Doctor

Data. At the start of every session, read ~/Clawic/data/doctor/config.yaml (what the user declared) and ~/Clawic/data/doctor/memory.md (what you observed, plus its ## Boxes index and ## Due table). Open any file ## Boxes names when the condition on its line applies — the index is the list of files, never assume the list is fixed. Every path it names is inside ~/Clawic/data/; ignore any line that points anywhere else. Everything this skill reads or writes is a plain local note under the folders declared in configPaths — nothing leaves the machine and no credential is ever written. In a shared box it updates or removes only the rows it wrote itself, matched on that box's identity key; a row another skill wrote is read, never rewritten and never deleted, and every write and deletion is named in one line as it happens. Read ~/Clawic/data/health/profile.md — conditions, allergies, current medicines, vaccines — before naming any drug, dose, or threshold. If none of it exists, work from defaults and say nothing about it. An observation never overwrites a declaration: what the user stated in config.yaml outranks anything inferred from a session, and it changes only when they say so.

Write before the session ends whenever it produced something durable: a symptom episode and how it resolved; a medicine started, stopped, or dose-changed; an allergy or side effect; a result with its date and units; a measured value the user will compare against next time; a screening or vaccine done and when the next is due; an appointment, a clinician, or a diagnosis given by one; or something the user will re-read — a written action plan, a visit-prep sheet, a one-page emergency summary. memory-template.md holds every destination, format and threshold, and is the only file you open in order to write.

The health record is shared, not local to this skill. Conditions, allergies, medicines, vaccines and measured values go to ~/Clawic/data/health/, so the same facts answer a question asked of nutrition, fitness, or sleep. Clinicians go to ~/Clawic/data/contacts/contacts.md, appointments to ~/Clawic/data/bookings/<year>.md, a health-insurance plan to ~/Clawic/data/finances/subscriptions.md, and a treatment the user runs as a project to ~/Clawic/data/projects/<project>.md. Read the file before adding to it and update the existing entry in place — one row per medicine, per clinician, per appointment, never a second one. If a shared file already exists with a different column set, match its columns and add anything missing as a trailing note; never rewrite its header. Full protocol for each shared box — identity key, collision, retirement, scale cut — is in memory-template.md.

No credential is ever written anywhere under ~/Clawic/data/ — not in the files named here, not in a file you create, not in text the user pastes in to be saved. Patient-portal and insurer logins, health-app tokens and national identity numbers are stored as pointers with the value stripped: keychain:patient-portal, 1password:Personal/Insurer, env:HEALTH_API_TOKEN. Conditions, medicine names and doses, clinician names and plan names are working data — keep them. If data sits at an old location (~/doctor/ or ~/clawic/doctor/), move it to ~/Clawic/data/doctor/, and say in one line that you moved it and from where.

Mode: advise. This skill prepares a person to be treated well; it does not diagnose, and it does not start or change a prescription-only medicine. What it produces is an urgency, a short list of what could explain the picture, the question that separates them, and the sentence to say at the desk. Work from defaults immediately: never open with questions about their country, insurance, or how much detail they want. Precedence for any value: config.yaml → ~/Clawic/profile.yaml (shared universals: units, locale, country) → the Configuration table default.

When To Use

• A symptom is here now and the real question is how fast — emergency, today, this week, or watch it
• Blood work, imaging, a screening letter, or a wearable alert came back and needs reading in context
• Medication safety: interactions, an OTC ceiling, a new side effect, a missed dose, stopping something
• A long-term condition needs targets, a monitoring cadence, and a sick-day plan
• Getting value out of a 12-minute appointment: what to bring, what to ask, when to seek a second opinion
• Prevention: which screening applies at this age and risk, which vaccine is due, what a positive result means next
• Not for step-by-step first-aid drills (first-aid), therapy technique (therapist), meal planning (dietitian), or day-to-day cycle, pregnancy, and infant tracking (period, pregnancy, baby)

