Refuse to let your doctor record you

https://buttondown.com/maiht3k/archive/why-you-should-refuse-to-let-your-doctor-record/

by speckx • 3 months ago

167 226 3 months ago

buttondown.com

josefritzishere• 3 months ago

This is a hard no.

pclowes3• 3 months ago

I understand the concerns and I am not sure I would allow myself to be recorded until I knew more.

However, I do think we are in a situation where everybody knows that healthcare costs need to come down that doctors and medical professionals are spread too thin, forced to see evermore patients in the same number of hours, and yet for every attempt to improve efficiency there is a “no, not that way“ response.

johndhi• 3 months ago

yes, this!

bluefirebrand2• 3 months ago

for every attempt to improve efficiency there is a “no, not that way“ response

They've tried everything except "train and hire more doctors" and they're just all out of ideas aside from "erode patients rights and lower overall quality of care"

pclowes3• 3 months ago

The economics of medical school cost, time, and capped residency spots (some would argue this is price-fixing with artificial scarcity) make it hard to just “make more doctors”. Combine this with a highly litigious society that always demands a full doctor (when for 90% of things an NP or PA would do) plus inverted population pyramid all exacerbate the problem.

We need more doctors now and it takes 12 years to make a doctor and by then the boomer cohorts aging and medical needs will peak.

Finally, even if we could do that, the top of the funnel candidate is substantially weaker with lower test scores and higher need for remedial classes. And for the good candidates, the ROI of medical school is not as good as it once was.

pj_mukh• 3 months ago

Yes, and also almost all of these issues could be ascribed to all digital medical record-keeping. The fact that AI transcribed it matters relatively little.

winrid• 3 months ago

"healthcare company lowers cost instead of absorbing new found profits" sounds like an Onion headline

awakeasleep• 3 months ago

news on inter-dimensional cable

midtake• 3 months ago

Is that why healthcare costs are up, or is it because of the insurance mafia?

jimbokun5• 3 months ago

It’s the doctors.

Insurance company profit margins are capped by law and if anything their incentives are to pay the hospitals less.

US physician salaries are astronomical compared to anywhere else in the world.

gosub100• 3 months ago

How do you know it's not the other way around? Give consent to incorporate another technology that will keep wages the same but allow them to treat more patients and extract more profit for the shareholders?

hyperific• 3 months ago

I definitely agree that medical professionals are spread too thin and automation seems like it would be a boon but, as the article points out, the introduction of automation likely won't translate to more doctor-patient time it'll translate to doctors seeing more patients.

The solution not only introduces a problem (decreased privacy) but could reinforce the existing problem it's trying to solve.

hamandcheese• 3 months ago

it'll translate to doctors seeing more patients.

This is also a good thing. Even in supposedly developed parts of the world like San Francisco it can be difficult to find a PCP that is taking new patients.

dheera• 3 months ago

How about this:

1. I have health insurance

2. The point of insurance is they're supposed to pay for shit

3. You figure out how to get them to pay for shit, sign an agreement that removes me of any patient responsibility of the balance bill, and assure me in writing that I will owe $0 no matter what

Then you can record me.

gedy• 3 months ago

Insurance, like a lot of subsidies turns into "we will take all of that, and still make sure your share is at the limits of your carrying capacity"

marricks2• 3 months ago

I do think we are in a situation where everybody knows that healthcare costs need to come down that doctors and medical professionals are spread too thin

The problem is over optimization AND lack of people. As soon as there's an excuse for less staff because we have "digital record keeping" we're going to have less money and even less staff.

Having in person or remote notetakers is a great entry level job to do before you become a doctor. It could be boring but at least the terms are familiar and you get to know the person you're working with.

It's not like healthcare is an impossible problem to solve that needs more tech, we just refuse to spend money on people and (inexplicably) cannot help but dump tons of money into tech.

toast0• 3 months ago

The problem is over optimization not lack of people or resources. As soon as there's an excuse for less staff because we have "digital record keeping" we're going to have less money and even less staff.

