Google sheet , cells update problem

What is the current best practice in n8n to safely perform a partial update of a Google Sheets row (without overwriting fields that are empty or not provided), while handling both cases: creating a new row and updating an existing one?

I’m facing an issue where the Google Sheets node always overwrites my existing data, even when it receives no input for those fields.

I’m updating patient data, and some biological values change from day to day. I only want to update a few cells in Google Sheets without overwriting the rest (age, name, etc.).

I also tried using the MCP tool “Google Sheets MCP – AI‑Powered Spreadsheet Management”, but it never manages to update a single cell, even when I provide extremely precise instructions in the prompt.

Additionally, I need a workflow that can:

  • update existing patient records based on their file number (unique ID),

  • create a new row if the patient’s file number does not already exist in the sheet,

  • and later update only a few specific cells for that patient without touching the other fields.

Either use a DB node that supports some real querys or an option is here :

Cheers!