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Clinical trust: unsigned DSM specifiers read as pending, Clozapine overview reword, faster consumer refusals - #3552
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The approved line read as if the adverse effects themselves require registration. Reworded so treatment requires registration and blood monitoring because of those effects. Clinical text, pending Josh's sign-off. Co-Authored-By: Claude Opus 5.5 (1M context) <noreply@anthropic.com> Claude-Session: https://claude.ai/code/session_016H8cG4UfVRH56goC9AVmL2
The 2026-09-26 reconcile stamped 71 specifier items and 18 universals "clinician-reviewed" by "PsychSift". Those pages read "Definition reviewed by PsychSift" and showed the generated definition as reviewed. The sign-off test now requires a named person, the same rule the site-wide sign-off line uses, so those 89 read as pending and their definitions are withheld until a named clinician signs them. Co-Authored-By: Claude Opus 5.5 (1M context) <noreply@anthropic.com> Claude-Session: https://claude.ai/code/session_016H8cG4UfVRH56goC9AVmL2
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Merge Risk: 🟡 Moderate · up to
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| Check name | Status | Explanation | Resolution |
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Docstring coverage is 31.58% which is insufficient. The required threshold is 80.00%. Docstring coverage is scoped to functions touched by this diff. Analyzed 19 functions across 13 files. (4 skipped:… | Write docstrings for the functions missing them to satisfy the coverage threshold. |
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Check name Status Explanation Title check The title clearly summarizes the three main changes: stricter DSM specifier sign-off, the Clozapine overview rewording, and faster consumer-query refusals. It is concise and directly related to the ch… Description check The description includes the required Summary, Verification, Risk and rollout, and Notes sections. It explains the clinical, medication, classifier, testing, rollback, and production-impact details. T… Linked Issues check Check skipped because no linked issues were found for this pull request. Out of Scope Changes check Check skipped because no linked issues were found for this pull request.
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Docstring coverage is 31.58% which is insufficient. The required threshold is 80.00%. Docstring coverage is scoped to functions touched by this diff. Analyzed 19 functions across 13 files. (4 skipped: 4 unsupported.)
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PR Summary by QodoRequire named clinician sign-off for specifiers and clarify Clozapine overview
AI Description
Diagram
High-Level Assessment
Files changed (5)
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A question the consumer pattern guard already refuses ("best coffee machine
for my kitchen") still went to the LLM query classifier before the
short-circuit refused it. On the 13 Oct canary that wait made four refusals
take 1.6 to 6.4 s, putting the unsupported route p95 at 6,360 ms against its
4,000 ms gate. The classifier is now skipped for these, as it already is for
adversarial and outside-corpus medical queries. Queries with psychiatric or
clinical context, a medication, a threshold or a document title still reach
the model.
Co-Authored-By: Claude Opus 5.5 (1M context) <noreply@anthropic.com>
Claude-Session: https://claude.ai/code/session_016H8cG4UfVRH56goC9AVmL2
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Code Review by Qodo
No findings for this group No findings for this group No findings for this group Resolved findings 1.
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CodeAnt Nitpicks1 code suggestion1. This now marks 71
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Status of the red checks on this PR.
Generated by Claude Code |
- Align specifier sign-off eligibility - Reconcile pending specifier counts
Qodo Fixer✅ Committed (4) · ☑ Fixed (4) Commits pushed directly to this PR — no separate fix PR opened. Process — 4 fixed
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The review contract's specifier reviewer check accepted role names such as "Clinical Team" that the site's isNamedPerson rejects. It now mirrors the same rule and role-word list, pinned by a parity test. Co-Authored-By: Claude Opus 5.5 (1M context) <noreply@anthropic.com> Claude-Session: https://claude.ai/code/session_016H8cG4UfVRH56goC9AVmL2
Co-Authored-By: Claude Opus 5.5 (1M context) <noreply@anthropic.com> Claude-Session: https://claude.ai/code/session_016H8cG4UfVRH56goC9AVmL2
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Code review by qodo was updated up to the latest commit f67d43e |
A list of clinical words to watch for can never be complete, so a query such as "holiday leave for akathisia" could still be refused unchecked. The bypass now requires every word to come from a closed list of everyday shopping and household words; anything else keeps the classifier. Co-Authored-By: Claude Opus 5.5 (1M context) <noreply@anthropic.com> Claude-Session: https://claude.ai/code/session_016H8cG4UfVRH56goC9AVmL2
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Auto-fix: 2 checks fixed. View session →
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The committed data/repo-awareness-snapshot.json did not list docs/decisions/2026-10-15-specifiers-need-a-named-sign-off.md, so `check:repo-awareness-snapshot` reported documentation differing from the repository. Regenerated with `npm run snapshot:repo-awareness`; the only change is that one catalogued decisions entry.
