Insights

Notes from practice.

Our physicians writing about chronic care, early detection, and what actually keeps patients out of the hospital. No product pitches. Just the thinking behind the work.

Latest

The pound a day nobody asked about

Richard Ferrans, MD, ScM 6 min read

A patient with heart failure who gains a pound a day is not gaining weight. They are retaining fluid, and that fluid has a predictable destination. Why the most preventable admissions are the ones nobody sees coming, and what a single weekly question would change.

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Care management

Why coverage, not capability, is the real problem

Care management has been proven for two decades. The constraint was never whether it works. It was how many people one nurse can carry, and what happens to everyone else on the list.

Richard Ferrans, MD, ScM

7 min read
Evidence

The blood pressure that counts is the one taken at home

For years the office reading was the number we treated. A decade of evidence changed that, and it changed what we should be asking patients to do between visits.

Richard Ferrans, MD, ScM

5 min read
Follow through

Telling a patient to see their doctor is not the job

Most systems stop at the recommendation and count it as a success. The work that matters happens afterward, when someone goes back and checks whether it actually happened.

[ Author ]

4 min read
Transitions

The 30 days after discharge

The riskiest month in a patient's year, and the one with the clearest playbook. What has to happen in the first week, and why so much of it does not.

[ Author ]

6 min read
Regulation

Care manager or medical device? The line matters

Where recognition ends and diagnosis begins is not a philosophical question. It determines what a system is allowed to do, and it should determine how it is built.

Richard Ferrans, MD, ScM

8 min read
Chronic care

Under control is not a destination

Getting a patient to goal is the easier half. Keeping them there for the rest of their life is the part the system was never designed to do.

[ Author ]

5 min read

Draft placeholders. Titles, excerpts, and dates are stand ins to show the shape of the page. Nothing here publishes until it is written and the byline has approved it.

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