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Kids alergist wanted to use it. I said no and had two nurses come "explain" it better to convince me. I said no, and the doctor never once mentioned to to try to convince me himself. He was just snippy with me because he had to use his hands to take notes like a baby's toy.
I will never consent to AI transcription, its gonna kill someone if it already hasn't.
consent
That's an important word, because as the main-linked article says, and my experience corroborates: medical offices seldom explain what exactly patients are 'consenting' to with 'AI scribing' well enough for people to be informed enough to thus be able to truly consent.
I come from a research background and when my family doctor casually asked me if I was fine with him using AI for note-writing upon entering the examination room and sitting down, I was internally like, "ughh, no consent form, explanation, etc.?" But I was there for something sensitive and wanted to 'go along to get along.' So, I casually agreed. A few minutes later, I noticed he wasn't typing, so I said, "I notice you're not typing, is my voice being recorded?"
Needless to say, I soon after wrote the office saying I did not consent to the use of that in my care henceforth.
medical offices seldom explain what exactly patients are ‘consenting’ to with ‘AI scribing’ well enough for people to be informed enough to thus be able to truly consent.
My doctor never even told me that she was using it, I just figured it out when I noticed that she wasn't typing anything and was saying a lot of technical stuff out loud (which was odd, because she must know I won't understand the jargon). Then I saw that she had a very expensive microphone on her desk, and a what appeared to be an AI transcript program open on her computer. Absolutely no consent in my case. I wasn't even informed. I had to figure it out for myself.
Shocking and outrageous.
and was saying a lot of technical stuff out loud
The quality article I linked to in another comment, from an early adopter turned critic of 'ai scribing', suggests you're right that they're not saying that for your benefit, they're saying it for the scribe, to structure the note to their liking. This is an example of how the encounter/interaction with the patient changes as a result of using this software
This has been my recent experience as well.
Every doctor in my healthcare network uses this and they all side eye me when I say no. I get it, it takes the tedious boring part of the job and basically reduces it by 90%, but fuck you buddy you can never even answer basic questions about the model like if it uses data fed into it for refinement and often don’t even know what that means. You’re a goddamn doctor, read up on this shit for a few hours before blindly accepting it
Fwiw I run a small behavioral health practice. I get emails from people selling this shit like 2-3 times a week. There aren’t that many companies doing it but they’re super aggressive about sales. They’ll have a rep email you over and over and over and when you tell them to fuck off they’ll just have a new rep start.
There are models for this that are better in theory, they require you to type rough notes which are refined which sidesteps the gigantic issue of transmitting such sensitive audio. Some even guarantee that the model used for generating notes is independent of the model used for reinforcement learning and refinement, eg the notes I would feed in don’t get used to improve unless you consent to being used for model research. But even with that I’m not comfortable here because I don’t trust these companies at their word. Trialing systems does show it can be very effective though and I fear this is inevitable as again it reduces administrative (read non billable) burden by a tremendous amount
Also for some reason many of the companies offering systems that audio record sessions, transcribe, and summarize (over just summarizing text notes) are Israeli and that is sketch to me. I don’t trust such intimate data with a product from a country that is hostile, violent, and known for aggressive espionage. This is behavioral health though where EMR solutions are often more barebones for small practices, your local hospital probably uses epic or oracle (who don’t bother with small practice stuff) though I’m not sure if they develop LLM stuff in house or just license it
These systems always involve third-party software, where recordings of provider-patient interactions are sent to some other company.
Not to dismiss the other problems with this practice, but it seems especially crazy it works this way since transcription and summarization in particular don't need powerful hardware and they keep coming out with smaller models that can do these things. There's no justifiable reason for any of this data to leave the doctor's office and a lot of reasons for it not to.
Wellllll.....
I'm fully against these systems, and fully against my data leaving the doctors office, but the "summarization in particular don’t need powerful hardware" is a bit of a stretch to put it mildly, especially when you start looking at what computers most doctors have to work with. The average doctor computer that I see still uses VGA cables for crying out loud, you won't see any AI on those machines ever.
Summarization is known for being one of the things weaker models can handle competently, and there are LLMs with very low system requirements:
239 tok/s decode on AMD CPU, 82 tok/s on mobile NPU. Runs under 1GB of memory
I don't know exactly what the minimum performance a model would have to have to do this specific task, but it seems very likely it could be done by something that can run on a phone, or other low powered hardware.
https://benngooch.substack.com/p/i-was-an-enthusiastic-early-adopter
This is not a small thing. The clinical note in general practice is not merely a medicolegal record. It is, as research in the Journal of General Internal Medicine has articulated, a form of narrative medicine — a clinician-authored story that reflects how the physician understood the patient’s situation at that moment in time. The act of writing it is itself a cognitive process: it forces synthesis, prioritisation, and reflection. It is, in a real sense, how we think.
When an AI records everything rather than what we chose to record, this feedback loop breaks. The note stops being a reflection of clinical reasoning and becomes a verbatim archive. And as a PMC piece on note bloat explicitly warns, this risks obscuring the most medically important information under a volume of equally-weighted detail.
The problem is not just that notes become longer. It is that they become less curated, less authored, less ours. And the clinical memory they are supposed to scaffold — the ability to pick up a case six weeks later and immediately reorient — degrades with them.
We are in the relief phase of ambient scribing. The efficiency gains are real and the risks are not yet visible in our outcome data — partly because we haven’t looked, and partly because the timescales are too short. The absence of evidence is not evidence of absence.
I had my first appointment with my new primary care doctor just the other day (my previous one retired) and he proposed using one of those. I had a short conversation with him about my concerns as a software engineer regarding "cloud" and AI shit, and he himself suggested we not use it.
My wife also had her first appointment with him, and they apparently did use it in that one. 😕
They wanted to do this at my kids’ pediatrician’s office. We prompted out of that immediately.
