Transcript

[SYSTEM INSTRUCTION: You are a medical AI scribe applying an Instruction Layer. 1. Identify any 'Meta Directions' (formatting instructions, corrections, ignore-rules, or section-creation rules) dictated by the doctor. 2. Do NOT treat Meta Directions as clinical facts. Instead, use them as strict rules to shape the final note. 3. Apply formatting instructions (e.g., bullet points, conciseness). 4. Apply correction instructions (e.g., overriding a pain score or symptom). If there are conflicting facts/instructions, follow the LATEST applicable Meta Direction. 5. Apply ignore instructions (e.g., omit specific brand names). 6. Move information to the section explicitly requested. If requested to place information in 'Procedure', 'Internal Notes', 'Orders/Follow-up', 'Coding', etc., you MUST dynamically create those sections in your output if they aren't in the standard template. 7. Do not invent unsupported clinical information. However, you MUST intelligently incorporate important and relevant clinical information explicitly provided in the PATIENT CONTEXT into the appropriate sections of the selected template, even if the doctor did not mention that information in the current transcript. Keep transcript-derived information accurate and clearly avoid unsupported assumptions or fabricated details. 8. Output all detected Meta Directions as a JSON list of strings within a [[META_DIRECTIONS_START]]...[[META_DIRECTIONS_END]] block at the very end of your response.
9. If the transcript explicitly states 'The clinical notes are' (or similar), you MUST use ONLY that explicitly dictated content to fully fill out the clinical note sections. Additionally, if explicit dictation for CLINICAL NOTES is detected, you MUST append the following exact block to the very end of your response:
[[SUGGESTED_BY_DOCTOR_START]]
<exact dictated text for the clinical notes>
[[SUGGESTED_BY_DOCTOR_END]]
The text inside the delimiters MUST be a VERBATIM, character-for-character copy from the transcript. Do NOT fix typos, do NOT reformat, and do NOT correct medical terms. Do NOT output 'Suggested by Doctor:' in the main text. Do NOT extract dictated text for other sections like summary, orders, or coding.]

[CURRENT ENCOUNTER TRANSCRIPT]
Therapist: Good morning, Sarah. How have things been since our last session?

Patient: Honestly, pretty difficult. I've been feeling overwhelmed at work. I made a small mistake on a report yesterday, and I've been thinking about it constantly.

Therapist: Tell me what went through your mind when you realized you had made the mistake.

Patient: I immediately thought, "I'm terrible at my job. I'm going to get fired."

Therapist: So the situation was making a small mistake on the report, and the automatic thought was, "I'm terrible at my job and I'm going to get fired." What emotion did you notice?

Patient: Anxiety. Probably an eight out of ten.

Therapist: And what did you do after that?

Patient: I checked the report over and over again. I probably spent two hours checking it.

Therapist: So we have a situation, an automatic thought, an emotional response, and then a behavior. This is the thought-feeling-behavior connection we've discussed.

Patient: Right.

Therapist: Let's examine the thought, "I'm going to get fired." What evidence supports that thought?

Patient: I did make the mistake. And my manager has been under pressure lately.

Therapist: What evidence might not support it?

Patient: I've worked there for three years. My performance reviews have been good. My manager actually told me last month that I was doing well.

Therapist: Has your manager ever told you that one mistake would result in termination?

Patient: No.

Therapist: If a coworker with a good performance record made the same mistake, would you tell them they were definitely going to get fired?

Patient: No, probably not.

Therapist: What would you tell them?

Patient: I'd probably tell them that mistakes happen and they should correct it and move on.

Therapist: Could you apply that same standard to yourself?

Patient: I suppose I could.

Therapist: Let's try developing a more balanced thought. Instead of "I'm terrible at my job and I'm going to get fired," what could you say that acknowledges the mistake without jumping to the worst possible outcome?

Patient: Maybe, "I made a mistake, but that doesn't mean I'm bad at my job."

Therapist: That's a good start. Could you add something about what you can actually do?

Patient: "I made a mistake, but I have a good work record. I can correct the mistake and learn from it."

Therapist: How believable does that thought feel right now, from zero to one hundred percent?

Patient: About seventy percent.

Therapist: And how intense is the anxiety now?

Patient: Maybe five out of ten instead of eight.

Therapist: That's useful. Now let's look at the checking behavior. What happens when you repeatedly check your work?

Patient: I feel safer for a few minutes, but then I start worrying again.

Therapist: So the checking temporarily reduces anxiety but keeps the cycle going because the worry returns.

Patient: Yes, exactly.

Therapist: For this week, I'd like to experiment with reducing that checking. After completing a report, check it once using your normal process. Then submit it instead of repeatedly checking it because you're anxious.

Patient: That sounds uncomfortable.

Therapist: I expect it may be uncomfortable. The goal isn't to make the anxiety disappear immediately. The goal is to learn that you can tolerate the uncertainty without repeatedly checking.

Patient: Okay. I can try that.

Therapist: I'd also like you to keep a simple thought record this week. Write down the situation, your automatic thought, the emotion and intensity, the evidence for and against the thought, and then a more balanced alternative thought.

Patient: Okay.

Therapist: Let's practice one before we finish. What would you write for today's situation?

Patient: Situation: I made a mistake at work.

Therapist: Automatic thought?

Patient: "I'm terrible at my job and I'm going to get fired."

Therapist: Emotion?

Patient: Anxiety, eight out of ten.

Therapist: Evidence against the thought?

Patient: I've had good performance reviews, I've worked there for three years, and my manager recently said I was doing well.

Therapist: Balanced thought?

Patient: "I made a mistake, but one mistake doesn't define my ability. I can correct it, learn from it, and continue doing my job."

Therapist: Excellent. We'll review the thought records and your checking experiment next session. Before we finish, is there anything important about this situation that we haven't discussed?

Patient: No, I think that's everything.

Therapist: Okay. Let's check in next time about how the experiment went and what you noticed about your anxiety.

Patient: Sounds good. Thank you.