Dr. Ralph is a Claude Code plugin that runs a 5-phase diagnostic workflow: records intake, literature research, differential diagnosis, treatment planning, and SOAP documentation. It uses the Ralph Wiggum plugin’s Stop hook pattern - the loop keeps iterating until diagnosis confidence reaches 80% or max iterations.
The interesting bit was adapting Ralph for multi-phase work instead of single-task refactoring. I used Thariq’s AskUserQuestion interview approach to spec it out first, which made the actual build surprisingly fast.
~1,600 lines. Uses the Stop hook to check for completion promise in Claude’s transcript, re-feeds the prompt if not done. State lives in a markdown file with YAML frontmatter. Not a replacement for doctors - just an experiment. Our team builds clinical decision support at the VA, so this was adjacent territory.