The staircase that started in Card 10 ends here: same defect, different reader, different ruler. There, a colleague inside confidentiality. Here, an employer, a school, a court, an insurer, and the same extra sentence becomes a confidentiality breach with legal consequences.
Three lines that leave the consulting room and land in front of someone who is not bound by medical confidentiality, and who may have interests of their own in what those lines contain.
Guiding question: What is this document obligated to leave out?
Structures long reports from what you provide, organizes answers to formal questions one at a time, and keeps a consistent register. In a long document, the draft saves real time.
Know what the patient authorized, or understand that the reader is not a clinician. In a three-line certificate, honestly, it has almost nothing to do for you.
What makes the tool dangerous in this genre comes from training: for a model, a good answer is a complete and convincing one, and it writes for whoever is asking, you, rather than for whoever will read, the third party. A certificate inverts that virtue. It is the document whose merit is saying the least: it transfers the clinical conclusion without the substrate behind it. The model's instinct is to justify with detail. The genre demands the bare conclusion.
The model completes the certificate with clinical substrate: diagnosis, symptoms, medications, "the patient reports." Every extra detail is information handed to someone with no right to it, and some of it can be used against the patient by the person reading.
The code or the diagnosis in full goes in "to give the document weight." The universal principle: the tool does not presume authorization. What may appear is decided by you, based on the rule that applies to the case.
The precise date you did not provide, the finding you did not report, the polished evolution. Card 10's failure at full voltage, because this paper can become evidence, and what you declare with your signature, you own.
The model may question your decision to certify absence, and its duration: "guidelines advise against bed rest" as an argument against a second day.
Prescribing bed rest is a clinical intervention with its own evidence. Granting time off work is a decision about occupational demand, and taking someone off work is not prescribing a bed. The two rulers are not interchangeable, and the model blends them.
Nothing in any guideline: the actual job, the lifting, the shift, the commute; the reported capacity; the right to recover with dignity; and the patient's own wishes, including the wish not to be off work.
That is a clinical and social ruler, yours together with the patient. The tool comes in after the decision, to write it up. Never before, to make it.
Use the trigger from Card 05: articulate why, and move on. A model's opinion about who deserves time off is not clinical data, and the prompt below states the decision as settled precisely so the draft does not reopen it.
The gesture here is the reverse of the other cards: instead of finding what is missing, you strike out what should not be there, until only the minimum valid document remains. Mechanical low back pain, three days off work, no consent for a diagnosis.
Correctly formatted, professionally worded, and carrying five things that should not leave the room.
That is why this card's role badge is honest: in a short certificate, the tool has almost nothing to do for you. The real gain is in long reports; the risk lives in the short ones.
The heavy lifting line reads like context, not like a disclosure. It is the item most people leave in, and it is the one most likely to be quoted back at the patient by someone with an interest in the outcome.
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Here, more than anywhere on this map, the review is not about what the text says. It is about what it was obligated to leave out.
Draft a [work note / report / formal assessment] for the purpose of [time off work / school / insurer / answering the questions below]. The reader is a third party outside medical confidentiality. Core rule: minimum necessary for the purpose. State the conclusion ([requires X days off work / fit / unfit / answers to the questions]) with no clinical substrate. The need for time off and its duration are already decided by me with the patient; do not question or adjust them. The patient authorized including: [nothing beyond the conclusion / the diagnosis in full / the code]. With nothing listed, do not include a diagnosis. Use only what I provided; no dates, findings, evolution, or medications I did not give you; mark anything missing as [confirm]. For listed questions: answer one at a time, only what was asked; for anything unknown, write "cannot be determined." Do not include identifiers; leave the identification field as [name], to be completed outside this tool.
The principles on this card are jurisdiction-agnostic. What may appear in a document for a third party, and under what consent, is not: those rules vary by country, by the document's purpose, and often by institution.
Brazil. CFM and LGPD govern confidentiality, consent, and medical documents.
United States. Applicable federal, state, and institutional requirements, including HIPAA depending on the entity and the data flow.
Elsewhere. Applicable professional, institutional, and legal rules.
Generated clinical documents have been rated highly on formal quality since 20231. Impeccable form in a medico-legal document is exactly what lets excess and invented detail slip past the person signing.
1 · Ali SR, Dobbs TD, Hutchings HA, Whitaker IS. Using ChatGPT to write patient clinic letters. Lancet Digital Health, 2023;5:e179-e181.