In the second edition of this manual I have retained the basic information about the special requirements of running a medical office. I have added a good deal of practical information about making the most of the electronic medical record. I have gone into detail, with step-by-step guides, on how to go paperless—which will free the office staff from non-productive chores like ‘pulling charts’ and filing; the result is that the staff ratio, and hence costs, can be reduced, or the staff can do more in terms of recording patient vital signs, maintaining chronic disease registers and generally educating the patients. Though written by a general practitioner for general practitioners there is much information that will be relevant for specialists Most graduates should now be joining established group practices. The information in this manual will enable the incoming physician to judge the safety and desirability of the medical group; and to confidently advise changes. This is a reference manual. There are inevitable repetitions and duplications. It is not designed to be read from cover to cover; I have used a generous number of hyperlinks to facilitate navigation between the reader’s areas of interest. I have aimed to enable a physician to make a practice safe, enjoyable and efficiently profitable. The most important of these is ‘safe’.