Signals, not transcripts

The easiest thing to build is a transcript. Record everything, hand it to the clinician, call it context. It is also the wrong thing to build, for two reasons: nobody reads it, and nobody consented to it.

Volume is not information

A clinician with forty patients cannot read forty weeks of conversation. Given a transcript, they will skim it, and skimming produces worse judgements than a well-formed summary because it feels like having read the material.

What changes a clinical decision is rarely a sentence. It is a direction: sleep declining since Thursday, avoidance rising around one specific topic, a coping strategy that was practised twice and then dropped. Those are patterns, and patterns are what we report.

Consent shapes the design

Patients talk differently when they believe a transcript is being forwarded. That is not irrational; it is an accurate reading of the situation. So the system is built so that it is not true. Patients choose what is shared. Clinicians receive patterns, not private conversation.

This is a real trade-off, and we accept its cost. There are cases where the exact wording would have helped. We would rather lose that detail than lose the honesty that produced it.

The brief, not the archive

Before each session the therapist receives a short brief: what changed, what repeated, what needs attention. It is designed to be read in about a minute, because a document that takes longer will not be read at all in a working clinic.