Shift handoff in emergency medicine has always been a compression problem: take twelve hours of a patient's course and hand over the two things the next clinician must not miss. Automated summarization is very good at the first half of that task.

At three departments that adopted generated handoff summaries, receiving clinicians rated the summaries as more complete and less useful. The complaint was consistent: the generated summary reported everything with roughly equal weight, and the outgoing clinician's judgment about what was worrying had disappeared.

One department's fix has been structural rather than technical. The generated summary is retained as a reference document, and the verbal handoff now requires a single spoken sentence — the concern — which is documented separately and attributed to the outgoing physician.

Ratings recovered. The department's medical director described the lesson in a way that generalizes: the model reliably produced the part of the handoff that was already written down, and the valuable part had never been written down at all.