For a day whose ordinariness I mean to defend, Tuesday has a surprisingly martial name in English and in Punjabi alike. In English it is Tiw’s day, after a Germanic god identified with the Roman Mars; the Latin was dies Martis. In Punjabi it is ਮੰਗਲਵਾਰ (Mangalvār), the day of Mangal, which is the name of the planet Mars and, in Hindu tradition, of a god of war. On the evidence of most Tuesdays in primary care, both languages are overstating things.
What follows is an imagined Tuesday. It is not a diary and not the reconstruction of any date. Its people are invented, its clock carries no exact times, and its clinic is no particular building. I have set it a few rules. It follows a single physician through a single day, and instead of a parade of encounters it follows three threads, each beginning in one part of the day and ending, or failing to end, in another. The first is a morning conversation in which a practical detail changes a plan that looked settled. The second is an interruption with a legitimate claim: a result for someone seen the week before, which needs a conversation that cannot happen at the moment it arrives. The third is a visit late in the afternoon, belonging to someone who has every right to the physician the morning had.
An essay about a working day might be expected to go hour by hour, and I have decided against that. The reason is not modesty. The hour is the wrong unit. A clinic day is scheduled in equal intervals, but it is lived in transitions, doors opened and closed, threads picked up and put down, and its most consequential moments seldom fall on the hour. An invented timetable would also lend an imagined day a precision it has not earned: a clock face beside each scene would suggest a record where there is only an illustration. So the day here is marked as people mark days when they are not filling in forms: early, mid-morning, after lunch, late.
The question is what such a day contains that its schedule does not show, and whether the ordinary work of medicine can be described without either hiding its difficulty under pleasant generalities or inflating it into heroism. Literature has been here before. The single day is one of the great forms of modern fiction, and two of its masterpieces, Joyce’s Ulysses and Woolf’s Mrs Dalloway, have a good deal to say about clocks, attention and the uneventful. They will come in where they help.
The Column #
Before the first person arrives, the day has an appealing order. The schedule is a column of names, each in a space the same size as the others, each space apparently holding an adequate amount of time. It is a promise made weeks earlier by people who had not yet met the day, and I have a certain affection for it, the way one can be fond of a map drawn before the road was built.
The column has a literary ancestor. Virginia Woolf’s working title for Mrs Dalloway (1925) was The Hours, and the novel’s single June day in London is struck off, again and again, by Big Ben: “First a warning, musical; then the hour, irrevocable. The leaden circles dissolved in the air.” Public time, in Woolf’s novel, is heavy and uniform, and everyone within earshot hears the same stroke. Private time is everything else. Clarissa Dalloway, walking out to buy flowers, is at once in the June morning and in a summer at Bourton more than thirty years before, and a single stroke of the bell sends half a dozen minds off in half a dozen directions. The schedule is Big Ben. Every person on it will arrive carrying a private hour.
Woolf also put a physician on those public clocks, and it is not a flattering portrait. Sir William Bradshaw, the Harley Street specialist to whom the shell-shocked veteran Septimus Warren Smith is taken, worships what he calls proportion, and his consulting is brisk, assured and disastrous. “Shredding and slicing, dividing and subdividing,” Woolf writes, “the clocks of Harley Street nibbled at the June day.” Bradshaw’s time is the grid’s time imposed on a man who cannot live inside it, and by the evening Septimus has thrown himself from a window rather than be taken away to the rest Bradshaw has prescribed. No physician should read those pages comfortably. They are a reminder that a column of names is not neutral. It can become the measure to which patients are trimmed.
Before the column comes to life there is preparation, and preparation is mostly an act of selection. The record of a patient seen for years is enormous: notes, results, letters, lists of medicines, problems resolved and unresolved. No one can read it all before every visit, and no one should try. The work is to choose from it the few questions on which today might turn. What was left open last time? What has arrived since? What did the specialist’s letter recommend, and has it happened? What was the patient worried about, and was it addressed? A good preparation is less a reading than a set of bookmarks. It readies the physician to listen in the right places, while leaving room for the likelihood that the person will arrive with something none of the bookmarks anticipated.
The schedule promises order, and it leaves each person’s meaning unknown. A line that reads follow-up might be a three-minute confirmation or the first visit at which a hard thing will finally be said. A line that reads new problem may describe a rash or a life. The space is the same size either way.
