A New Way Forward - Physician Prompt Engineering

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"Pithy" A/P Prompt as mentioned in the video:

Reformat the assessment and plan into a structured, problem-oriented format. The output should be extremely concise for rapid scanning.

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Output Structure for Each Problem/Diagnosis

*[Problem/Diagnosis Name]*
[A very brief bullet point summarizing a key finding, action, or follow-up plan]
[Each point should be a separate bullet, written as a short clinical shorthand phrase]

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Conditional Boilerplate Text

[Insert after the bulleted list when applicable. This text should be italicized.]

If well child check or health maintenance discussed:
"All forms, labs, immunizations, and patient concerns reviewed and addressed appropriately. Screening questions, past medical history, past social history, medications, and growth chart reviewed. Age-appropriate anticipatory guidance reviewed and printed in AVS. Parent questions addressed."

If any illness discussed:
"Recommended supportive care with OTC medications as needed. Return precautions given including increasing pain, worsening fever, dehydration, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with treatment plan."

If any injury discussed:
"Recommended supportive care with Tylenol, Motrin, rest, ice, compression, elevation, and gradual return to activity as appropriate. Return precautions given including increasing pain, swelling, or failure to improve."

If ear infection discussed:
"Risk of untreated otitis media includes persistent pain and fever, hearing loss, and mastoiditis."

If strep test discussed:
"Risk of untreated strep throat includes rheumatic fever and peritonsillar abscess. This problem is moderate risk due to pending lab results which may necessitate further pharmacologic management."

If dehydration, vomiting, diarrhea, or decreased urination discussed:
"Patient is at risk for dehydration, which would warrant emergency room care or admission for IV fluids."

If trouble breathing discussed:
"Patient is at risk for worsening respiratory distress and clinical deterioration, which would need emergency room care or hospital admission."

If ADHD, obesity, or strep throat discussed:
"PCMH Reminder"

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Formatting Rules

1. Bold formatting for problem names
2. Italicized formatting for all boilerplate text
3. Do NOT use section headers like Assessment or Plan
4. Use a hyphen (-) for all bullets
5. Indent all bullets with 8 spaces
6. Write all bullet points in extremely brief, professional shorthand phrases
7. Keep bullets concise (ideally under 10 words per bullet)
8. Use standard medical abbreviations (RTC, PRN, BID, etc.)
9. Never fabricate or infer information not present in the source text
10. Insert a blank line between problems when multiple diagnoses exist
11. No references

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Few-Shot Examples

*Asthma*
Flovent 44mcg 2 puff BID started
Continue albuterol PRN
Use spacer
RTC 3mo/PRN

*Well Child Check*
Growing and developing well
Reviewed anticipatory guidance
RTC 1yr/PRN

*Vomiting, mild dehydration*
NDNT on exam with MMM
Zofran PRN, pedialyte, Tylenol, Motrin
RTC PRN

*ADHD*
Concerta 27mg not effective
Transition to Vyvanse 20mg PO daily
RTC 1mo

*Viral URI*
Supportive care, fluids
Declined COVID test
RTC PRN