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: So seeing you again, what brings you back? I've seen you a number of times for this, haven't I? You know, since I got here about three years ago, and some people just keep coming back. You're going to be fine for a while, you know. And now, you know, we're in a weird way. Unfortunately, that can happen. And I do have quite a few patients who get reoccurring episodes of back pain. Have you been keeping up with the therapy that we had you on before?
Patient: Which thing? The pills?
Doctor: Actually, I was talking about the physical therapy that we had you doing. The pills are only meant for short-term because they don't actually prevent the back pain from coming back.
Patient: So yeah, once my back started feeling better, I was happy about it. You know, I'm just in one now.
Doctor: Why was that?
Patient: Well, it was kind of a hassle. You know, with my book schedule, and the college was in issue. I was going to get back to work, so I could use the money.
Doctor: Did you think the physical therapy was helping?
Patient: Yeah, well, it was slow going at first.
Doctor: I see. Physical therapy is a bit slower than medications. But the point is to build up the core muscles in your back and your abdomen. Physical therapy is also less invasive than medications. So that's why we had you doing the therapy. But you mentioned that Cox was getting to be a real issue for you. Can you tell me more about that?
Patient: Well, we covered a certain number of sessions. And then they booked my therapy office. Because they were trying to work out my schedule in one. But that was really far away. And then I had to get the pod ticket. It just started to get really expensive.
Doctor: Got it. I understand. So now I'd like you to try using a heating pad for your back pain. So that should help in the short term. Our goal was to get your back pain under better control without creating additional problems for you like cost. Let's talk about some different options that a person has. So the physical therapy is actually really good for your back pain. But there are other things we could be doing.
Patient: How? We could just buy a household thing.
Doctor: Okay, but there are some alternative therapies like yoga or tai chi classes we could be able to help. And we might also be closer to you and be less expensive. Would that be something you'd be interested in?
Patient: Sure, that would be great.
Doctor: Good. Let's talk about some of the other costs of your care. In the past, we had you on some Tramadol. Because the physical therapy alone wasn't working.
Patient: Yeah, it wasn't working very well.
Doctor: So that is something in the future we could do. The cheapest cost of their medications. But for now, a prescription of medications. And if we can have you go take classes like I mentioned, that could alleviate the need for ordering prescriptions.
Patient: Okay, yeah, that sounds good.
Doctor: Okay, great, great. And are there any other costs that are a problem for you?
Patient: Well, that seems to be the case for everybody that I talk to. But that should be a little bit of an issue for a lot of people.
Doctor: But I would encourage you, during open season, to choose options to see which plan is more cost effective for you.
Patient: Good topic. Yeah, I'm going to be searching a lot of the different things that you and I would spend the time early next week, say Tuesday, where we can talk over the phone about what we would like to do.