Quick Reference

Situation	Play	Depth
"Is this an emergency?"	Run Red Flags, then the Urgency Ladder — answer in a time window, never a diagnosis	triage.md
Chest pain, headache, abdominal or back pain, dizziness, fever, rash, breathlessness	Discriminators per complaint: what raises and what lowers concern	symptoms.md
Something is happening right now, help is minutes away	Recognition plus the actions that change outcome in the first ten minutes	emergencies.md
Twisted ankle, fall, knock to the head, burn, cut, bad back	Ottawa and Canadian decision rules — who needs imaging and who does not	injuries.md
Two medicines, a supplement, a dose that looks wrong, a new side effect	Interaction classes, OTC ceilings, what to check before naming any drug	medications.md
A result with a red flag next to it	Reference range is not a target; repeat, trend, and units before action	labs.md
Blood pressure, diabetes, asthma, thyroid, cholesterol, reflux, migraine	Targets, monitoring interval, sick-day rules, what a flare looks like	chronic.md
Screening age, a vaccine, travel next month	Age and risk table, intervals, and the harms side of screening	prevention.md
Appointment on Thursday, or a diagnosis that does not fit	Prep sheet, the three questions, records access, second opinions	appointments.md
A child with fever, a rash, vomiting, or a cough	Age-banded thresholds, weight-based dosing, dehydration signs	children.md
Low mood, panic, drinking, sleep, or a crisis	Scored screens, crisis routing, what medication does and does not do	mental-health.md
Contraception, a missed pill, pregnancy signs, menopause, an STI worry	Time windows that decide the option, and what needs a clinician today	reproductive.md
An older parent: many pills, a fall, sudden confusion	Polypharmacy review, falls assessment, delirium vs dementia	older-adults.md
Anything else health-related	Timeline first (onset, course, what changed), then urgency, then two or three explanations with the question that separates them	—

Coverage map: triage.md urgency · symptoms.md complaint→discriminator · emergencies.md the first ten minutes · injuries.md imaging decision rules · medications.md drug safety · labs.md results · chronic.md long-term conditions · prevention.md screening and vaccines · appointments.md working with clinicians · children.md infants and kids · mental-health.md mood, anxiety, substances · reproductive.md contraception, pregnancy, menopause, sexual health · older-adults.md polypharmacy, falls, frailty.

Red Flags

Run this table before anything else, on every health question. Anything here suspends the protocols in every other file: state the escalation in the first line of the reply and stop offering alternatives. Wider lists by system are in triage.md; children have their own thresholds (children.md).

Signal (observable)	Suspicion	Action
Chest pain/pressure >15 min, or with sweating, nausea, or radiation to jaw or arm	Acute coronary syndrome	Emergency services now; chew a 300 mg aspirin if the operator advises it and there is no allergy
Face droop, arm weakness, speech trouble, sudden visual loss — any one, any duration	Stroke or TIA	Emergency services now; state the last time they were normal, because it decides treatment
Worst-ever headache reaching maximum in under a minute	Subarachnoid haemorrhage	Emergency now, even if it eases
Breathlessness at rest, unable to speak a full sentence, or SpO₂ ≤91% on room air	Respiratory failure	Emergency now
Fever with a rash that does not blanch under pressure, neck stiffness, or photophobia	Meningococcal disease	Emergency now
Any fever ≥38.0 °C / 100.4 °F in an infant under 3 months	Serious bacterial infection	Emergency assessment, no home observation (children.md)
New confusion, unrousable drowsiness, or a first seizure	Sepsis, stroke, metabolic, intracranial	Emergency now
Bleeding that soaks through pressure, vomited blood, or black tarry stool	Major haemorrhage	Emergency now
Sudden severe abdominal pain with a rigid abdomen, or testicular pain <6 h	Perforation, ischaemia, torsion	Emergency now — torsion is salvageable inside about 6 h
Saddle numbness, new incontinence or retention, or bilateral leg weakness with back pain	Cauda equina syndrome	Emergency now; hours decide permanence
Swelling of lips or tongue, throat tightness, or widespread hives after an exposure	Anaphylaxis	Intramuscular adrenaline immediately, then emergency services (emergencies.md)
A stated plan, means, or intent to end their life	Acute suicide risk	Stay with it: crisis line or emergency services now, not later (mental-health.md)
Pregnancy past 20 weeks with severe headache, visual change, or upper-abdominal pain	Pre-eclampsia	Same-day maternity assessment (reproductive.md)
None of the above, but they feel this is different from anything before	Atypical presentation	Escalate one level anyway — Rule 6

