The shortest that works
"I'd like to record this to help with your letter. I check it before it goes out, and you can say no or stop me at any time. OK?"
Three points, two sentences.
A guide for clinicians
Getting the best from ClinoVoice
ClinoVoice is an ambient scribe and dictation service for clinicians: it records the consultation, or a dictation, and drafts the clinic letter or note for the clinician to review and approve.
It writes from what it hears. The habits on this page, most of them a sentence or two said out loud, are the difference between a draft you tweak and a draft you rewrite.
Revised
On this page
ClinoVoice is built never to fill a gap. A pulse you felt but did not mention is not in the letter. A plan you decided in your head is not in the letter. What is missing goes in the review list, not in the draft as a guess.
That is deliberate: a letter that invents a normal examination is worse than one that asks you for it. So the way to get a complete letter is to say the complete consultation.
Before you start
Ask the patient, open the right appointment, put the recorder between you and check the meter. A minute at the start saves ten at the end.
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Ask the patient, before you press Record
The console shows the full wording when you press Record and keeps the version the patient was shown with their answer. You do not need to recite it, but what you say out loud must cover three things: that the consultation is being recorded; that it is to help write the letter, which you read and approve before it goes anywhere; and that they can say no, or ask you to stop, and nothing changes about their care. The poster and the leaflet carry the rest, which is why they matter. Say "record": patients must understand that part, and "a voice tool" hides it. End with a question they can say no to, and ask it before you press Record. Then record their answer with the button.
You have seen the posters
"You may have seen the posters. I record the consultation so a tool can draft the letter, which lets me concentrate on you rather than the keyboard. I check every word before it is sent. Are you happy with that?"
The poster has done the explaining; this is the ask.
Follow-up, agreed before
"Same as last time, if you're happy: I'll record to help write the letter. Still OK?"
Asked every visit; the answer is kept per appointment.
If they hesitate
"That's completely fine. I'll write the letter the usual way."
Press Patient declines and dictate afterwards. Never persuade: a reluctant yes is worth less than a clean no.
A new patient, or no posters
"Before we start, one thing to ask. I record my clinics to help write the letter afterwards. Nothing is sent until I have read it, and it is entirely fine to say no. Shall I?"
The full version, when nothing has prepared them.
A relative or interpreter in the room
"I record the consultation to help with the letter; it will pick up everyone speaking, including you, [name]. Is that all right with you both?"
Everyone who will be on the recording hears the ask.
Telephone or video
"Just so you know before we go on, I record these calls to help write your letter. I review it before it is sent, and you can ask me to stop. Happy to carry on?"
Said before the history, as in the room.
An anxious patient
"I'll record this so I can listen to you properly instead of typing. The recording is only used to draft your letter, which I check, and you can say the word if you'd rather I didn't."
The benefit to them, said plainly; no retention figure.
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Open the right appointment
The patient's name and date of birth are at the top of the console. Check them as you would a wristband. Check the appointment type too (new patient, follow-up with results, follow-up after a procedure, general review or outpatient procedure): the draft is shaped by what a clinician would expect that kind of appointment to cover.
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Put the recorder between you
On the desk, within about a metre of everyone who will speak, with nothing on top of it. The recorder is made for the room, but beyond a metre or so the further voice fades and the transcript suffers. A phone or laptop microphone is fine for dictation and a poor choice for a consultation; if it is all you have, the same placement applies, and keep the screen on.
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Press Record and glance at the meter
If the meter is not moving when you speak, nothing is being heard. Fix that before the history, not after.
During the consultation
Talk as you always would, with one habit added: say the clinically important things out loud, including the ones you would normally only write down. Each card below is something the draft needs from you, with how it sounds in the room.
Why they are here
"You've come today because your GP found a lump in your right groin, and it's been there since about March."
One sentence at the start opens the letter, and tells the patient you have read the referral.
Your examination, as you do it
"Both femoral pulses are easy to feel. I can't feel anything below the knee on the left, and the foot is cooler than the right."
The recorder cannot see your hands. An examination done in silence reaches the letter as not documented. Patients like hearing it, too.
The results, with the numbers
"Your scan from the 3rd of March shows the aneurysm at 4.6 centimetres, up from 4.2 last year."
