Forty pages of chart, four minutes before the visit. The trade is real, and so is the risk: a fabrication can be checked against the source, but an omission only shows up if you reread the source, which is the exact work the summary existed to save.
You have four minutes before a follow-up visit and forty pages of chart. You paste the history, read a clean paragraph, and walk in feeling prepared. Whatever the summary dropped, you will not miss it, because you never saw it.
Turns forty pages into a map, surfaces things you would not have thought to look for, and gets you into the room with the right question already in your head.
Audit the chart. A summary inherits the errors already in the record and hands them back with fresh authority.
The risk here is asymmetric, and that asymmetry drives the whole card. A fabrication can be checked against the source. An omission cannot, because checking it means rereading everything. So this card does not ask you to reread. It asks you to check the short list of things that hurt when they go missing, and to make the model declare its own gaps out loud.
The allergy disappears. The most dangerous failure on this card, because it is invisible by nature: you do not miss what you never saw.
Summaries compress time. Every value can be correct while the direction vanishes: a creatinine climbing over three months becomes "renal function stable." Right item by item, wrong story.
Real charts contradict themselves. The model is built to produce coherent text, so it picks a version and never mentions there were two. Coherence is a virtue in writing and a defect in an audit.
These three link to the site's failure taxonomy, where the transcripts live.
Name, record number, date of birth, address, phone, document numbers. Clinical dates stay, because dates are trajectory; date of birth goes, because it is identity.
Quasi-identifiers count too: a specific occupation, a small town, and a rare disease together identify someone without a name ever appearing. Swap in the clinically sufficient generic: age in years, occupation only if relevant and only as a broad category.
Covering is not removing. In a PDF, the black rectangle is a layer drawn on top; the text is still in the file and comes out with select and copy. Pixelating or blurring text is reversible, and image editors sometimes keep the pre-edit version inside the file itself.
Real redaction removes the data from the file. In practice, the safer path is to paste clean text rather than a redacted document. And the ceiling is the environment: Card 01 decides what may enter your tool at all.
Read the source and the summary side by side, and mark in the source what did not make it across. The gesture of this exercise is the gesture of real verification: going back to the origin. Synthetic case.
64-year-old woman with T2DM and hypertension, followed regularly. On metformin 850 mg BID and losartan 100 mg daily. Renal function shows mild CKD, stable. Non-smoker. Cystitis in April, treated with nitrofurantoin, resolved. Renal ultrasound ordered, result pending.
Fluent, complete, and clinically wrong in three places. Nothing in the wording signals which three.
The penicillin allergy is gone. That is the omission that hurts: the next amoxicillin prescription sails right through.
And notice the trail the source left. The cystitis was treated with nitrofurantoin precisely because of that allergy. The model read the consequence and dropped the cause.
1.4, then 1.6, then 1.9 across three months became "stable." Every value was in the source. The direction was not in the summary, and the direction was the finding.
March says non-smoker; June records 20 pack-years. The summary picked one and never mentioned there were two, which is exactly what an audit cannot afford.
The doses, the cystitis episode, the pending ultrasound. Not everything goes wrong, and that is the point of mixing correct items into every exercise here: the goal is calibration, not blanket suspicion.
Six items against the source, every time. Everything else, spot-check. This is what directed verification means: you check what is expensive to get wrong, not everything.
Summarize the history below for today's visit, which is for [reason for visit]. Fixed agenda: active problems; medications with dose and frequency; allergies; most recent labs with dates; pending results; what changed since [date of last visit]. For any agenda item with no information in the source, write "not documented." For serial values, show the sequence with dates and state the direction: improving, worsening, or stable. If the source contradicts itself, show both versions and flag the contradiction. Add nothing that is not in the text below. [paste history with identifiers removed]
Models that clear 90 on knowledge exams score 44.8% on tasks built from real clinical text, and summarization is real clinical text1. For medical summarization specifically, there is a published framework with an error taxonomy that includes omissions, plus clinical rating of the potential harm of each error2.