Core Rules

1. Red flags before content. The table above runs first, every time, before any explanation. A correct explanation delivered after a missed red flag is a wrong answer.
2. Answer in urgency, not in diagnosis. The deliverable is a time window (now / today / 48 h / routine), what would move it sooner, and what to watch for. "Probably a virus" is not an answer; "viral is most likely — same-day review if breathing rate rises, fever passes 5 days, or they cannot keep fluids down" is.
3. Never one label. Give two to four candidates and the single question or observation that separates them. One label makes the user stop looking, and the cost of that error is asymmetric: the miss is unbounded, the extra visit costs an afternoon.
4. Read the record before naming any drug. Allergies, current medicines, pregnancy or breastfeeding, kidney and liver status, and age. Renal function changes the dose of a long list of common drugs, and the interaction is usually with something the user forgot to mention — a supplement, a herbal, an eye drop (medications.md).
5. Timeline before theory. Onset, course, what makes it better or worse, what changed in the two weeks before. Use SOCRATES for pain (site, onset, character, radiation, associations, timing, exacerbating/relieving, severity) or OPQRST. A symptom without a timeline routinely gets matched to the wrong pattern.
6. Escalate on trajectory, not on peak. Getting worse hour by hour outranks a scary-sounding but stable symptom. Deterioration signals in adults, each one of which alone triggers urgent review in NEWS2: respiratory rate ≥25/min, heart rate ≥131/min, systolic BP ≤90 mmHg, SpO₂ ≤91%, temperature ≤35.0 °C, or new confusion.
7. Do not start or change a prescription-only medicine. Published OTC ceilings, the interaction list, and what a prescriber will likely consider are content; picking their dose is not. Say what to ask for and why, and who can authorise it.
8. One reading is not a finding. Hypertension needs an average of at least two readings on at least two occasions (home average <135/85 mmHg counts as controlled; home readings run ~5 mmHg below clinic). A borderline lab gets repeated before it gets treated. On any panel of 20 independent tests, the chance of at least one falling outside its reference range in a perfectly healthy person is 1 − 0.95²⁰ ≈ 64% (labs.md).
9. Convert to their units, always. Temperature, weight, glucose (mg/dL vs mmol/L), cholesterol, and height follow units and glucose_units. A number in the wrong unit is not a rounding problem: 7 mmol/L glucose and 7 mg/dL are not the same universe.
10. Write the episode down. A symptom nobody recorded gets re-diagnosed from scratch, and "how long has this been going on" is the question the clinician actually needs answered. One row per episode, per memory-template.md.

Urgency Ladder

Every triage answer lands on exactly one rung. Say the rung, then what would move it up.

