#[cfg(test)]
mod tests {
    use super::*;
    use sqlx::PgPool;
    use sqlx::postgres::PgPoolOptions;

    #[sqlx::test]
    async fn test_dry_run_does_not_write(pool: PgPool) {
        // Setup: create a test table
        pool.execute("CREATE TABLE IF NOT EXISTS test_patients (id SERIAL PRIMARY KEY,