The First Thread #
Imagine, then, that one of the morning’s names belongs to a man in his fifties, listed for follow-up. His last visit began a plan: a new medicine, a recheck in a few weeks with a blood test beforehand, and a referral whose recommendations have since arrived in a specialist’s letter. Read in advance, the visit looks straightforward. Confirm that the medicine suits him, review the letter, arrange the next steps.
He is courteous and brief, and the first part of the visit goes as the schedule imagined. Then, when the physician mentions the recheck in a few weeks, the man hesitates and says that the harvest work starts on Monday. He will be gone before dawn and back after dark, six days a week, for as long as the season lasts. He did not mention it before, because nobody asked, and because it did not seem like a medical matter.
It is entirely a medical matter. The plan assumed a man who could reach a laboratory on a weekday morning and a clinic on a weekday afternoon, who could take a medicine at a regular hour, and who would notice and report a side effect promptly. The man in the room can do none of these things reliably for the next two months. Nothing in his chart said so. The plan was correct for a patient who does not exist.
What happens next is the real work of the visit, and almost none of it is visible. The physician has to decide what in the plan is essential and what is merely customary. Can the recheck move earlier, before Monday, or later, after the season? Is there a laboratory that opens early enough to reach before work? Could part of the follow-up happen by telephone? How should the medicine’s timing be explained so that it fits a day that begins in the dark? None of this requires new medical knowledge. All of it requires a kind of listening that alters the feasibility of a plan, and the explanation of it, more than its content. A plan that cannot be carried out is not a plan. It is a hope with a signature.
Before he goes, the physician does one more small thing, slightly awkward and among the most useful habits in primary care. He asks the man to say the new plan back in his own words: not as a test, he explains, but to check that he has explained it properly himself. The man gets most of it right. He has the early laboratory visit and the telephone follow-up. But he has taken the instructions about the medicine’s timing to apply only to working days, and he would have done something different on his day off. It is a small misunderstanding, of the kind that leaves the room unnoticed and comes apart weeks later. Caught here, it costs a minute. The plan a physician has just made and the plan a patient believes was made are not always the same plan, and the gap between them is where good plans quietly fail.
There is one more piece. The specialist’s letter, read closely, recommends a further test “if indicated,” without saying what would indicate it. The physician could guess. He would rather ask, and tells the man so: he will clarify it with the specialist’s office and let him know. It is a small promise, and ordinary days are made of exactly such promises. It is small enough to seem easy to remember and important enough that forgetting it would matter. Holding it continuously in mind would interfere with the next conversation. Letting it vanish would fail this one. The useful thing is to give it a dependable place outside immediate attention, a task with a description, a date and an owner, where it can be resumed by the right person at the right time.
The man leaves with a plan rebuilt around his calendar instead of the clinic’s, and with a promise outstanding. The column shows a completed visit.
A Claim at the Door #
Between that visit and the next, someone leans in at the door. Call her the nurse, since in this imagined clinic that is her role, though in real practices the question might come from any of several colleagues. A result has come back for a woman seen the week before. It is not an emergency. But it changes her plan, she ought to hear about it today, and she will have questions that need someone able to answer them.
The interruption has a legitimate claim. It would be easy, in an essay about attention, to treat every interruption as the enemy of focus, and some are. This one is not. It is the system working: a result has been noticed, brought to the right person, and brought while there is still time to act on it today. The nurse is doing exactly what she should. The only question is what the physician should do with it, and it has to be answered in the time it takes to walk to the next door.
He cannot make the call now. The next patient has been waiting, and the call deserves more than a hurried minute in a corridor. He could ask the nurse to make it, and often that would be right. But this result requires a decision about what comes next, and the conversation may raise questions only he can answer. So he decides to call her himself at the end of the morning, and asks the nurse, if she can reach the woman sooner, to tell her that the physician will be calling later today. The decision takes half a minute. Its consequences will occupy pieces of the rest of the day.
What must be recorded? Enough that the thread can be picked up again, by him or by someone else, without depending on his memory: what the result was, what he intends to say, when he intends to say it, and who has been told what. That record is what allows the next patient to have his full attention, which makes it something better than bureaucracy. A thread that has been given a place can be put down. A thread that exists only in a physician’s head will tug at him through the next conversation.
Joyce understood the anatomy of such a day better than any stopwatch could. Ulysses (1922) is set on 16 June 1904, a Thursday, and follows Leopold Bloom, a canvasser of advertisements, from the pork kidney he fries for breakfast through a funeral at Glasnevin, a newspaper office, a library, a pub and the strand at Sandymount, to a maternity hospital, the brothel quarter and home. Its most clinic-like episode, to my eye, is “Wandering Rocks,” in which Joyce breaks one Dublin afternoon into nineteen short sections, each following a different person across the city at roughly the same time. Paths cross; errands are interrupted; a minor figure glimpsed in one section reappears in another. Nothing much happens to anyone, and the interest lies almost entirely in the crossings. Joyce’s friend Frank Budgen recalled him saying that he wanted to give a picture of Dublin so complete that the city could be rebuilt from the book if it ever disappeared. A clinic day is a small Dublin. Its threads run in parallel, meet at doorways and in corridors, and depend on one another in ways that no single column records.
Between the Threads #
Most of the morning belongs to no thread at all. The three threads are a device, chosen because they cross the day and show its joins. But most visits on an ordinary Tuesday begin and end within their own spaces, and leave nothing behind but a signed note and, with luck, a person who understands a little more than when they came in. Such visits would make the dullest possible reading, which is exactly why they deserve a moment.
Their real work is too small to narrate. Choosing the next question, and noticing which question not to ask yet: the one that will be right next month, when there is more trust, and wrong today. Finding out what a person means by better: better than yesterday, better than last month, or better enough to go back to work. Hearing that a little means a great deal to one man and almost nothing to another. Deciding that a symptom deserves a test, or deserves watching, or deserves a plain explanation and nothing more, and then saying which, and why, in terms that make sense outside the room. Each of these is a judgement. None leaves a trace that an observer could count.
Imagine someone watching such a morning with a stopwatch and a clipboard. Studies of that kind have been made of primary care, and they are useful for what they measure. The observer would record the length of each visit, the gaps between them, the minutes at the keyboard, the interruptions. Every number would be accurate. The record would still miss most of what mattered, because the work lies less in the durations than in the choices made within them, and choices have no durations of their own. A decision not to order a test takes no time at all to observe and may have taken years to learn to make.
Somewhere around the middle of the day the light through the window changes. This being the harvest season, the heat has been building since morning and will hold well into the evening; out beyond the town, the work the man from the morning will begin on Monday is already under way in other hands. Inside, the change is of another kind.
The Middle of the Day #
The schedule gives every visit a beginning, but the physician’s attention does not always begin in the same place. By the middle of the imagined day, several conversations are complete in one sense and open in another. A plan has been rebuilt, but the promise attached to it has not been kept, because the specialist’s office has not yet been reached. A result has been discussed at a doorway, and the call it requires is waiting. A decision made in one room has been entered in the record, but the message that carries it has not yet reached the person it concerns. The patients involved have gone on to lunch and the rest of their lives. The paperwork about them is at a different stage, and someone has to keep track of the difference.
Meanwhile the next patient enters a room whose visible surfaces have been reset: fresh paper on the table, a closed chart, a cleared screen. The clinician has not been reset. He is still carrying several unfinished sequences, and he has to re-establish, for the person now in front of him, a whole context: who this is, why she has come, what was decided last time, what she was worried about. The room’s reset is instantaneous. The mind’s is not.
I am cautious about how this is usually described. It is commonly said that clinicians tire as a day goes on and that their decisions drift, and there is evidence pointing that way. One much-cited study of primary care visits, published in 2014, found that clinicians became somewhat more likely to prescribe antibiotics for acute respiratory infections as their clinic sessions wore on. But an association across many visits is not a law that operates the same way on every person every day, and I would rather not lean on fatigue as a universal explanation. The specific thing worth noticing is less dramatic. Each transition costs something: a few moments of rebuilding context, a small risk that something from the last room will leak into this one, a pull from the unfinished threads waiting elsewhere. None of these costs is large. Over a day they accumulate, and the accumulation is invisible on the schedule, which shows only that one visit ended and another began.
This is one reason ordinary medicine depends so heavily on organisation that is hard to see. A note to oneself, a clear assignment, or a colleague’s acknowledgement can protect the next patient’s chance to be heard. The administrative action and the humane action are sometimes the same action viewed from different distances. The quality of the conversation in one room can depend on whether the unfinished work from another room has somewhere trustworthy to wait.
