If Brevity is the Soul of Wit, Why are Clinical Office Notes So Lengthy?

Part of a series

It is ironic that the Shakespeare passage in Hamlet that contains the immortal six words “brevity is the soul of wit“, is quite a rambling piece of writing. But his statement, if not his framing of it, has struck a cord with many writers who came after him.

I have been impressed that the majority of the small number of specialist and hospital reports I get on my Maine patients from Mass General and other Boston ivory tower practices are so brief and to the point, while many local discharge summaries are both lengthy and stilted and also very difficult to find the essential information in. Some hospital systems put the Assessment and Plan right on top, but you have to go hunting for the Subjective and Objective. Those charts also belabor the malpractice defense functionality of rattling through which differential diagnoses seemed unlikely.

I’m far from convinced that AI generated clinical notes could even come close to the succinct reports I get from Boston. I have not yet tried using AI for my own notes, but read on, I have a different suggestion.

I hear horror stories about how chitchat about a fishing trip often ends up in the social history of a patient.

Transcription does not require anywhere near the muscle of full-fledged AI office note generating software. But I’m thinking that could be enough:

Imagine office notes that really only contain the important information, the medical corollary to Who, What, Where and How, and each office note had a supplemental file, namely a transcript of the entire conversation for anybody who needs to dig deeper.

The amount of time it takes to find the essential information in the average office note or discharge summary I read is outrageous. Things actually get missed because of all the fluff.

The Greeks had four virtues and the Bible has seven. I think I just started a series on which are the virtues in the practice of Medicine.

Stay tuned.

P.S. Here’s another piece about brevity, in terms of the now nearly extinct “brief office visit”: