The Running Note - Raw Transcript
So let's make the following dictation into the note then, okay? Or into the article. We'll see what happens, okay? So, I've been experimenting with utility in contexts. So, I guess as a doctor, just kind of thinking about the different contexts of a visit. There is the pre-visit, which requires the, I guess, requires you to pre-rounds, is what we say. So what you really need here for the pre-rounding is a good synopsis. And I think a good tool would be one that just sort of like, at a glance, tells you what you need to know. What you need to know is quite different depending on your context. As an internal medicine doctor, I think it's highly specific. And even between internal medicine doctors, it's likely highly specific as well. So there may not be a universal, this is what someone needs to know. I don't know if there'll ever be one tool to fit them all. But anyways, there's definitely, I think, tools to fit individual people. And whether we fine-tune these things is a different idea. Now, the other thing to think about is, then there's after the visit. This is pretty well known because the after the visit has been being played out for a very long time. This is like the, you know, this is what people generally see after the visit. You want to look back and remember what happened during the visit, you get the note that you wrote. And again, there's some pretty standardized things that need to be in such a note. You need to have, I would always think of like, you know, the HPI needs to be a good story for like exactly, it needs to answer the questions about what, why you have the problems that you have in the assessment and plan. That's why I still am a fan of the HPI, assessment and plan version of the note, because I feel like the HPI is like the narrative that leads you to the assessment and plan. There's certainly a movement towards putting sort of the HPI for each plan in the assessment and plan area. But I'm not sure if this is, you know, if this is the best way. I'm not clear or not. It's not the way I enjoy it, because I think that when there are a number of different things that need to be addressed, you know, it just happens. I think that is pretty clunky, especially when like if a problem, a plan only really needs like one line, having the HPIs repeated over and over again may not be valid. Anyways, this is getting a bit off topic though, because I would say the next thing I'm thinking about is, but again, this is, yeah. So anyways, I'm still a fan of the like, hey, let's have like a narrative, tells us exactly like a little bit about the context of the person so that we can remember them later, a little bit about like what exactly their issues are today, and then moving into like, well, here's all the different individual problems we talked about, and here's the plan to address all these problems. I like that as a way to characterize the final note. I look back and I think that's been quite adequate. Then there's like the, I guess, other things, and I think less well explored, and less difficult, much more difficult to explore, is like what's really needed in the room itself. And so what's needed in the room itself is sort of like as we are in there, everyone has a different style, I think, so doctors for sure. There are some people, like me, historically what I used to do would be just chart, like I would be, hey, I'm like, you're right, you're talking, and I'm writing things, so that I could sort of be able to build the HPI. It was really quite terrible due to the fact that there was really very minimal prose. I was just noting down like jot notes of what was happening. So, but that was like my style. Some people write it down on paper and then maybe dictate or then transcribe it or just type it out later in their note proper. That's kind of like undefined, I think at least a little bit undefined in the primary care setting, like what's really needed during a visit itself. Like what would be most helpful while you're actually in the visit? I think there's a lot of ideas which would not be helpful, that's for sure. So like, I think finding out what's most useful is going to be somewhat of a challenge. I remember I ran a couple of fake transcripts through like, which I've mentioned prior, through OpenEvidence at home, I was just kind of like, I wonder what happens with OpenEvidence when I run this through. They have this concept of a running note and then the final note. And I like that. That's a good idea. But I wonder like about the running note and the utility of it. What's the most useful, what really comes from a running note? I think to be honest with you, when I'm in the room with a person, like having sort of like summarization of the facts we've talked about is only sort of helpful because I guess it, I don't know, I just feel like it's only a little bit helpful for some reason. But then I think the thing that I like is, think about, I told residents about this, what I've settled on may be useful, we'll find out for multiple reasons, is the story. So if you think about a visit less like a series of facts that are to be cataloged, and more like a narrative that is to be sort of captured, then I think that during the visit you get much more utility. Because first of all, I think our brains like work better for stories. So if you're willing, because really in the visit, you don't want to be looking at a computer for a long time. You want to glance at it. And if you're going to glance at it and you want to know where you've been, really stories a pretty good way to do that, because you have a pretty good feeling like you've just lived through the story, you're talking about it. So when you actually go to like look for where things is, you can think about where you are in the story. And then additionally, I think that having sort of a summary of things you've said you would do, not really a plan, just like a, hey, like you would order this or that, may be helpful so that you can check to ensure you have actually like done the things you said you would do. And this is very different from like the after note, because there really is like this note is really specifically just for during a visit. So, and then additionally, I wonder if like once you have this story of the visit, you have like, end up with multiple pieces of data created during the visit. You have, you might have like a transcript, that's like the back and forth discussion, pretty messy because speech is messy. And then you have like sort of a running narrative story generation from the, that's created. And then you can input both the transcript and the story into sort of another databank to come out with like a proper final note. I think this is going to be an interesting experiment to see what comes of things in the future. Because to now, we didn't really have like all this, you know, I think it's a really interesting time because yeah, everything used to just be in your head or on a piece of paper. And now you sort of opened up the possibility space into many new areas. That's a pretty exciting thing. It's a pretty exciting thing. Anyways, we'll see what comes of this.