At the end of the morning the physician makes the promised call. The woman from last week does not answer. He leaves a brief and unalarming message saying who he is, that there is a result he would like to discuss, that it is not an emergency, and when he will try again; then he notes that he has done so. The thread is not closed. It has moved from call her to call her again, which is progress of a kind the column has no way to show.
The Afternoon Person #
Late in the afternoon, after the clinic has fallen behind in the way clinics do, a woman in her seventies is called from the waiting room. She has been there for some time. When she sits down she apologises for taking up time, which is the wrong way round.
She bears no responsibility for whatever was difficult earlier: the visit that ran long, the interruption at the door, the unanswered call. The physician comes to her visit carrying the accumulated day. She comes carrying only her own. The person at the end of the afternoon is entitled to the same physician as the person at the beginning of the morning, and that is harder to arrange than it sounds, because the difference is difficult to notice from the inside.
The disciplines that help are unglamorous. Reading the reason for her visit again, as though for the first time. Letting the previous room stay in the previous room. Declining to answer her apology with an apology of his own, which would make her the audience for his day. Asking, early, what she most hopes to settle today. Her answer is not on the schedule, which says routine follow-up. She is going to Punjab for a family wedding, for several weeks, and she wants to know whether she is well enough to go, and what she should do to stay well while she is there.
The visit that follows is ordinary in every respect. Her examination and recent results give no reason to keep her at home. The rest of the conversation is practical, and it takes longer than the medical part: whether she will have enough of her medicines for the whole stay; a written list of them, by their generic names, that a doctor or pharmacist abroad could read; a copy of her recent results; what she should do, and whom she might contact, if she feels unwell while she is away. Nothing in it would make a story. Any of it might matter on some evening in a village half the world away.
Joyce gives Bloom a late visit of his own. Near the end of his long day, he calls at the maternity hospital in Holles Street to ask after Mina Purefoy, an acquaintance who has been in labour for three days. It is a small kindness, unrequested and unrecorded; nobody in the book thanks him for it. Joyce, who had himself briefly tried to study medicine, sets a party of medical students drinking in a room along the corridor while she labours, and the episode’s prose famously works its way through the history of English style as the child is born. What stays with me is Bloom himself: an ordinary man at the end of his day, still able to attend to someone else’s ordeal. That is very nearly all the afternoon asks.
It asks it, though, under conditions that are not always fair, and I want to resist any suggestion that a breath at the door can solve them. No intention renewed at the threshold makes an unreasonable schedule reasonable. If the day is built so that the afternoon person always meets a physician running an hour behind, the remedy lies in how the day is built. The small disciplines are real and worth practising. They are not a substitute for a schedule that leaves room for them.
The Case Against Tuesdays #
There is a serious objection to the whole enterprise of praising ordinary days, and Chekhov, a physician who knew ordinary days as well as any writer has, made it in a story. In “Ionych” (1898) a young doctor, Dmitri Startsev, takes up a district post near a provincial town, falls in love, is refused, and settles into his practice. The rest of the story is what the years do to him. He grows stout and prosperous. He buys property. He drives a troika with bells. In the evenings he takes from his pockets the banknotes his practice has earned and enjoys them. With his patients he becomes irritable, rapping his stick on the floor and telling them to confine themselves to answering his questions. By the end the townspeople call him simply Ionych, by his patronymic, as one names a fixture.
Chekhov gives Startsev no disaster. He gives him an accumulation of ordinary days, each unremarkable, which together hollow him out. That is the darker possibility in any account of the ordinary: that the repetition which builds expertise also builds routine, and that routine, unexamined, produces a physician who has stopped listening. It is worth noticing exactly how Startsev has failed. He has kept the questions and lost the curiosity behind them. His patients must answer him; he no longer needs to hear them.
Woolf, as it happens, makes the same point with her own doctor. Late in the evening of Mrs Dalloway the Bradshaws arrive at Clarissa’s party, and Lady Bradshaw explains why they are late: a young man has killed himself, and Sir William was telephoned about it just as they were setting out. It is Septimus. For the physician whose clocks nibbled at his last day, the death has become an excuse for arriving late at a party, mentioned in passing among the guests. Clarissa, who never met him, withdraws to a small room and thinks about him more seriously than his doctor has. Woolf places her warning precisely. It lies not in a dramatic failure but in the ordinariness with which a case is carried from one engagement to the next.
