This is an article that I’ll keep updating. ...

The previous post, Getting Started from Scratch, was about how to install it and get it running. This post is about using it well. And that is completely different from just getting it to run. I’ve found that what really determines the outcome isn’t which model you use or whether you can code. It’s how you delegate tasks and how you set up guardrails. The stuff in this post isn’t tied to a specific tool; it applies even if you use ChatGPT (I’ll explain the differences in the last section). ...

Why “too many notes” and “no notes” are the same thing Let me start with a rule I decided on early and haven’t changed since: in my note vault, there can only be one note per topic. It’s not about being a neat freak. It’s because if the same thing is covered in five different places, I have to open five files when I look something up, and figure out which version actually counts. That organization work didn’t disappear, it was just left intact for my future self. And my future self is usually seeing patients in clinic or rushing to finish slides, with no time to do this. The chaos caused by too much information is the exact same pain as not having enough information. ...

I was recently preparing an introductory AI lecture for our therapist colleagues, and thought I’d put together an advanced list of all the tools I normally use and the programs I’ve written. This way, when you want to do something, you can quickly look up “who to go to for this function.” It’s also something I’ve always wanted to organize for myself, so I’m taking this chance to write it all out. ...

Origin I’ve loved taking notes since medical school and have accumulated thousands of medical notes over the years. But honestly, with information so easy to get and so much to learn now, it’s become hard to keep every note at the same quality using my own structure. On the other hand, in an era of ever-increasing information, trustworthy, high-quality sources have ironically become precious, which makes textbooks a great source of information. However, there are over forty designated reference books for the physical medicine and rehabilitation (PM&R) board examination, and the same concept might be scattered across different chapters in several books. Actually reading through all of them is almost impossible. ...

Recently I was spending time with an older adult, and he said to me: “Life really doesn’t need to be that long. I’m already in my 80s, why would I still go exercise and work out? I already go out and walk several times a day, that’s already very good!” Honestly, the first half—“life doesn’t need to be that long”—stumped me. That’s a question about the meaning of life, not something I can answer in a few sentences in clinic. But the second half—“walking several times is enough”—happens to be my own specialty, and I’m confident about this: walking is great, but for an 80-something older adult, relying just on walking really isn’t quite enough. I’ll start from here in the rest of this post. ...

Let me say the most important thing first: when some elders “take things lightly, have fewer friends, and like to be quiet by themselves,” it doesn’t necessarily mean something is wrong; it might be a healthy shift in mindset. Gerontology calls this “gerotranscendence”: the body slowly declines, but the mind actually becomes calmer and knows more clearly what it wants. This post is an extension of Does an 80-year-old still need to exercise?, written for those of you worrying about why your older family members are getting “more and more indifferent.” ...

Let’s start with the most important point: When older adults with dementia say “I’m fine, no problem,” it’s often not stubbornness, nor a refusal to face reality. It’s that their brain literally cannot detect its own decline. In medicine, this is called impaired insight, and it’s a part of dementia itself. This is an extension of the post Do 80-Year-Olds Still Need to Exercise?, written for those of you who are caring for a family member with dementia and feeling frustrated that “they won’t admit it and won’t listen.” ...

Let’s start with the most important thing: depression in older adults often doesn’t look like “depression." They might not cry or say they’re sad. Instead, it turns into aches and pains all over, poor appetite, bad sleep, and a lack of energy for everything. And so it’s very easy for the whole family (sometimes even physicians) to write it off as “that’s just what happens when you get old,” and quietly miss it. ...

First, the most important sentence: the harder you push someone to change, the more they will defend “not changing”; letting them state their own reasons for wanting to change is how change actually happens. This conversational method is called “motivational interviewing.” Healthcare professionals use it to talk to patients about quitting smoking, exercising, and controlling blood sugar, but it works just as well for persuading your parents to exercise or your partner to see a doctor. ...