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]
I am the psychiatrist here in this department. I came to see you because my GP sent me to see you, didn't he? Yeah, yeah. He said, come and see a trick cyclist because then you'll be all right. Come and see a trick cyclist, a psychiatrist? Yeah. He not had time to listen to me, you see. Okay, he's a GP, he's a doctor. But I don't think he's very clever. He's not very clever because he's not okay. Getting to this UC, he won't let me talk about this. He sort of listens to it sometimes, but then sometimes he doesn't. Right, can I just clarify why you were here and why I'm here? I'm the psychiatrist. Well, I've come to see you in the emergency clinic today. Okay. And your GP has asked me to see you. So that's why I'm here. Is that right? Yeah. Cause I got to tell you about this. There's important stuff in there. Really important stuff. Okay. Well, before we start with that, I come to see you. Can I just ask you what you would like me to call you? What name? Yeah, name, name is a game. I don't bother with names. That's just too good. Right. Okay. Call me Audrey. Okay. I'm the psychiatrist over here. Okay. Now, what is Audrey? Can I ask you how old you are Audrey? How old? Oh, don't. You're only as old as the woman you feel, aren't you? I feel quite young and better than most women in their 20s. Right. Okay. So how old would that make you archery? My idea would say I am 35, but I feel 23 and free. Free food, food for the soul. A nice bit of soul. Yeah. I, right. A bit of fish. Ah, fantastic. I'm not half hungry. Right. You have any food, any food here. You have any food. I'm starving. Not. They won't be able to get you any food. Let's, okay, now let's get back to this. This is important. Yes, that's a good idea. Yep, okay. This is why I'm here to talk to you about this, right? Okay, to tell you what's going on. Okay, tell me a bit about this then. Well, this is the work I've been doing, and it's really important. It's my cure for world hungry hunger. That's what it is, you know. It's all written down here. Well, it's not written down. It's here. It's at home in my books at home. Right. What I get from the paper is I get is I get sort of clues, right? As to what I'm supposed to do now and how I'm supposed to get, get the other clues to hone it down and come up with a final thing. And how long has all of this been going on? Would you say it's been for ages now? How long would you say? Absolutely ages now. Well, I've been up all week. About a week? Well, this week I've been working really hard at it because before it's been going on longer than a week. Right. But I've been working really hard on it for this week because you normally have another. It's the numbers you see. Right. It's the numbers you have to find out. Am I right and thinking you normally do a different job? Yeah, I have a small business with my sister selling pottery. I am a potter You're a potter and on a business with your sister. Yeah, not full-time just part time Okay Audrey the odd is what they call me Audrey the on yeah Who calls you that my sister Libby? I showed her this and she told me to go get help in that I was bonkers She said that you were bonkers. In fact, she didn't say go away and she told me to get the fuck away from her. My goodness, she did. She said, get the fuck away, your bonkers. Did she? Anyway, okay. So she did that and her, so I said, yeah, I didn't think she was very clever enough. You know not. And while I went to see the doctor about it, okay. because I thought I'd show her, because she's a doctor. You know, she's been to university. She's done stuff. Yeah, nah, thick as shit. She didn't. She said she didn't have time. I thought how you cannot have time to hear about the cure for world hunger. Although starving children, you know what I mean. Right, yeah. So that's why she sent me here to tell you all about it. Right. Okay. Tell me about it. Tell me what's going on. Okay. Right. Well, it's I've got my various bits and pieces here I find in the papers like you know the football results. Right. They need adding together. Okay. And then I have found some other information on this page. There are some pages and page numbers there. Right. those together and take it away from what's on there. Right. So I do that and you find, and you find you find other things. And then what does that number do that? That number corresponds to numbers. I've got on my chart at home. I've got a big chart on my wall. Right. And I find that number. Okay. And that adds up to something else. It's all there. I mean, that's really good. I'm going to get one of those. What's that? That's really good. That's a phone. It does the internet, right? And everything. So I'll be able to find out more stuff. You know that way when I'm out and about. And so there's numbers you see. I'll use those numbers there. Right. be they'll need adding up. Okay and talking away from someone something else. When you've done all this with all the numbers, yeah, in the chart, yeah, where will that leave you? What is it you're headed for? Well, it's the cure for world hunger in it. That's what it is. The cure for world hunger? The cure for world hunger. Yeah. Okay. So how's that going to work then? Well, how it works is God tells me you know that I'm really, I'm doing a really good job. Right. And how great I am and how fantastic it is. I'm working at this, you know. Okay. And I just keep going at it. Okay. You know I don't stop. I don't stop at all. Okay. Can I just take you back a step? Yeah, sure. Yeah, sure. Because you said God tells you. God tells me, go on. Can you tell me a bit more about that? Well, he tells me, he just talks to me. Yeah. He talks to you. Yes, he talks to me. Okay, all right. And he tells me, right. I'm doing a really good job. Okay, I'm, I'm fantastic. So God talks. And I'm really wonderful. Oh, and I'm great. You know, I'm doing okay. When God talks, I have to show this to people, right? And that's why I've come here to show you. And when God talks to you, can I just clarify this with you? What? Does he talk to you like I'm talking to you? Would the voice coming through your ears? Or does it feel more like voice doesn't come through your ears? It comes out of your mouth. voice comes out of your mouth and goes in your ears. Is that right? Yeah, I get you should know that because you know your doctor as well aren't you? Yeah, so you should know these things. Yeah, and is that how the voice seems to you? I hear him