There is a second objection, the mirror of the first. An essay like this one can inflate small acts into heroism, as though rereading a reason for visit were a moral achievement, or a telephone message about a result a deed worth narrating. It is not. Most of what happened on this imagined Tuesday is simply competent work, done by several people, and most of it would have been done the same way by any conscientious clinician. To present it as virtue would be its own kind of falsification, and unjust to the nurses, receptionists, medical assistants, laboratory staff and others whose part in it was at least as large.
Joyce faced the same choice and declined to settle it. Ulysses lays the scaffolding of the Odyssey over Bloom’s Thursday; the names by which readers know its episodes, Calypso, Cyclops, Nausicaa and the rest, are Homer’s, though Joyce left them out of the published book. A man who buys a kidney and attends a funeral becomes, in some sense, a wandering hero. The parallel runs in both directions at once. It raises Bloom, and it gently mocks the raising: the Cyclops is a bigoted drinker in a pub, and the hero’s burning stake is a cigar. Readers still argue about which direction prevails. I would want neither for a Tuesday in a clinic. The day needs no Homer laid over it, and it does not deserve to be laughed at for lacking one.
Between those two errors, the deadened routine of Ionych and the inflated sentiment of the hero, I think an honest description of an ordinary day sits somewhere quite plain. The day is made of skilled judgements so small that they do not look like judgements: which question to ask next, which part of a plan is essential, which interruption deserves to be let in, which thread can safely be put down and where. Ordinariness is not the absence of expertise. It is expertise working at a scale too small for anyone, including its owner, to notice. What Chekhov warns against is ceasing to notice ordinary days.
What Remains #
Eventually the waiting room empties, and the building’s sound changes. Work remains, though of a different kind: going back over what was decided, finishing explanations, making sure nothing open has been mistaken for something closed. Return, then, to the three threads, and notice that each has ended in a different state.
The first is unresolved. The physician has written to the specialist’s office about the ambiguous recommendation, and no reply has come. The question now sits where it will be seen tomorrow, together with a note of what was promised to the man and by when. If the answer requires a change, the plan rebuilt around the harvest will have to be rebuilt again, by telephone, in whatever hour the season leaves him. The visit is closed in the record. The man’s situation is not.
The second has been handed on with care. Before leaving, the physician tries the woman from last week once more, and again she does not answer. He arranges with the nurse that she will try first thing tomorrow, and that if the woman would like to speak to him, he will call her back himself; the details are written down so that the call depends on no one’s memory. The thread has an owner and a time. It has been delegated, not dropped, and that distinction is the whole difference.
The third is complete, in the sense the record understands. The woman going to Punjab has her list, her plan and her copy of the results, and the note is signed. But a closed note is not a settled life. She will decide at home how long to stay; something may happen on the trip that no plan anticipated; she will come back in a few months with news, or she will not. The visit is complete only on the physician’s side.
Then there are the people who did parts of all three, without whom none of them would have gone anywhere: the nurse who noticed the result and brought it to the door; whoever at the front desk found the man a laboratory appointment early enough to keep; the staff who readied the rooms, brought in the patients, measured the vital signs and answered the telephones while the physician was with someone else. A day in primary care is narrated, if it is narrated at all, from the physician’s point of view. It is not lived from there alone.
Clarissa Dalloway, defending her parties to herself, thinks of them as an offering: a way of bringing together people who would otherwise stay scattered across London, made for no one in particular, perhaps for the sake of offering. Peter Walsh, her old suitor, mocks her as the perfect hostess, and the novel does not wholly disagree with him. But there is something in her defence that fits a day like this one. Much of the work of an ordinary clinic day is the work of combining: a plan with a harvest calendar, a result with the person it concerns, a woman’s travels with the medicines she will need on them. It is offered to people who will mostly never know how much combining it took, by people who mostly do not think of it as an offering at all.
The satisfying ending to a day like this is less an empty list than a truthful one: a list on which every open thing is marked open, every handed-on thing has a name beside it, and nothing has been closed merely to make the count come out right.
