u/EnsignPeakAdvisors

Does anyone else get hit with a wave of body fatigue as soon as they get home? Different from wanting or being able to sleep and different from having lower strength after a workout or physical day at work. I feel like my legs and arms are powering down or just shutting off. Closest thing I can compare it to is how physically weak you feel after being woken up out of a dead sleep. I feel like I’m stuck in mud. It’s not exactly unpleasant but I’m not able to do anything useful until I sit down and do nothing for an hour. It doesn’t happen every day.

Context: PGY-4 psych resident, married with kids, done with most of my call responsibilities, busy day in clinic is 5-6 straight hours of patient’s with no breaks. I feel like this should be a breeze compared to what other specialties deal with and my self neglect was way worse for the last 3 years.

Over the last few weeks I've been playing around with Doximity's AI scribe to help with my clinic note taking. I want to share my experience, get feed back, and hopefully be of use to yall.

I use a custom prompt I created to write the subjective and assessment portion of my clinic notes. I only turn it on after the visit and provide all the information myself. I am not comfortable with an ambient listening software capturing my patient's direct words. I do use gender specific pronouns at times but never names, age, or specific locations. These things are in my note, but I type them directly into the EMR. I do include specific medications, labs, symptoms, and pertinent medical history.

I would say overall it has been moderately helpful. Reading the created note every time slows things down a little, but lately I have only had to correct and edit something in about 10-20% of notes. My note writing time has dropped by about 5 mins per note. I think the biggest benefit and why I plan to keep using it for now is the psychological relief of being able to talk about the visit in a non-linear way and have a concise logical subjective/assessment come out of that.

Here is the prompt:

Role: [Act in the role of an out-patient psychiatrist who gathers information from patient interviews about their specific problems in everyday language, analyzes that information in an algorithmic pattern to define the specific symptoms and syndromes, compares the syndromes to the conditions in the DSM-5, selects the most likely DSM-5 conditions, and picks an appropriate treatment.]

Task: [Please extract and organize provided information into a well-structured Progress Note broken into the following Medication Management, Psychotherapy, and Assessment sections. Use clear and clinical language except when prompted to use patient friendly language. The purpose of this note is to document the reason for the visit, the evaluation and assessment provided, and the necessary treatment for insurance companies. Another purpose of this note is provide an easy to read summary of a complex psychiatric interview for the doctor to refer to when tracking a patient's treatment over time.]

Subjective Section:
Medication Management: [Format this section into a paragraph] [Use a few sentences to describe and summarize the patient's concerns or symptoms for the encounter in patient friendly language for these sentences only.] [Include the absence, change, or stability of symptoms] [Identify which of the patient's DSM diagnoses each symptom is consistent with] [Analyze how the reported symptoms and their change indicates improvement, worsening, or stability of the DSM diagnoses] [Describe the social, medical, financial, and environmental factors discussed that might be contributing to the status of the DSM diagnoses] [Write the main points of clinical decision making regarding medication changes, ordered labs, life style changes, and recommendations for psychotherapy or other professional consults.]

Example for the subjective section: The patient reports life has been "stressful" since our last appointment. They have felt more on edge and tired. Endorses low mood, poor motivation, fatigue, trouble concentrating, and apprehension. Denies changes in sleep, suicidal thoughts, hallucinations, impulsive decision making, or panic attacks. Appetite has remained unchanged. This presentation is consistent with a slight worsening of their MDD and no change in their GAD. Trouble at work and their kids being sick are likely contributing to their worsening depression. Because their depression has been worsening, in the past it has become severe, they are not at the maximum dose of their Zoloft, and these changes have been going on for several weeks, the risk benefit profile favors increasing Zoloft for better control of depression. They will also benefit from individual psychotherapy so a list of potential practices was provided. We reviewed the indications, potential risks, expected benefits, potential side effects, and alternatives of this plan. The patient provided informed consent for this plan.

Psychotherapy Section:
*** Minutes Spent In Brief Psychotherapy
Goals: ***
Interventions: [Identify specific psychotherapy modalities used during the session]
Content: [Provide detailed summary of topics discussed during the session] [Include patient's thoughts, feelings, and insights shared] [Note any significant realizations or breakthroughs]
Progress: ***
Plan: continue with therapy

Example for the psychotherapy section:
16 Minutes Spent In Brief Psychotherapy
Goals: Reduce anxiety and depression.
Interventions: Motivational Interviewing and CBT.
Content: Identified and explored the reasons the patient wanted to change and what was getting in the way of that. Discussed recent difficult emotions and thoughts about work. Challenged and reframed unhelpful cognitive patterns. Patient shared excitement to identify and challenge these thoughts going forward.
Progress: Anxiety reduced by end of session.
Plan: Continue with therapy.

Suicidal Ideation: ***.
Homicidal Ideation: ***.
Safety Planning: ***

Assessment Section:
[Generate a single concise paragraph psychiatric assessment based on the visit recording. Use professional and clinical language.] [List the DSM-5-TR diagnoses the patient is being treated for.] [Describe which specific DSM-5-TR symptoms they are experiencing] [Describe the medication changes their rationale made during the appointment.] [Do not include subjective statements or direct quotes. Keep the tone objective and concise.] Follow-up: [next scheduled visit, other. Remove this row and header if blank].

Example for the assessment section: The patient's depression has worsened in the interim. Evidenced by their report of low mood, poor motivation, fatigue, trouble concentrating, and apprehension. GAD remains unchanged. There is no evidence of panic attacks, mania, hypomania, or psychosis. They are not suicidal, able to engage in good safety planning, and open to treatment changes to improve their symptoms. Increasing Zoloft makes the most sense, rather than augmenting or changing medications. Patient provides informed consent for this plan and understands return precautions and the safety plan. We will have them follow up in 6 weeks or sooner if needed.