I want to describe a specific clinic day.

It was a Tuesday. Full schedule — seventeen patients, which is normal for my practice. Nothing unusual about the day on paper. What was unusual was that I had spent the previous week intentionally changing the structure around how I was managing notes and transitions.

By midmorning I noticed something I didn't have a name for yet.

I wasn't behind. Not just not-very-behind — actually not behind. The notes from the morning were closed. The referrals I'd sent were sent. When I walked into each new room I wasn't holding the weight of the rooms before it.

There was a visit — a 9-year-old with a complicated chronic condition and a mom who had a lot of questions. I remember sitting back in my chair and actually listening to her. Not managing the time. Not calculating how many minutes I'd spent and how many I had left. Not half-composing the note while she was talking. Just listening, because I had the bandwidth to listen.

That visit took longer than it should have by the schedule's accounting. And I didn't care, because I wasn't behind, and I could afford the time the visit actually needed.

That's presence. Not a feeling I conjured. Not a mindfulness technique I applied. A structural condition that made it possible.

The rest of that day held the same quality, mostly. Some visits were harder, some slots ran over, the EMR was uncooperative in the afternoon. But the baseline was different.

I drove home that night and realized I wasn't thinking about any of it. Not because I'd stopped caring — because it was done.

That's what I'm trying to help physicians build toward. Not a perfect day. A day that actually ends.

— Ryan

P.S. If you want to build this kind of day by design rather than by accident, coaching is where that work happens: mededwell.com/coaching