + cardiometabolic drift
Gray zone
Survivorship pathway has slipped. Model flags her back into active surveillance.
Gray zone · pattern emerging
Lifestyle programme → −34% (Triglycerides)
Drafts to approve
7
· written from this patient's record + trajectory
Letter
Kidney function update — action needed
Margaret Chen · grounded in eGFR · UACR · HbA1c
grounding 92%
Referral
Nephrology — early CKD with albuminuria
Margaret Chen · grounded in eGFR · UACR · SBP
grounding 88%
Letter
Your health check — a reversible picture
David Okafor · grounded in ALT · HbA1c · Triglycerides
grounding 87%
Letter
A couple of tests before we next meet
Linda Prescott · grounded in NT-proBNP · SBP
grounding 82%
Letter
Your results — reassurance
James Wright · grounded in LDL-C · SBP · HbA1c
grounding 90%
Letter
Blood pressure readings & today's plan
Helena Voss · grounded in SBP · DBP · LDL-C
grounding 90%
Referral
Hepatology — MASLD with FIB-4 intermediate
Carlos Hirano · grounded in ALT · FIB-4 · HbA1c
grounding 86%