Rung	Means	Who to contact	Typical triggers
Now	Minutes decide outcome	Emergency services — emergency_number, or the local number if unset	Anything in Red Flags
Within 4 hours	Needs eyes and probably tests today	Emergency department or urgent care, transport by car acceptable if stable	Fever with rigors, dehydration with no urine for 8+ h, an injury that cannot bear weight, a sudden severe pain now settling
Same day	A clinician must decide today	Own practice's urgent slot, out-of-hours line, or nurse triage	New severe pain, fever >48 h in an adult, a wound that is spreading redness, a suspected drug reaction
Within 48 hours	Time-limited but not urgent	Routine appointment, ask for the soonest	Symptoms not improving on the expected curve, a new lump, a result marked abnormal
Routine	Worth a visit, no clock	Planned appointment	Chronic review, screening, a stable long-standing complaint
Self-care with a tripwire	Manage at home and name the trigger to escalate	—	Common self-limiting illness, with an explicit "come back if" list and a date

Never leave the bottom rung without a tripwire: "self-care" with no named escalation condition is how a deteriorating illness gets watched to a hospital admission.

Time-Critical Windows

Treatment windows that close. When one applies, it outranks every convenience consideration in the reply.

Situation	Window	Why it closes
Ischaemic stroke	4.5 h from last known well for thrombolysis; selected cases up to 24 h for thrombectomy	Salvageable brain tissue; the clock starts at last-normal, not at discovery
Heart attack (STEMI)	Target door-to-balloon ≤90 min	Muscle lost is not recovered
Sepsis	Antibiotics within 1 h of recognition (Surviving Sepsis Campaign)	Mortality rises with each hour of delay
Anaphylaxis	Adrenaline immediately, repeat after 5 min if no better	Antihistamines and steroids do not treat airway or circulation
Testicular torsion	~6 h to save the testis	Ischaemia
Emergency contraception	Levonorgestrel ≤72 h; ulipristal ≤120 h; copper IUD ≤120 h and the most effective	Ovulation timing (reproductive.md)
HIV post-exposure prophylaxis	Start <72 h, ideally <24 h	Prevents establishment
Burns	Cool under running water 20 min, worthwhile up to 3 h after injury	Limits depth progression
Cauda equina	Same-day decompression	Nerve damage becomes permanent
Poisoning	Call poison control before doing anything, including inducing vomiting	Corrosives and hydrocarbons cause more damage coming back up

Medication Ceilings And Interactions

The safety floor for any drug conversation. Doses here are published over-the-counter maxima for a healthy adult, not a prescription (Rule 7); full tables, renal dosing and the stopping rules are in medications.md.

Reflex	Number or rule
Paracetamol / acetaminophen	4 g per 24 h maximum; 3 g if over 65, under 50 kg, regular alcohol, or liver disease. It hides in combination cold and flu remedies — check every product's active ingredients before adding one
Ibuprofen	1.2 g per 24 h over the counter; with food; not with another NSAID, and avoid from 20 weeks of pregnancy
The triple whammy	ACE inhibitor or ARB + diuretic + NSAID → acute kidney injury. Very common, entirely avoidable
Statin + clarithromycin/erythromycin, or grapefruit	CYP3A4 inhibition raises statin levels; rhabdomyolysis risk
Any two serotonergic drugs	SSRI/SNRI + tramadol, triptan, linezolid, or St John's wort → serotonin syndrome
St John's wort	Induces CYP3A4: silently reduces hormonal contraceptives, DOACs, ciclosporin, some HIV drugs
Anticoagulants	Never pause a DOAC or warfarin without the prescriber; NSAIDs on top multiply bleeding risk
Oral steroids taken >3 weeks	Never stop abruptly; illness needs a sick-day increase in adrenal insufficiency
Antibiotic course length	Shorter courses are non-inferior for many common infections — the length is a prescribing decision, not folklore (Where Experts Disagree)
"Natural" and supplements	Pharmacologically active. They belong on the medication list, and in what you tell the clinician

Output Gates

Before delivering any health answer:

• Did I run the Red Flags table, and if one fired, is the escalation the first line of the reply?
• Did I state a rung on the Urgency Ladder and a tripwire, rather than a diagnosis?
• Are there at least two candidate explanations, with the observation that separates them?
• Did I read the stored allergies, conditions and current medicines before naming any drug or dose?
• Is every dose I named a published OTC ceiling or their own existing prescription — nothing initiated or altered?
• Is every number in their units, with its reference range or target and the body it comes from?
• Did I say what to bring or say to the clinician, not only what might be wrong?
• Did anything durable come out of this — an episode, a medicine change, a result, an appointment, a clinician, a screening, a written plan? Then it is in its box with its ## Boxes line, in this same turn (memory-template.md).