Unremarkable #
Nothing extraordinary has happened on this imagined Tuesday, and that is close to the point. The most successful days in primary care tend to produce no stories, because the things that might have become stories were noticed while they were still small: the question asked in time, the result followed up, the plan rebuilt before it failed. Prevention is invisible by nature. Nobody tells the tale of the complication that did not occur, and the person it did not happen to never learns there was anything to be spared. Even that claim needs care. Nothing in this imagined day can be said to have prevented anything. The most honest account is that some things became clearer, some plans became workable and some uncertainties became smaller. It is a modest list, and it is enough.
Medicine has its own word for this kind of success, one that would sound like faint praise anywhere else. When an examination or an imaging report finds nothing of concern, the finding is called unremarkable. Inside medicine it may be the most welcome word a report can contain, and a good Tuesday earns it the same way a good report does: by being looked at carefully and found to hold nothing that needs a story.
William Carlos Williams, who practised medicine for some four decades in New Jersey, published in 1923 a poem of sixteen words about a red wheelbarrow, glazed with rain water, beside some white chickens. It begins “so much depends / upon,” and it never says what depends, or how much. Readers have argued about it for a century. I find it hard not to read it as a physician’s poem: an attention careful enough to find weight in the most ordinary object in a yard, and disciplined enough not to inflate that weight into a moral. So much depends upon the call returned, the plan that fits the harvest, the list a woman carries to Punjab. Not everything. Much.
Wednesday’s schedule, meanwhile, is already waiting: a column of names, each in its equal space, promising once again an adequate amount of time. Mars, as far as anyone could tell, was never consulted.
Evidence and Editorial Note #
Documented findings. The essay relies on the author’s public biography: a primary care physician practising in California since 2010; Punjabi as his first language and English among his languages. The English name Tuesday from Old English Tīwesdæg, Tiw’s day, Tiw being identified with Mars, and the Latin dies Martis: standard etymological references. The Punjabi ਮੰਗਲਵਾਰ (Mangalvār) as the day of Mangal, the name of the planet Mars and of a war deity in Hindu tradition: general Punjabi usage and standard references. Virginia Woolf, Mrs Dalloway (1925): its working title The Hours; its single June day in London; Big Ben’s strokes; Sir William Bradshaw, proportion and the clocks of Harley Street; Septimus Warren Smith’s death and the Bradshaws’ late arrival at Clarissa’s party with news of it; Clarissa’s thought of her parties as an offering and Peter Walsh’s mockery of her as the perfect hostess: the novel, with two brief quotations from its text, which is in the public domain in the United States. James Joyce, Ulysses (1922): its setting on 16 June 1904 (a Thursday, by calendar calculation); Bloom’s day; the nineteen sections of “Wandering Rocks”; Mina Purefoy’s labour and the Holles Street maternity hospital in “Oxen of the Sun”; the Homeric episode names, left out of the published book, and the Cyclops episode’s bigoted drinker and cigar; Joyce’s brief medical studies; Frank Budgen’s recollection of Joyce’s wish that Dublin could be rebuilt from the book (paraphrased): the novel and standard biographical sources. Anton Chekhov, “Ionych” (1898): plot and the details of the banknotes, the troika, the stick and the instruction to answer only questions, described from the story. The association between later clinic hours and antibiotic prescribing for acute respiratory infections: a 2014 study in JAMA Internal Medicine by Linder and colleagues, described in general terms and not as a universal finding. William Carlos Williams, “The Red Wheelbarrow,” in Spring and All (1923), public domain in the United States; his medical practice in New Jersey. Asking a patient to explain a plan back in his own words: a general clinical courtesy, described as such. The use of unremarkable in examination and imaging reports to mean that nothing of concern was found: general medical usage. Vendor representations. None.
Recollection and tradition. The whole day is hypothetical and illustrative. It does not describe the author’s actual schedule, workload, clinic, staffing, colleagues, patients or any particular date. The man starting harvest work, the woman with the result, the nurse, and the woman travelling to Punjab are imagined; none is drawn from or presented as a real person, and the practical matters discussed with them are general courtesies of care, not recalled encounters or advice to readers.
Analysis and forecast. The reading of the appointment schedule beside Woolf’s public and private time and Joyce’s crossing threads; the distinctions among completed, delegated and unresolved work; the reading of “Ionych” as a warning against ceasing to notice ordinary days; and the reflections on fairness across a day, the invisibility of prevention and the value of ordinary work are the author’s personal interpretation as of November 6, 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer. It is personal reflection, not medical advice; readers seeking care should contact their own physician’s office.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.