Read it off the screen rather than pointing at it: side, site, measurement and date, exactly as you want them in the letter.
What you think, and how sure you are
"I think this is most likely a hernia. It isn't dangerous as it is, but it won't go away on its own."
Your impression, in your words. Hedges are kept exactly as you said them: likely stays likely, possible stays possible, and no diagnosis is ever added for you.
The options, and the risks you actually covered
"We could leave it alone or repair it. The risks of repair are infection, bleeding, some numbness, and it coming back."
Only risks you discuss appear in the letter. ClinoVoice never adds a standard list, so "the usual risks" produces a letter with no risks in it.
Medicines, specifically
"Carry on with the aspirin, 75 milligrams once a day, and I'd like to add atorvastatin 80 at night."
Name, dose, frequency and what changes. Numbers and drug names are copied as heard and marked for you to verify.
Their questions, and your answers
"You asked whether you can still drive. Yes, until the operation, and for about two weeks after."
Answer aloud and fully. The letter weaves the question and the answer in, rather than reproducing the conversation.
Who does what
"I'll ask your GP to check your kidney function in two weeks. I'll refer you to the cardiologists about the murmur. We'll see you in six months with a scan."
An action for the GP, a referral with its question, a follow-up with its interval, and the safety net ("if the foot goes pale or the pain becomes constant, ring the ward the same day") each become a line in the plan.
The most valuable half-minute: say it before they stand up
Close with two or three sentences: what the problem is, what you have agreed together, and what happens next. "So, to sum up: this is a hernia, you'd like it repaired, I'll list you as a day case, and if it ever becomes painful and won't go back you'll go to A&E that day." It confirms the plan with the patient, and it gives the letter its ending in your words rather than the draft's.
The trick for the quiet voice: repeat it back
The transcript has no speaker labels; ClinoVoice works out who said what from context. When the patient is softly spoken, turned away from the recorder, or on the phone, reflect the key points back in your own words: "So the cramping comes on after about two hundred yards and goes off when you stop." That checks you have it right, and it puts the fact on the recording in a clear voice, unambiguously yours.
Referring to a colleague: say it as a sentence
Every referral you say you will make becomes its own letter, drafted alongside the clinic letter and shown as a "Referral to" tab on the appointment, for you to approve as you would any letter. It can only be as good as the sentence it came from, so give it four things: that you will make it, the service as you would name it, the name if you have one, and the question.
"I'll refer you to the cardiologists, Dr Patel's clinic if I can, to look at the murmur and tell us whether your heart is fit for an anaesthetic. I'd like that done before we list you."
Counts as a referral
- "I'll refer you to..." or "I'll write to the diabetes team about..."
- The specialty as spoken, a named clinician only if you name one
- Urgency only as you state it ("before we list you", "urgently")
Does not
- "I'll ask your GP to refer you": that is an action for the GP
- "We might involve cardiology later": a possibility, not a referral
- "I'll copy Dr Patel in": a cc, not a letter
- A scan or test within your own service: that is the plan
A few more habits that pay
- Name the change of subject. "Turning to the hernia." A consultation can cover more than one problem; a spoken signpost keeps them apart in the letter.
- Say roles, not first names. Colleagues are written by role ("the sonographer", "my secretary") and never by a first name overheard in the room. If who does something matters to the plan, say the role.
- Small talk is fine. The holiday and the grandchildren stay out of the letter. There is no need to change how you talk to your patient.
- No punctuation, no headings. Those are for dictation. In a consultation, just speak.
- Telephone and video. The recorder hears your side clearly and the patient's only as well as your speaker carries it. Use the speaker, and lean on repeating back.
How it comes out
What a clinician says in the room, and the paragraph that results. Everything in the letter was said; nothing was added.
In the room
"So you've come today because your GP found a lump in your right groin, and you first noticed it in March."
"Let me have a look. There's a soft lump above the groin crease on the right, about three centimetres across, it goes back easily when you lie down, and there's a cough impulse. The left side is normal."
"This is an inguinal hernia. We've talked about leaving it alone or repairing it, and the risks we discussed were infection, bleeding, some numbness and it coming back."
"You'd like to go ahead, so I'll put you on the list as a day case. If it ever becomes painful and won't go back, go to A&E the same day."