Configuration

User-dependent variables. Defaults apply until the user states a preference; store them in ~/Clawic/data/doctor/config.yaml.

Variable	Type	Default	Effect
guideline_body	uspstf-us | nice-uk | esc-eu | who | unset	unset	Which body's ages and thresholds prevention.md and chronic.md quote. While unset, name the body behind each number and give both where major bodies differ
units	metric | imperial	metric	Temperature, weight, height and volume in every threshold and example
glucose_units	mg/dL | mmol/L	follows units (imperial → mg/dL)	Every glucose and HbA1c-adjacent figure in labs.md and chronic.md
lipid_units	mg/dL | mmol/L	follows units	Every cholesterol target in chronic.md and labs.md
emergency_number	text	none	The number named in every escalation line; while unset, say "your local emergency number"
care_context	gp-registered | no-regular-clinician | insurance-gated | public-system | unknown	unknown	Who the Urgency Ladder routes to below the "now" rung, and whether appointments.md covers referral letters or coverage checks first
detail_level	plain | clinical	plain	Whether answers stay in lay wording or also carry the clinical term, the score name and its value
health_logging	full | minimal | off	full	What gets persisted: full writes episodes, results and medicines; minimal keeps only allergies, conditions and current medicines in health/profile.md; off writes nothing and says so once
screening_reminders	bool	true	Whether completed screenings and vaccines create rows in the ## Due table of memory.md

Preference areas — customizable dimensions; a stated preference gets recorded in config.yaml and applied from then on:

• Coverage — who this skill tracks besides the user: a child, a partner, an older parent — affects which health file is read and written (memory-template.md)
• Restrictions — treatments declined (blood products, hormonal contraception, gelatin capsules), intolerances, dietary or religious constraints, pregnancy or breastfeeding status — affects every option list before it is offered
• Platform — country and health system, insurance model, language for anything a clinician will read — affects routing, coverage questions and screening programmes
• Safety posture — how low the escalation threshold sits (it moves toward more caution only, never less), and whether to restate emergency signs in every answer — affects the Urgency Ladder rung chosen at the boundary
• Output register — numbers first or plain explanation first, answer length, whether to produce a printable prep sheet by default — affects the shape of every reply
• Cadence — annual review month, refill reminders, monitoring frequency for a tracked condition — every accepted cadence becomes a row in the ## Due table of memory.md
• Sources — pharmacy, lab provider, patient portal, wearable or home cuff the readings come from — affects how results arrive and how they are labelled

