The shift starts quietly. Twelve patients on the ward list, mostly stable post-ops, two new admissions overnight. By 9 a.m. the resident is on the third bed when her phone vibrates. New admission in casualty — query meningitis, junior wants senior review. She puts the round on pause.

She resumes the round at 9:23. She is now thinking about the meningitis case as she stands at Bed 4. She misses that the diuretic dose was doubled overnight and that urine output dropped 200 ml. She moves on.

At 11:14, the lab rings. K+ on Bed 4 is 5.9.

That is not a clinical error in the textbook sense. The resident saw the patient. Notes were complete. But the interruption between Bed 3 and Bed 4 cost her the working memory needed to register the trajectory before it became urgent.

The published data on this is older than most realise. Tipping and colleagues (J Hosp Med, 2010) shadowed US hospitalists and found they were interrupted once every nine minutes on average. The cognitive recovery cost — the time before reasoning fully re-engages with the original task — runs from 23 seconds for trivial work to several minutes for complex differentials.

Westbrook and colleagues (BMJ Qual Saf, 2010) measured the dose-response. Each interruption during medication administration was associated with a 12.7% increase in clinical error rate. Four interruptions roughly doubled the rate of major errors.

These numbers were measured in 2010. The structure of ward work has only gotten denser. Indian government hospital admission days mean 20–30 patients per resident, and the interruption count per shift — measured informally by the residents I've spoken with — sits comfortably above forty.

We talk about resident burnout as if it were primarily about hours. Hours matter. But hours alone don't explain why a resident finishing an 80-hour week feels different from a junior software engineer finishing the same hours. The difference is the cost of every interruption, multiplied by the density.

What I keep coming back to is this: every ward tool we have — paper, EHR, WhatsApp, search engines — assumes the doctor's working memory is intact. None of them are designed to preserve context across an interruption. The patient list disappears when the screen locks. The handover sheet is paper, susceptible to smudge and pocket damage. The EHR has no notion of "where you were."

When we started designing Medows, this was the hidden problem we kept finding. Not "save the doctor time." Not "make the documentation faster." Preserve the context across the interruption.

A workspace, not a record.