Can an AI scribe write a mental status exam or a formulation?

Not well, according to clinicians in psychiatry who have tried. One said an institutional tool was good at summarising behavioural strategies and useless for formulations. Another said the software has no capacity to read between the lines. And much of a mental status exam is observed rather than said, so a tool that only hears the conversation cannot capture it.

Why can't it write the mental status exam?

Because the tool only has the audio. Appearance, psychomotor activity, affect, the gap between what a patient says about their mood and how they look saying it: none of that is spoken. Clinicians have also pointed out that some of it cannot be said aloud in front of the patient without changing the visit.

A clinician in a psychiatry forum made the same point about human scribes years ago: psychiatric language and the mental status exam lose their subtlety in someone else's hands.

Why can't it write the formulation?

A formulation is not a summary. It is your argument about why this person is presenting this way, now. It draws on history, observation and experience at once. One psychiatrist who uses a tool daily described it as poor at recognising the diagnostically important parts of a conversation, which is the raw material a formulation is built from.

What can it do in a psychiatric note?

Summarise what was discussed, recall the medication conversation, and capture the interventions you described. A physician using another tool said it saved about half the time on history drafts, with details still to add and sections to reorder.

How should I split the work?

Let the tool hold what was said. Write the mental status exam from what you saw, and write the formulation yourself. It is the same division that works in general practice: let it write the history and keep the assessment and plan yourself.

The short version

An AI scribe can summarise what was said. It cannot see affect, read between the lines or write your formulation. Write those yourself. Solanto is being built for therapy practices to write the history and leave the judgement to you, in Cloud mode or in Private Mode, where the note never leaves your device.

Solanto has not shipped yet. The price is on the page rather than behind a call, and early access is open: solanto.ai/pricing

Ask a colleague which part of their note they would never hand over. It is usually the formulation.