On Monday, January 6th, 2025, at 8:47 AM, a woman named Patricia Okafor walked through the front door of Verdant Family Medicine, sat down in one of my consignment-store armchairs, looked around at the plants and the books and the little tea station, and said, "Oh, this is lovely." She was my first patient. I will remember her for the rest of my career.
I want to tell you about opening day because I think the reality of it deserves to be recorded, not just the polished version but the actual, messy, emotional, imperfect experience of opening a medical practice from scratch.
The morning started at 5:30 AM, which is when I woke up having not slept much. James made coffee and told me I was going to be great. My medical assistant, Denise, whom I hired in December after interviewing twelve candidates, arrived at 7:30 and immediately started adjusting things I'd already adjusted twice. She moved the hand sanitizer dispenser three inches to the left, and honestly, she was right, it was better there. Denise has excellent spatial awareness and a calm demeanor that I'm already grateful for.
I had five patients scheduled for opening day. Not a full schedule by any means, but I'd deliberately kept it light to give us room to work out the kinks. These were patients I'd recruited through word of mouth over the preceding months: friends, neighbors, colleagues who'd expressed interest, and people who'd found me through the local DPC directory.
Patricia, my 9 AM, was a 62-year-old woman with hypertension and pre-diabetes who had been frustrated with her previous physician's fifteen-minute appointments. When I told her that her initial visit would be forty-five minutes, she looked at me like I'd offered her a winning lottery ticket. We talked about her blood pressure management, her diet (she's an amazing cook, apparently, and we spent five minutes discussing how she could modify her favorite Nigerian recipes to reduce sodium), her exercise habits, and her concerns about her family history of diabetes. The Hero EMR ambient scribe captured the entire conversation and generated a note that I reviewed and edited in about three minutes. Three minutes, for a comprehensive new patient visit note that would have taken me twenty to write manually. I kept glancing at the screen, half expecting it to be wrong or missing something important, but it wasn't. The note was thorough, well-organized, and accurate.
My second patient was a 34-year-old software developer with anxiety and chronic tension headaches. He'd never had a doctor who spent more than ten minutes with him. We talked for thirty-five minutes, and by the end of the visit, I had a much clearer picture of how his work stress, sleep habits, and caffeine consumption were all contributing to his symptoms. I prescribed a low-dose SSRI (the e-prescribing workflow in Hero EMR is genuinely fast, about ninety seconds from medication selection to pharmacy transmission) and we made a plan for stress management that included specific, actionable steps rather than the vague "try to relax" advice he'd gotten before.
Patient three was a no-show, which, I've been told, is perfectly normal and not a personal rejection but which still felt like a tiny knife to the heart on opening day.
Patients four and five were a married couple in their fifties who signed up together. They were delightful and brought me a plant as an opening day gift, a fiddle-leaf fig that is now sitting in the exam room next to the Japanese maple window. We spent an hour between the two of them, doing comprehensive health assessments and talking about their goals for the year.
At the end of the day, Denise and I sat in the waiting area with cups of tea and debriefed. The things that went well: the clinical workflow felt natural and unhurried, exactly what I'd hoped for. The EMR performed flawlessly, no crashes, no freezes, no mysterious error messages. The ambient scribe saved me at least thirty minutes of documentation time across four patient encounters. The patient self-registration system meant that all four patients (the couple had registered together) arrived with their paperwork already completed in the system, and Denise didn't have to scan a single piece of paper.
The things that didn't go perfectly: I forgot where I put the hemoglobin A1c test cartridges and spent five minutes opening every cabinet in the lab area. The printer jammed during a patient's after-visit summary (printers are my nemesis and always will be). I realized I hadn't ordered the specific brand of exam table paper I wanted and had to use the generic brand, which tears too easily. Small things. Human things.
After Denise left, I sat in my office alone for a while. I looked at the four charts I'd created that day. Four patients who had chosen to trust me with their health. Four people who would pay me a monthly fee, not because an insurance company directed them to my practice, but because they believed in the model and wanted this kind of care. I thought about where I'd been a year ago, crying in a parking lot after another impossible day. I thought about the business plan and the lease hunt and the drywall dust and the DEA forms and the three hundred moments of doubt.
I didn't cry this time. I just sat there and felt grateful, all the way down to my bones.
As of today, I have eighteen enrolled members. My breakeven is 120. I have a long way to go. But I have started, and the practice is real, and the medicine I'm practicing is the kind I always wanted to practice. That's enough for now. That's everything.