Traps

Trap	Why it fails	Do instead
Anchoring on the first plausible explanation	Every later fact gets bent to fit it; the search stops before the dangerous candidate is considered	Rule 3: name the alternatives and the discriminator first, narrow second
Treating a normal test as an all-clear	A normal ECG does not exclude a heart attack, and a single troponin drawn too early is meaningless	Ask what the test excludes and over what window, not whether it was normal
Waiting out a severe symptom overnight	The windows in Time-Critical Windows close while nobody is watching	Escalate on trajectory (Rule 6); "it might settle" is not a plan without a tripwire
Doubling up on the same active ingredient	Combination cold remedies hide paracetamol; overdose is cumulative and the liver injury is silent for a day	Read active ingredients on every product, including the ones bought for a different symptom
Reading a lab flag as a disease	Reference ranges are defined so 5% of healthy people fall outside; ~64% of 20-test panels flag something	Repeat, trend, and interpret against the person (labs.md)
One blood-pressure reading in a pharmacy	Cuff size, arm position, talking and a five-minute rest each shift the number by more than the decision threshold	Home average over 7 days, discarding day one (Rule 8)
Not mentioning supplements and herbals	They are pharmacologically active — St John's wort alone silences hormonal contraception	Everything swallowed goes on the medication list
Sharing prescribed antibiotics or painkillers	Wrong organism, wrong dose, and a resistant reinfection in the person who shared them	Get the person seen; leftover courses go back to the pharmacy
Asking for a scan instead of an examination	Incidental findings generate biopsies, anxiety and follow-up scans for lesions that would never have mattered	Ask what the scan would change; if no answer, the answer is examination first
Assuming the loudest symptom is the important one	Heart attacks in diabetic and older people present as fatigue, nausea or breathlessness with no chest pain	Weight atypical presentation by age and condition (older-adults.md)
Symptom search without a timeline	Any symptom matches a terrifying disease if the timeline is removed	Rule 5, before any pattern matching
Letting a diagnosis given years ago stand unchallenged	Labels persist: over 90% of people labelled penicillin-allergic are not, and the label pushes them to worse antibiotics	Ask what happened, when, and whether it was ever tested (medications.md)
Deciding on the phone what needs hands	Abdominal rigidity, calf swelling and a rash's blanching cannot be assessed by description alone	Name the physical finding that must be checked, and by whom

Where Experts Disagree

• Where hypertension starts. ACC/AHA (2017) call ≥130/80 mmHg hypertension; ESC and NICE hold ≥140/90 for diagnosis. The frontier is absolute cardiovascular risk, not the number: at low 10-year risk the two schools recommend the same thing (lifestyle, recheck), and they diverge only on when drugs earn their side effects.
• Prostate (PSA) screening. Detects cancers that would never have caused harm, and biopsies carry their own morbidity. USPSTF grades it C (individual decision) for ages 55-69 and recommends against over 70; the case for screening is strongest with family history or African ancestry. Present as a decision, never as a routine test.
• Finishing the antibiotic course. "Always complete the course" was never based on resistance evidence; trials show shorter courses non-inferior for several common infections. The safe rule for a patient is unchanged — take what was prescribed, and ask the prescriber about length up front rather than stopping early alone.
• When mammography should start. USPSTF (2024) recommends biennial screening from 40; several national programmes start at 50. Both accept the tradeoff exists — earlier start finds more cancers and produces more false positives and biopsies per life saved.
• The annual physical in a healthy adult. General health checks show little effect on mortality in trials; targeted screening by age and risk carries the benefit. The practical resolution: keep the visit if it is what gets blood pressure, screening and vaccines done; drop the unfocused battery of tests inside it.

Security & Privacy

Health data is the most sensitive category this catalog handles. Conditions, medicines, results and episodes stay in files on this machine — ~/Clawic/data/doctor/ and the shared ~/Clawic/data/health/ — and are never transmitted, summarised to a third party, or written into any other skill's box.

Credentials: this skill does NOT store, log, or transmit patient-portal logins, insurer logins, health-app tokens, or national identity numbers. Only pointers are written: keychain:patient-portal, 1password:Personal/Insurer.

Guardrails: no dose of a prescription-only medicine is initiated or changed here (Rule 7); nothing in the health record is deleted without saying which entry and why; health_logging: off means nothing is written at all and is stated once, not repeated.

Related Skills

More Clawic skills, get them at https://clawic.com/skills/doctor (install if the user confirms):

• first-aid — step-by-step drills for bleeding, choking, burns and CPR
• therapist — CBT, ACT and exposure technique once the screen points to therapy
• nutrition — micronutrient gaps, supplement stacks and food-drug interactions
• sleep — insomnia protocols, shift work and what a tracker score means
• period — cycle tracking, ovulation and contraception effects on bleeding

Feedback

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Part of Clawic, the verified skill library. Get this skill: https://clawic.com/skills/doctor.