The Doctor Who Treats Patients With a Gaming Mouse

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Dr. James Ries sees patients in 37 states. He never touches a stethoscope, never walks a hospital floor, and almost never types a full sentence into a chart.

His main clinical instrument is a Razer Naga V2 Pro. It’s the same mouse World of Warcraft raiders use to fire off 12 abilities without lifting their fingers from the buttons.

That sounds like a joke. It isn’t.

Dr. Ries is the founder of Twenty Mile Medical, a telehealth practice handling urgent care, mental health, and weight management visits across most of the country. He runs his entire clinical workflow through a setup that pairs an MMO gaming mouse with TextExpander Snippets, and he says it’s the single most important tool in his practice.

We had Dr. Ries on a recent webinar to explain the setup. What we expected to be a conversation about clinical documentation turned into something stranger and more useful: One of the most interesting productivity workflows we’ve seen anyone build on top of TextExpander, and a set of principles that work just as well for a customer support team or a law firm as they do for a telehealth practice.

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The problem he was trying to solve

Telehealth has a quality-control problem that nobody talks about much. You hire good clinicians. You give them logins and patient queues. You assume the training they brought from prior practices is enough to deliver consistent care.

It isn’t.

“Every provider had their own version,” Dr.Ries told us. “Some are really meticulous, some are really fast, but they missed out on things. The patients themselves experience completely different interactions depending on who they saw.”

The drift wasn’t about clinical judgment, but about everything that surrounds the judgment: Documentation, patient communication, follow-up instructions, the empathetic phrasing that turns a transactional encounter into something resembling care. Discharge instructions going out at 8 am from a fresh provider look nothing like the ones going out at 4 pm from the same provider after eight hours of visits.

That’s a workflow problem, not a training problem.

What a monster Snippet actually is

Most TextExpander users build dozens of small Snippets, each tied to a specific phrase. You type ;sig and your signature appears. Type ;addr and your address fills in. Predictable, useful, and learnable in an afternoon.

Dr. Ries went the other direction.

He built what he calls monster Snippets . Each one is a single Snippet containing an entire clinical scenario with branching options inside it. One Snippet for sinus infections that covers the introduction, the assessment, prescription options, patient instructions, and follow-up plan. Another for psych refills. Another for general patient communication. Each is essentially a small interactive form that the provider walks through in seconds.

When he expands one, he gets a fill-in dialog with checkboxes, dropdown menus, and optional sections. He picks what applies, removes what doesn’t, and the Snippet generates a complete, clinically appropriate response. The whole thing takes about as long as a normal conversation, except every required element is there, every time.

One scenario. One Snippet. Everything inside it.

Watch Dr. Ries run a psych refill, l and you see why this matters. A returning patient, minimal improvement, looking to increase the dose. Some sexual side effects. Depression is controlled, but anxiety is still running high. He clicks through the built-in options, bumps the medication to 100 mg, and the entire note is ready: The assessment, the medication change, the check-in plan, the internal follow-up, the handouts, and the suicide resources.

Every required element is there because the Snippet carries them. “You’re not worn out,” he says, “because it remembers to send them everything.”

Not every Snippet is a monster. Dr. Ries keeps single-purpose buttons alongside the big ones: One for his signature, one for his intro. The branching Snippets handle whole clinical scenarios. The small ones handle the things he types constantly. Both live on the same mouse, a thumb-press away.

Why the mouse matters

You can run monster Snippets from any keyboard. Dr. Ries could type abbreviations like everyone else. He doesn’t, and his reasoning is worth understanding even if you never buy a gaming mouse.

The Razer Naga V2 Pro has 12 programmable buttons on the side panel. Dr. Ries maps each button to a single character, typically one of the symbols above the number keys he doesn’t use in normal typing. Each symbol is the abbreviation for one of his monster Snippets.

A press of his thumb fires the Snippet. That’s it.

“If you design a system where you’re not...