In the letter
Thank you for referring [patient name], whom I saw today with a lump in the right groin first noticed in March.
On examination there is a soft, reducible swelling about 3 cm across above the right groin crease with a cough impulse; the left side is normal. This is an inguinal hernia.
We discussed leaving it alone or repairing it, and the risks of infection, bleeding, numbness and recurrence. He would like to proceed, and I have listed him for a day-case repair. If it becomes painful and will not reduce, he will attend A&E the same day.
When the patient has left
Press Stop, add anything the recording will not have, and press Done. The draft follows on the appointment.
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Press Stop, and write down what the recording will not have
The sheet that follows has a box for it: examination findings you did not say aloud, something you decided after they left, history you heard that the recorder may have missed. Your note counts as your own record: where it differs from the transcript, the note wins and the point is flagged for you to check. It is still quicker to have said it in the room.
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Press Done
Nothing is sent for transcription until you press Done or a short countdown runs out. Hold keeps the recording waiting until you choose to process it; Discard deletes the audio, and nothing is sent.
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Let it run
Transcription, fact extraction and drafting follow, and the draft appears on the appointment. You can add to your note later from the appointment; a changed note extracts the facts again and redoes the draft.
Reviewing the draft
The draft is yours to shape. Read it the way you would read a registrar's letter: the facts first, then the wording.
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Read the review list first
Under the letter is a numbered list of everything ClinoVoice is not sure of: a word that looked like a mishearing and how it was read (a drug name, say), a passage that could be taken two ways, and anything expected for this kind of appointment that was not said. Codes and numbers are marked to verify. Each item is a question for you, not a fact in the letter.
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Check the facts panel
The facts the letter was drafted from sit beside it, each with where it came from in the recording. Items that changed or are uncertain are marked, so you can go straight to them.
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Choose the voice and the length
To GP or To patient, Standard or Compact. The same facts, written for a different reader.
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Edit, then approve
Change anything you like. Approving removes any review notes left in, and the approved letter goes in the clinic's batch to the secretary, to the recipients your organisation has verified. Nothing leaves without your approval.
Approve › then opens the next thing still to approve on the same appointment: a referral, the clinic letter if you started with a referral, or the clinical summary for your notes, which you approve too but which is never sent. When nothing is left on the appointment, it takes you back to the list you opened it from.
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Tell us when a draft let you down
The feedback drawer on every appointment takes a line. Your edits and your feedback are how the drafting improves.
Habits that cost you a rewrite
Most rewrites come from a handful of habits in the room. Each is below with what it does to the draft and what to do instead.
| In the room | In the draft | Instead |
|---|---|---|
| Examining in silence | Examination not documented; the review list says so | Narrate as you go |
| Pointing at the screen: "this bit here has narrowed" | No side, site or figure to record | Read out side, site, measurement and date |
| Showing the size with your hands | No measurement | Say the number |
| "We'll do the usual" or "the risks are on the leaflet" | An empty plan, a letter with no risks | Say each item you mean |
| A quiet answer from across the desk | A garbled passage, flagged for review | Repeat it back in your own words |
| Deciding the plan after they have left | Not in the draft | Say it before they stand up, or add a note straight after |
| "I'll get the heart people to see you" | A referral with no service and no question | Name the service and say what you want them to do |
| "Not much change since last time" | Nothing to compare with | Say what is unchanged, and what the last figure was |
Dictating is different
A dictated letter or note is written as you spoke it: your sentences, in your order, in your words, with nothing added or summarised. Say who it is to first ("letter to Doctor Patel") and then speak naturally: the letter is punctuated and paragraphed for you, and anything you do say ("new paragraph", "full stop") is applied exactly. Correct yourself with "scrub that", and finish with "end of dictation". A phone's microphone is fine for dictation. The full list of spoken commands, and the headings for a procedure note, are on How to dictate.
Before they leave, have you said out loud...
- why they came
- what you found on examination
- what the tests showed, with the numbers
- what you think it is, and how sure you are
- the options, and the risks you discussed
- any change to their medicines, with the dose
- what you agreed together
- what happens next, and who does it
- any referral, with the service and the question
Print this page (the checklist comes out on its own sheet) and keep it by the recorder for the first few clinics. It stops being needed sooner than you expect.