| | | Specialty Hospital Medicine · Internal Medicine |
The assessment and plan is the hardest section of a progress note to write quickly. It requires synthesizing overnight events, current data, and your clinical reasoning into a problem-based structure that reflects what you are actually thinking, not just what happened to the patient.
Doximity Ask can draft a complete A&P in seconds, but how well it does depends almost entirely on what you give it. This guide covers exactly what context to include, how to structure your prompt for multi-problem patients, and how to push back when the output is not quite right. Why the A&P Is Different from the Rest of the Note
The subjective and objective sections of a progress note are largely transcription: what the patient said, what the numbers show. Doximity Ask handles those reliably with minimal context.
The A&P is interpretation. It requires knowing which problems are active, which are improving, which need a change in management, and which can be monitored. Doximity Ask cannot infer that from a nursing note alone. You have to tell it, or provide enough context that it can reason through it. The two most common A&P failures:
- Generic plans: "Continue current management" with no specifics
- Missing problems: An active issue from yesterday does not appear because it was not in today's nursing note
Both are fixable. Here is how.
What to Include in Your Prompt for a Strong A&P
For a hospitalist-quality A&P, include four things:
1. Active problem list Paste the current problem list from your EMR, or type out the two to five problems you are managing today. This ensures nothing gets dropped. 2. Overnight events The nursing note or shift report: what happened, any changes in status, anything flagged overnight. 3. Current data Vitals trend (not just the most recent), any labs with results from the last 24 hours, imaging reports if relevant. 4. Your management direction One sentence per problem is enough: "HCAP, improving on current abx, plan to narrow tomorrow." This is what separates a generic plan from your clinical reasoning. |
The Hospitalist A&P Prompt
Copy this prompt: Problem-based A&P for inpatient progress note: Write a problem-based assessment and plan for an inpatient progress note. Use the active problem list below and incorporate the overnight events and current data. For each problem, include a one-sentence assessment and specific plan items. Avoid generic language like "continue current management." Flag any problem that may need a change in management based on the data.Active problems: [list]Overnight events: [paste nursing note]Current vitals: [paste]Relevant labs: [paste]My management direction: [one sentence per problem] |
PRO TIP The "my management direction" field is the key to getting a specific A&P. Even a rough note, such as "CHF, still volume up, increase Lasix tomorrow," gives Doximity Ask enough to write a specific plan instead of a placeholder. |
Handling Multi-Problem Patients
For patients with five or more active problems, break the prompt into two passes.
First pass: give Doximity Ask the medical problems (CAD, CHF, CKD, etc.) and ask for plans for those. Second pass: add the social and systems issues (goals of care, discharge planning, therapy consults) and ask it to append those to the A&P.
Doximity Ask allocates its attention more evenly across fewer problems per pass, which produces more specific plans than one large prompt for complex patients. When the Output Is Not Right: How to Push Back
If the A&P comes back too generic, do not start over. Use a follow-up prompt:
Copy this prompt: Revise a vague plan: The plan for [problem] is too vague. Rewrite it with the following specifics: [your clinical details]. Keep everything else the same. |
If a problem is missing entirely:
Copy this prompt: Add a missing problem: Add a problem-based entry for [problem] to the A&P above. Assessment: [your one-liner]. Plan: [your plan items]. |
These follow-up prompts are faster than editing manually for complex patients, and keep the note in Doximity Ask where you can continue refining before you copy to your EMR. The Note That Writes Itself, and the One That Does Not
Doximity Ask will produce a strong A&P when you give it clinical context and direction. It will produce a mediocre one when you give it only a nursing note and hope it figures out the rest. The physicians who get the most out of this workflow treat Doximity Ask like a fast scribe who writes well but needs direction, not like a tool that independently knows what the plan should be. Give it direction. Get a note that reflects your thinking.
