The letter travels. Whatever goes wrong here does not stay in your office: it lands on a colleague's desk with your signature and becomes the starting point for their assessment. And formal prose lowers the reader's guard, which makes this prime territory for the elegant error.
Twelve letters to write, and the tool drafts a clean one in seconds from four lines of input. It reads better than what you would have written tired at 7 p.m. The question is whether everything in it came from you.
Guiding question: Is there anything in this letter I did not write?
Builds a clear letter in seconds from what you provide: question, relevant summary, workup already done, medications. Adjusts register for the recipient. And drafts the reply back to the referring clinician with the same discipline, in reverse.
Know what you did not tell it, or notice that it filled a gap with something plausible. The skeleton is delegable; every fact inside it is yours.
The failure here is not bad writing. It is good writing that contains something you never said, and the better the prose, the less likely you are to catch it. So this card puts almost all of its weight on the input and the review, and almost none on the draft itself.
An exam finding you did not report, a date nobody gave, a history item that does not exist, written in the sober register of a medical document. Surrounded by correct sentences, a fabricated detail reads like a chart entry.
The subtler version of the same failure: your hypothesis goes into the elegant draft and comes out as an established diagnosis, and it travels under your signature.
The reason for referral is the soul of the letter, and the model dilutes it into "referring for evaluation." Without a clear question and a stated expectation, the specialist starts from zero and the letter failed at its only job.
The reader here is another clinician, also bound by confidentiality, and the minimum-relevant principle still applies: the letter carries what serves this assessment, not the entire chart. A sensitive detail that does not change the specialist's assessment does not go in by default; it goes in when it is relevant, by your decision. Keep the ruler in mind, though: when the reader is outside confidentiality, an employer, a school, a court, the same defect changes category, and the principle tightens from minimum relevant to minimum necessary. That is Card 12.
Left to itself, a language model resolves missing information the way prose does: smoothly. The dose it was not given becomes a plausible dose, the missing date becomes a plausible date, and nothing in the sentence signals that anything was supplied.
A bracket in the middle of a letter is an honest gap you close in seconds. A fluent sentence in the same spot is a fabrication you will not see.
It costs a slightly uglier draft, and one pass of filling in blanks before the letter goes out.
It buys the only reliable way to tell, at a glance, which facts in this letter came from you and which the tool would have had to invent.
Synthetic case. What you gave the tool: 52-year-old woman, three months of altered bowel habits and iron deficiency anemia (Hb 10.2, low ferritin); no known prior colonoscopy; taking losartan; your hypothesis: lower GI blood loss, to be investigated; your question: prioritization for colonoscopy.
Well structured, correctly formatted, and ready to send. Five of its clauses did not come from you.
The first four are errors: the letter states things that are not true or not established. The fifth is not an error at all, which is what makes it worth practicing.
Deciding what to leave out is a clinical judgment about the reader, and it is the one part of this review the tool can never make for you.
The complaint, the labs, the clear question with urgency at the top.
The skeleton was good. The contents needed you, which is the whole reason this card is a delegable draft and not a delegable letter.
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The second box is the one that catches the elegant error, and it is best done by reading the letter against your input rather than against your memory of the visit.
Draft a referral letter to [specialty]. Question for my colleague, which should open the letter: [opinion / take over care / procedure] with urgency [routine / expedited / urgent]. Relevant case: [summary aimed at the question]. Already worked up: [tests with dates and results]. Current medications: [list with doses]. My hypothesis, which must remain labeled as a hypothesis: [hypothesis]. Rules: use only what I provided; do not add findings, dates, values, or history; mark anything missing as [confirm]; do not include patient identifiers; do not upgrade a hypothesis into a diagnosis.
Generated clinical letters have been rated highly on formal quality since 2023, and that is precisely the trap of this card: the fluency that impresses a reviewer is the same fluency that hides the invented detail from the person signing.