in my ears. You hear him in your ears because that's what I'm used to hearing And he talks to me with his mouth because he's he's So the voice that seems to come through your ears rather than from inside your head It's quite loud because he's a big guy. He's a big. He's a big guy He's a big guy. Yeah. Yeah, and he's got a big beard What's he like then? Well, he's a big guy with a big beard. Yeah, I call him beardy once he didn't like that. He got a right Oh, Christ, I called him beauty. Beauty. Yeah, I can imagine. Yeah, because I just, and I just kind of, so I, I, I just call him sir. We call him sir. He likes to be called sir. Yeah. Okay, and what kind of things when he's talking to you? What kind of things does he say to you? He tells me and I'm fantastic. You know how great I am for doing this. and getting stuck into this and keeping at it and that I should show it to people. And that's what I do. I come out and I show it to people. There's some stuff. So who have you been showing it to? Well, okay, who have I been showing? I've sent copies of stuff to the Pope, right? And the archbishop of Canterbury. And none of them have written back. You'd think they would, you know. So now replies yet, because they're close to God. They probably know him. They probably met him and stuff. Yeah. Well, I mean the Pope, he claims to have met him, right? I mean, you don't know. Yeah. I would assume the Pope knows God, right? He knows he's got his address, his telephone number, everything like that. But then you know, or see the archbishop, the Canterbury, I think he's just rude, because he's not written back at all. Right. It sounds as though this has all been keeping you really busy. Have you been sleeping at all? No, I haven't had time to sleep. No. No time to sleep. No, no, no. One was the last time you had a good night's sleep, would you say? Don't need it. You don't need it. Don't need it. I've got all this enthusiasm from God, right? You know? So what's your? It's the energy inside me. It's there to make me do work. So you feel as if you've got a lot of energy. Yeah, tons of it, tons of it. And how are your thoughts? Are they going fast? Are they, are you thinking lots, lots of ideas? Well, yeah, you have to think very intensely. You look at stuff down here. There's, there's, I've got that in the door the other day, you know? Okay, there's lots of numbers out there that need adding up and taking away. And how are you feeling about yourself? Your self esteem. How do you feel about yourself as a person at the moment? I feel fantastic, you know, because God's telling me, right? I am, yeah, okay. And I'm doing a really good job. Yeah, it's all there and it's all happening. And tell me this, because I couldn't get it from your GP's letter. Have you ever had anything like this before in your life? Where you felt full of energy and lots of bread ideas. No, no, it's not happened before. No, but this has been going on for so long. I can't really remember anything else, you know. And have there ever been any times in your life where you kind of been the opposite? Were you had a bit down in the depths, not much energy? Sometimes. Well, I don't have, I have been low sometimes when I was younger a long time ago. I don't remember that was long ago. Once I felt very sad and low, but not now. No, not now. Dr. put me on Prozac. Didn't do anything though. Let's get back to this. Do you remember when you were on Prozac and what dose? No, long time ago. Okay, and what about family history? Does anyone in your family have things like this? No, no, it's just me. It's really well. They're not really that clever, you know. who's not my clever? My family, your family. You know, that's why I have come to see the doctors, places, hospitals, and things like that because they have clever people. You're a clever person. Right, so do you feel as if you're more clever than perhaps other people? Well, well, yeah. You know, I'm certainly more clever than those people at work. Okay, you know, because they're a bit sick. I guess I'm wondering what might have happened to start all of this off for you. Have you had any thoughts yourself? What's brought this on? Well, well, God, yeah, God, yeah, yeah. Okay, and he just came to me one day, right? One day he just came to me, you know, okay. And I started noticing connections with numbers and things. I wonder. It's all there. You've just got to find it. Okay, I wonder. You've got to dig deep and look for it, you know what I mean. Yeah, yeah, right. Okay, how have you been feeling physically in your physical health? Any problems there? Basically fine. I'm fine, yeah, absolutely. And have you been taking any prescribed medications besides the prosack in the past. No, no, nothing like that. Just like I told you, it was a long time ago. I just need everything that's within me now. I don't need anything else. And you know how you were saying that you're sister? Yeah, said that you were. Who, Audrey? Yeah, yeah, she said Ruth things. She said Ruth things. And I don't like repeating it. She kind of suggested you might be. I told you what she said and I didn't I. She used the F word and I don't like that. No, no, no. It sounded like she thought you weren't very well at the moment. No, I'm fine. Now look, can we look at this now because this is what I want to talk about? It's just that I've come here to talk about this and you seem to be going off on one for some reason. Yeah, and you're not really a pain attention to me. Do you wanna do that now? Can we talk a bit more about this now? Well, I guess before we get back into that, I guess what? Well, no, I don't want to get back in. I want to talk about it now. Can we talk about it now, please? I guess what I'm wondering is whether this might be a sign that you're not very well at the moment. No, I'm fine. I want to talk about this. You seem to want to change the subject. Yeah. So I don't want to talk to you anymore. I've had enough of you and I've had enough of being here. I want to talk to some VLs. I want to talk to the boss. I want to talk to your boss. Right. Where's your boss? Audrey, I am the boss. I'm a consultant. You see? Well, you're a shit boss and I want to talk to somebody else. There must be some VLs I can talk to. There is an Audrey. I want to talk to the head person. I'm fed up with talking to the old nag rag. I want to talk to the engineer, the driver of this unit. No more monkeys. I want to talk to the top person, top boss, top dog. That's who I want to talk to.