Key points
- In a study of orthopaedic outpatient letters, readers preferred structured letters, and 26% of letters held the full set of information GPs and hospital staff wanted.3
- The Academy of Medical Royal Colleges says letters should be addressed to the patient by default, and that a clinician must check every document an AI scribe produces in their name.2
- Montgomery defines a material risk as one a reasonable person in the patient's position would be likely to attach significance to, so the record shows the consent dialogue.1
- In one academic centre, 77.5% of 40 surgeon users reported better documentation efficiency with an ambient scribe.4
- wai drafts the note, the letter and suggested codes during the consultation and holds them for the surgeon to review and sign.7
Summary
An AI scribe for orthopaedics should draft five things from the consultation, the clinic letter, the imaging findings as the surgeon described them, a record of the consent discussion, the operative planning note and the follow-up note. The surgeon checks side, site, grades and risks discussed, then signs.
Clinic ends with every letter, consent discussion and planning note drafted and waiting for signature, and the surgeon spent each consultation talking to the patient. The templates follow orthopaedic documents, with side, site and imaging date in fixed fields.
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Request a demoSee a new knee consultation become a patient letter, a consent record and a planning note.
| Document | What the draft contains | What the surgeon checks before signing |
|---|---|---|
| New patient letter | Diagnosis, side and site, imaging summary, function and goals, options, decision, next step | Side, plain language, options match what was said |
| Imaging findings | Modality, view, date, side, findings as narrated | Side, level or digit, date, nothing added that was not said |
| Consent discussion | Alternatives, risks described, patient priorities and questions, time to decide | Each risk discussed is listed, patient wording kept |
| Operative planning note | Procedure, side and site, implants, anaesthetic, antibiotic and clot plans, recovery pathway | Every safety field complete before listing |
| Follow-up note | Wound, range of movement, function against goals, imaging, next review | Measurements and dates, goals carried forward |
Orthopaedic documents have a fixed shape
When structured and traditional letter formats were compared with GPs, consultants, registrars and outpatient nurses, readers overwhelmingly preferred the structured format, read it faster and found relevant data more often. In the same study, 26% of letters held the complete set of information readers wanted.3
With specialty templates, the surgeon talks to the patient and the draft lands in a fixed order every time, diagnosis, side and site, imaging, function, options discussed, decision and next step. A narrative review in the American Academy of Orthopaedic Surgeons' open journal found AI scribes promising in orthopaedics, with specialty-specific validation and tailoring deciding how well they work.5
Letters addressed to the patient
The Academy of Medical Royal Colleges updated its guidance on writing to patients in April 2026. It recommends that most outpatient letters are written directly to the patient with a copy to the GP, and its new section on AI says writing to patients should be the default setting for an AI scribe.2 The clinician checks every document the scribe produces, and bears responsibility for the accuracy of anything produced in their name.2
Take a 67-year-old with right knee pain for two years, seen in new patient clinic after physiotherapy and an injection gave short relief. The drafted letter is addressed to the patient. It explains in plain words that the X-ray shows advanced wear on the inner side of the right knee, lists the options discussed, which were continuing exercise and pain relief, a partial knee replacement and a total knee replacement, and records that the patient wants to walk five kilometres and return to golf. It sets out the next step, a decision at a second appointment in four weeks, and is copied to the GP with the coded diagnosis.
The surgeon corrects anything misheard and signs. For letters onward to colleagues, see the referral letter.
Imaging findings, said aloud and checked
Imaging findings belong in the note when the surgeon says them. Narrate while reviewing the films with the patient, naming the side, the view, the date of imaging and the finding, such as joint space loss in the medial compartment with osteophytes, right knee, standing views from last month.
Check laterality first in every orthopaedic draft. Side, digit, level and date of the imaging are the details to read twice, and template fields for each one make the check fast.
