Reasoning Labs.Get early access

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A Gram stain: violet rods and cocci scattered across a pale field.
.gramMicrobiology
A peripheral blood smear, May-Grünwald stained.
.cbcHematology
A CT angiogram of the head: gold cerebral vessels branching against black.
.angioVascular
A whole-slide scan of kidney tissue.
.akiNephrology
A grid of axial MRI brain slices in false colour, blue and amber on black.
.mriNeurology
A lateral radiograph of the skull and cervical spine.
.xrRadiology
Sunlight and the shadow of a tree falling on a sheer linen curtain.
.consultConsult

Reasoning Labs is a breakthrough in physician tooling.

You said22words

52-year-old man, brought in overnight with confusion and ataxia. Wide anion gap on the ED chemistry. Fluids started before I saw him.

The note247words

came from your voice

HPI
52-year-old man brought in overnight by family with
confusion and ataxia. No fever, no head trauma, no witnessed
seizure activity. Last known well 2100 the prior evening. No new
medications, no known ingestion.
Labs
Na 138 · K 4.1 · Cl 100 · HCO3 11 · BUN 34 · Cr 2.4
Wide anion gap at 27 on the ED chemistry. Baseline Cr 0.9.
Measured osm 322, calculated 291 — osmolar gap 31.
VBG 7.24 / 32. Lactate 2.1. Serum ethanol negative.
Exam
Gen: somnolent, rousable to voice, oriented to self only.
CV: regular rate and rhythm. Resp: clear. Abd: soft, non-tender.
Neuro: dysmetria on finger-to-nose bilaterally. No focal deficit.
Assessment
1. High anion gap metabolic acidosis with an elevated osmolar gap.
A negative ethanol narrows this to a toxic alcohol — ethylene
glycol or methanol until proven otherwise.
2. Acute kidney injury, KDIGO stage 2 (Cr 0.9 → 2.4).
3. Confusion and ataxia consistent with the same exposure.
Plan
Fluids started in the ED before my evaluation — continue
isotonic crystalloid and reassess the gap in two hours.
Fomepizole loading dose now — do not wait on the send-out level.
Nephrology at the bedside regarding urgent hemodialysis.
Urine microscopy for calcium oxalate crystals.
Thiamine and pyridoxine. Hold nephrotoxics, renally dose all
standing medications. Poison control notified.
Disposition
Admit to the MICU for q2h labs and possible urgent dialysis.
Discussed with the accepting intensivist and with the patient's
daughter at the bedside, who is the healthcare proxy.

Why this exists

Nobody went into medicine to do paperwork.

Administration turned care into documentation and left the patient whatever attention survived it. Engineers fixed this for themselves long ago: they pick their own tools, and nobody files a ticket for permission to work better. Medicine never got that. We are building it the only way it works — by physicians, for the physicians using it, on a phone the hospital never issued. The point was never the hour saved. The point is making being a physician human again.

Status quo
0 phrases
Reasoning Labs
Every service
200+ phrases
Status quo
12+ weeks
Reasoning Labs
No IT ticketNo SSONo hospital deviceAny phone
0 weeks

What we keep

Nothing. That is the entire security model, and it is the reason a tool physicians actually chose can exist outside the hospital at all.

No note, no patient, no transcript is written to a database. The text exists in your session and then it does not. Nothing to export, subpoena, or breach — and that is a real cost, not just a feature: you cannot come back tomorrow for yesterday's note.

It runs on the phone you already carry. Not a hospital device, not inside the hospital network, nothing for IT to provision. The reason that is allowed is unglamorous: they never gave you a phone in the first place.

The phrase library is written by physicians and open to read. You can see exactly what a dot expands to before you ever put it in a chart, and a phrase you disagree with is a phrase you can fork.

Audio and text pass through a transcription model on the way to becoming a note, and nothing is retained on either side of that trip. Signed agreements with every processor in that path are in progress, and we will publish them here before anyone charts a real patient.

Image 01 · placeholder

The admission, spoken

The H&P is the longest note of the day and the most templated. Most of it is scaffold — the same ten systems, the same normal exam — wrapped around four sentences that are actually about this patient. You say the four sentences. The scaffold is already there, and the blanks are the only thing still waiting on you.
Image 02 · placeholder

The report, read back

A pathology report arrives as prose written for another pathologist. The clinician reading it needs three things out of it and finds them by scanning past everything else. The report goes in, the three things come out, and the original stays one click away — because nobody should take the summary on faith.

Lab

Open questions we are working in the open. None of this is published yet.

In progress01How much of a note is structure?
In progress02What a shared phrase library does to variation
In progress03Dictation accuracy on ward noise
In progress04Where physicians stop trusting a summary

Early access

Built with the physicians who will use it.