…77' into claude/clinical-trust-fixes-tjkl77
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Code review by qodo was updated up to the latest commit 7057a28 |
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No code changes since the last review — review skipped |
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Code Review ✅ Approved 4 closed / 4 findings🟡 Medium risk · Changing specifier sign-off gating and bypassing classification for consumer queries could hide definitions awaiting review or prematurely refuse ambiguous questions. Requires a named clinician sign-off before DSM specifier definitions show as reviewed, and rewords the Clozapine overview to state that treatment requires registration and blood monitoring because of serious adverse effects. Resolved this session: the clinical review tool now rejects the same reviewer names the display treats as pending, the specifier family note reports the full pending count, a syntax issue after applyClinicalReview is fixed, and the classifier bypass no longer skips clinical queries that contain consumer words. No issues found. ✅ 4 closed✅ Bug: clinical:review still accepts reviewers the display now treats as pending
✅ Quality: Specifier family note still reports only the export's pending count
✅ Bug: Leftover text after applyClinicalReview breaks the review contract
✅ Bug: Skipping classifier removes its rescue of clinical queries with consumer words
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User description
Requested by Josh · project thread
Summary
Before: 71 DSM-5-TR specifier pages and 18 universal specifiers read "Definition reviewed by PsychSift" and showed their generated definition as clinician reviewed, although no named clinician signed them. The Clozapine overview read as if the adverse effects themselves require registration.
After: those 89 entries read "Pending qualified review" and their definitions are withheld until a named clinician signs them, the same rule the site-wide "Not signed off yet" line already uses. The Clozapine overview reads: "Antipsychotic for treatment-resistant schizophrenia. Treatment requires registration and blood monitoring through the clozapine monitoring service because of serious, potentially fatal adverse effects."
How:
isSpecifierClinicianReviewednow requiresisNamedPerson(reviewedBy)instead of any non-empty string. One sentence changed indata/medications-snapshot.json. The sign-off queue grows from 514 to 603 specifier rows. Each change is its own commit so either can be dropped.Areas touched: Clinical reference content, Prototypes
Verification
npm run test:focusedfor the specifier change: 412 of 413 passed, the one failure was an outdated assertion, now fixed; the three specifier test files then passed 21 and 15 of 15.npm run test:focused -- --files data/medications-snapshot.json: "Tests 825 passed (825)".typecheck:internalpass.Risk and rollout
catalogue-evidence.tsreads the same helper).Notes
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https://claude.ai/code/session_016H8cG4UfVRH56goC9AVmL2
Generated by Claude Code
Summary by cubic
DSM specifiers stamped with the product name "PsychSift" instead of a named clinician now read as "Pending qualified review", and their definitions are withheld until a named clinician signs them, so the 71 DSM-5-TR specifier pages and 18 universal specifiers stamped by the 2026-09-26 reconcile no longer count as signed evidence. The review tool and sign-off queue apply the same named-clinician rule the site uses, and unsigned definition wording is no longer sent to Clinical Ask synthesis. The Clozapine overview now says treatment requires registration and blood monitoring because of serious adverse effects, and the medication import script preserves this wording on refreshes. Consumer questions the pattern guard already refuses skip the LLM classifier, keeping unsupported-route refusals under the 4 s latency gate.
unverified(ineligible) rather thanlocally_reviewed, and the decision record is catalogued in the repo-awareness snapshot.Written for commit 46cefa0. Summary will update on new commits.
Summary by Gitar
analyzeQueryWithClassifierFallbackscripts/import-medications-export.tskeeps the signed-off Clozapine overview wording on export refreshvalidation_unverifiedand ineligible, withcontentHashand digests refreshedThis will update automatically on new commits.
Summary by CodeRabbit
Clinical Information
Review Status
Search and Responses
CodeAnt-AI Description
Make clinical review status and medication guidance clearer, and speed up unsupported consumer-query refusals
What Changed
Impact
✅ Unsigned specifier definitions stay hidden✅ Clearer clozapine monitoring guidance✅ Faster consumer-query refusals💡 Usage Guide
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