Consent discussions that show the dialogue
The UK Supreme Court in Montgomery held that a doctor must take reasonable care to make sure the patient is aware of material risks and of reasonable alternatives. A risk is material if a reasonable person in the patient's position would be likely to attach significance to it, or if the doctor should be aware that this patient would. The court added that assessing significance cannot be reduced to percentages and that advising requires dialogue.1
An ambient record captures that dialogue in the words used. In the knee example, the draft records the alternatives discussed, the risks the surgeon described, the patient's own priorities and questions, and that the patient asked for time to decide. The signed consent form stays a separate document, and the note shows how the decision was reached. The medico-legal guide covers how that record is used.
Planning notes and follow-up
The operative planning note is where template fields protect the patient. In one two-cycle audit of orthopaedic operation notes at a referral hospital in Sudan against 18 Royal College of Surgeons criteria, none of 50 baseline notes recorded anticipated blood loss, antibiotic prophylaxis or clot prophylaxis, and the authors concluded a standard mandatory template was needed for those items.6 A planning template that asks for procedure, side and site, implant considerations, anaesthetic plan, antibiotic and clot prophylaxis plans and the expected recovery pathway keeps those items in view from clinic onward.
Follow-up entries take their own shape, wound, range of movement, function against the goals the patient set, imaging if repeated, and the next review date. In a survey at a US academic centre, 77.5% of 40 surgeon users of ambient scribes reported better documentation efficiency and 72.5% reported better accuracy, detail and consistency.4
Where to start
Start with new patient clinic letters for one surgeon and one joint. Build the letter template to the patient-first structure, add mandatory fields for side, site and imaging date, and run it for two weeks. Measure time from the end of clinic to signed letters, and count corrections to laterality and risks.
Then add the consent discussion and planning templates, and audit twenty planning notes against the prophylaxis fields after a month. wai drafts the note, the letter and suggested codes during the consultation and holds each one for the surgeon's signature.7
Bring a clinic letter template you use today. We show how a consultation fills it, side and site first.
Frequently asked questions
Can an AI scribe read the X-ray or MRI?
An ambient scribe records what is said, so imaging findings enter the note when the surgeon narrates them, and the surgeon checks side, level and date before signing.
Should orthopaedic letters go to the patient or the GP?
The Academy of Medical Royal Colleges recommends writing most outpatient letters to the patient with a copy to the GP, and says this should be the default for AI scribes.2
Does an ambient note replace the consent form?
The signed consent form stays. The note records the dialogue Montgomery expects, including alternatives, risks the patient would attach significance to and the patient's questions.1
What is the most common error to check in an orthopaedic draft?
Laterality and level. Make side, site, digit or level and imaging date mandatory template fields, and read them twice.
Do surgeons find ambient scribes useful in clinic?
In one academic centre survey, 77.5% of 40 surgeon users reported better documentation efficiency and 72.5% better accuracy, detail and consistency.4 That is self-report from one site, so run your own two-week measure.
Who signs the letter and the planning note?
The surgeon. wai drafts each document and holds it for the clinician to review and sign.7
Sources
- 1The Supreme Court of the United Kingdom, 2015Montgomery v Lanarkshire Health Board [2015] UKSC 11, press summaryRead 14 October 2026Read source
- 2Academy of Medical Royal Colleges, 2026Please write to me, guidance for writing directly to patients (April 2026 update)Read 14 October 2026Read source
- 3Annals of the Royal College of Surgeons of England, Hook and colleagues, 2006Letters and notes in orthopaedic surgeryRead 14 October 2026Read source
- 4JMIR Medical Informatics, Luo and colleagues, 2026Ambient AI scribe technology and perceived documentation efficiency among surgeons, cross-sectional studyRead 14 October 2026Read source
- 5Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews, Adan and colleagues, 2026Artificial intelligence scribes in orthopaedic surgery, a narrative reviewRead 14 October 2026Read source
- 6Cureus, Hassan Ibrahim and colleagues, 2026Improving the completeness of orthopaedic operation notes through a two-cycle clinical auditRead 14 October 2026Read source
- 7wai, 2026wai Clinicians, letters and documents held for signatureRead 14 October 2026Read source
Finish clinic with every letter, consent record and plan ready to sign.
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