The question that never gets asked

precharting → the doctor → extraction & reasoning → the usage log · DOM-computed particles, TypeGPU-rendered · ← back to the essay (print-safe version)

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Ms. R · 58 · HFpEF follow-up

2019 discharge summary (amiodarone start) — in the chart, never opened

did the outside echo get uploaded? · eGFR trend since March?

does her strain pattern fit an infiltrative process?

> sglt2i egfr cutoff in heart failure 2026

“could this be ATTR amyloid?” — never formed

Mr. T · 71 · AF · new fatigue

outside cardiology consult — faxed, unread

who started the amiodarone? · last TSH?

is the fatigue drug, thyroid, or rate-related?

> amiodarone × apixaban interaction dosing

“thyrotoxicosis screen overdue?” — never formed

speaker notes

Every gray dot is a before-visit inquiry — unscheduled, uncounted, unpaid; most of the chart is never reviewed.
The doctor is the filter: attention, time, and what they know to ask — only a fraction enters, and color is assigned on the way out.
praxis classifies what emerges (intent → subintent): extraction = interval history · med rec · outside records · guideline lookup; reasoning = differential · risk synthesis · dose in context · goals of care.
Both lanes end in the answer-engine log, counted as product usage (“1M consultations a day”) — the same cognition, relocated; the tool takes credit.
Never formed — the red dots in the pile: “could this be ATTR amyloid?” exists only if you’ve read the 2026 guidance — an unasked question is indistinguishable from no need.