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]
Doctor: Hi, before we sit down really nice. Thanks for being here of course.
Patient: Thank you for being here for sure.
Doctor: So what do you hope to get out of our meeting today anything in particular?
Patient: Honestly, it's largely. It's just a curiosity about how different clinicians can't operate especially since the Unfortunate part about my therapy right now is that my therapist does not specialize in personality disorders So and she's well aware of the fact that she has some limitations and treating me But then I'm kind of at like an impasse where I'm like, okay on one hand it took me two years to open up To this person. I don't want to start over on the other hand. I could be probably finding better treatment So like I'm really juggling that right now and I think this will give me a better idea of what I want to do going forward if I want to find somebody new Or if I didn't want to stick through it and hope for the best
Doctor: So when did that start to occur to you that maybe she might not be the right person?
Patient: Honestly, it was pretty quickly after my diagnosis She like was pretty she was pretty like open on the fact that like it's not her wheelhouse And that like, you know, she'll keep treating me But it's like I might want to consider that which I took a little bit of offense to but I was like wow abandoning Me that's fine But I am so it felt more like she was rejecting you than Protecting you there was a little bit of a like that was the that was the there's a paying of that emotion there But I knew that was like irrational on my end Yeah, where it was like, you know Like I think it's fair for people to be able to kind of recognize their limitations when it comes to their abilities Yeah, I mean she's only treated like five people person I disorders and her entire career including me, right? So it's like how how effective could she really be? So I think it's a reasonable thing to offer.
Doctor: Right, right So when you think about it, if you take yourself out of it a little bit and look down on it, what's your story? What's your life been? You know, where were you born? What was your relationship with your parents? Like what was school like?
Patient: So I was born in The middle of the Rust Belt as a city called Canton, Ohio home of Pro Football Hall of Fame I was the oldest sibling of me and my sister middle class family Both my parents were like relatively speaking pretty educated by But my parents got my mom left my dad when I was five for a woman And like that was cut and like I kind of had this mindset of like, oh cool. That's conditional. That's awesome. I Told my I remember I told my sister that My mom was taking away the love that she had for me her and my dad and giving it to this her new partner And then things like went downhill real quick from there like that woman ended up being very controlling and Probably I would say abusive to my mother and my dad's became what started a like a heroin junkie and came like really depressed and like Would very rarely interact with us and stuff and my mom was to absorb in her relationships to pay much attention to us There was some physical violence too, but like I won't get into that too much my sister developed some very very Complicated issues. She like she like got very happy in the drugs crime Like horrible like anger issues and violence Like I can't do like I can't I can't tell you how many times nines have been pulled on me and that house And like in shoes I know it's with borderline personality disorder and a conduct disorder Which in my opinion probably progressed into full-blown ASPD, but you know, she was Iraq officially diagnosed Eventually and like by time I was like I Don't know 15 or so 15 16 My mom basically had she got rid of that old partner and found a new partner moved in with him I was and my sister was like in out of jail. So I was just kind of alone in the house most the time Unless I was at my dad's which in that case like I was just trying to avoid him because I didn't want to deal with like You know Anything like I didn't want to like accidentally piss him off and you know bad things happen And then and socially I was I was like fucking I was a loser up until I was 14 Between 14 and 16. I forget exactly how old Why because I had like no friends up until that point then once I did get friends. I was very socially domineering. I had like Huge social groups mainly used for self-esteem regulation. There were some people I valued more than others, but you know And like I was like obsessed with like never being alone I spent like I spent three years Two three years where like I did not spend a single day without like hanging out with people and seeing people because like I couldn't bear It and like it was great because my house was always empty. So it's like I had like the perfect party place Eventually went off to college Joined the army Got when I got back from basic training. My friend group fell apart. I became miserable and because I didn't have that self-esteem regulation anymore Made some really bad decisions during that period Dropped out of college. Sorry, we can't prison quit the prison bought a house and Basically travel a little and now I'm here basically
Doctor: And what do you do now?
Patient: Mainly just the social media stuff.
Doctor: Okay, that's a lot
Patient: Yeah, I've lived if nothing else. I've lived a very full life in my opinion
Doctor: you just sort of You made a little bit of a joke just now What what were you feeling right before you did that?
Patient: I Felt like I was afraid you were won't pity me
Doctor: What does that mean pity yeah What do you mean by that?
Patient: I Don't know when people What the fuck does pity me now? I mean, I know what it is. It's like whenever I talk about Like my childhood and stuff people are always like I just don't like the way that people like look at me and like They're like, oh, like you must have had so horrible blah and it's like to me that feels I Just almost feels demeaning because it's like there's an implication there that like there's a chance. I wouldn't get through it alone Because like to me it's like I don't know that was a norm it's like not like It's not like there was anything Particularly it wasn't challenging just because that was just how life was
Doctor: it's all you knew
Patient: Yeah, and and like I don't know I try not to bitch about it too much just because I mean I just I Don't know it um, I was fine more or less I made the best of it and I took care of myself