I spent a week shadowing a PGT at AIIMS Bhubaneswar last year. He gave me three hours a day for five days. He let me sit in the resident room, walk on the round, watch the handover, eat at the canteen.

Three things I did not expect:

The paper list is the most carefully maintained artefact in the building. Every PGT carries one in their coat pocket. It is folded into quarters along precise creases. It is updated in pencil, then re-copied in pen if the day's annotations make the original illegible. Loss of the list is treated as a near-miss event.

WhatsApp is the primary clinical communication channel. Not the EHR. Not the hospital pager (those exist but are slow). Lab results from the lab manager go to a unit WhatsApp group. The night-shift senior gets called on WhatsApp. The decision to escalate goes through WhatsApp. The handover, in many units, is a voice note on WhatsApp.

The handover is the most stressful eight minutes of the day. Not the admissions. Not the codes. The handover. Because everyone knows that the things you forget to mention will not be remembered by the receiving doctor. Twenty-eight patients in eight minutes is impossible — and known to be impossible — and done anyway, because there is no slack in the schedule for a longer one.

What this taught me is that the existing tools — EHR, paper, WhatsApp — are not failures. They are adaptations. The PGT didn't choose paper because they don't know about EHRs. They chose paper because the EHR has no notion of "the ward list as a working surface" — and so paper does the job better.

The implication for what we're building: do not try to replace paper. Replace what paper is being forced to do because nothing else fits. The patient list. The handover. The carry-across-the-shift-with-you context.

That is why Medows lives on a phone, syncs in real time, and treats the handover as the most important affordance — not the documentation. The PGTs at AIIMS taught me that. Worth saying out loud.