It is ironic that the Shakespeare passage in Hamlet that contains the immortal six words “brevity is the soul of wit“, is quite a rambling piece of writing. But his statement, if not his framing of it, has struck a cord with many writers who came after him.
I have been impressed that the majority of the small number of specialist and hospital reports I get on my Maine patients from Mass General and other Boston ivory tower practices are so brief and to the point, while many local discharge summaries are both lengthy and stilted and also very difficult to find the essential information in. Some hospital systems put the Assessment and Plan right on top, but you have to go hunting for the Subjective and Objective. Those charts also belabor the malpractice defense functionality of rattling through which differential diagnoses seemed unlikely.
I’m far from convinced that AI generated clinical notes could even come close to the succinct reports I get from Boston. I have not yet tried using AI for my own notes, but read on, I have a different suggestion.
I hear horror stories about how chitchat about a fishing trip often ends up in the social history of a patient.
Transcription does not require anywhere near the muscle of full-fledged AI office note generating software. But I’m thinking that could be enough:
Imagine office notes that really only contain the important information, the medical corollary to Who, What, Where and How, and each office note had a supplemental file, namely a transcript of the entire conversation for anybody who needs to dig deeper.
The amount of time it takes to find the essential information in the average office note or discharge summary I read is outrageous. Things actually get missed because of all the fluff.
The Greeks had four virtues and the Bible has seven. I think I just started a series on which are the virtues in the practice of Medicine.
Stay tuned.
P.S. Here’s another piece about brevity, in terms of the now nearly extinct “brief office visit”:
Interesting read.
I’m a community paediatrician based in the UK. I spend my time completing neurodevelopmental assessments for children with suspected autism and ADHD, neurodisability assessments and child protection work. My reports are not short! Our manager probably want them to be, GP often complain they are too long. But we cannot really skimp on detail a many of these children are quite complex. What we do make sure is that at the beginning of the report, there is a clear diagnosis and action plan and that the summary at the end of the report is concise.
When I write my reports I’m often thinking of the future me (and other paediatricians) who might see this child for follow up and wonder how I got to my diagnostic formulation. I’m thinking of the parents who value the fact that somebody had documented their child’s development in a way they can share with other professionals and services that often want ‘evidence’ of their child’s needs and abilities.
Child protection reports are a horror to write because they might need to be submitted to court, so I’m always checking double checking everything before I release them to social care and have to clear about fact and opinion, who said, what why etc
A different ballgame I expect from other fields of medicine. But there is much to be learnt about thinking about when is less needed and when more is needed.
Thank you for your post. Food for thought.