At least in my area, it seems like lack of people is a problem. Sometimes it's lack of people because the pay is too low, but more of it it's lack of people because the pool of qualified people is too small. And increasing pay increases healthcare costs, and healthcare costs are already very high. If digital tools allow the available staff to see more patients while delivering the same level of care (and without burning out the providers), then that means more capacity and less times people want to see a doctor, but can't. Similar arguments for same number of patients ans greater level of care. If it's more patients, but worse level of care, then it becomes tricky.

pclowes3• 3 months ago

I don’t necessarily disagree with you here. However, there is a timing concern. Training doctors takes too long and the boomers are aging now.

hansvm• 3 months ago

If I paid all my doctors $1200/hr and doubled how much time they spend with or on me, that'd still pale in comparison to healthcare expenditures attributed to me between actual insurance payments and actual money leaving my bank account. Doctors being spread too thin is very much a separate issue.

vlovich1232• 3 months ago

One massive way to reduce healthcare costs is to remove caps from becoming a doctor; as long as you pass the tests and meet the requirements, why are we turning doctors away? So that existing doctors can be paid well above the market rate. There's a reason there's so many doctors in politics - it's very important for them to protect this business model.

bonsai_spool4• 3 months ago

There's so many doctors in politics - it's very important for them to protect this business model.

Uh... politics is almost uniformly lawyers and business people.

Also tests are the table-stakes to being a doctor (like leet code and programming).

kelnos9• 3 months ago

The problem is that (as addressed by the article), any efficiency wins end up pushing more patients on the provider. So if you used to have a 15-minute appointment, and five minutes of that were spent with the doctor writing down notes, with AI transcription, now you'll have a 10-minute appointment, and the doctor will be forced to see two more patients per hour.

sys_64738• 3 months ago

I understand the concerns and I am not sure I would allow myself to be recorded until I knew more.

Which is your choice obviously. But your doctor can also drop you as a patient and that will happen eventually if you say No too many times.

scrawl• 3 months ago

The false promise of efficiency [...] that is extremely unlikely to mean more time with each patient. Instead, it will mean more patients.

nit: that is a real efficiency gain. seeing more patients sounds better on the face of it.

woopwoop• 3 months ago

That's not a nit. There's not much left of the articles point once you take this on board.

apparent2• 3 months ago

Exactly. It means that if you've ever tried to get an appt and been told there's a 4 month waiting list, AI could help get you in sooner. That is a real win.

walrus01• 3 months ago

It's interesting how lots of service providers of all sorts will insist that you agree to their Terms of Service, Acceptable Use Policy, End User License Agreement (or whatever they want to call it) before engaging with you, but when the consumer insists on enforcing their own personal policy in the opposite direction such as refusing consent to recording or feeding your PII into some opaque AI system, suddenly it's a problem.

k2xl2• 3 months ago

I think the post conflates two issues:

1. AI-generated charting. 2. The existence of a reliable record of the visit.

I am skeptical of the first in some cases (i.e. bias), but strongly in favor of the second.

My father is 80 and has Parkinson’s. He routinely leaves appointments unsure of what the doctor said, what changed, or what he is supposed to do next. Even when I attend with him, we sometimes disagree afterward about what exactly was recommended.

This happens with pediatric appointments too. My wife and I occasionally remember instructions differently: medication timing, symptoms to watch for, when to call back, whether something was “normal” or needed follow-up.

That is a care quality problem, not just a convenience problem.

The risks are real: privacy, consent, retention, training use, liability, and automation bias. But those argue for strict controls, not for a blanket refusal. Make it opt-in, give the patient access, prohibit training without explicit consent, keep retention short, and require clear auditability.

I do not want opaque AI quietly rewriting the medical record. But I also do not think “everyone relies on memory after a stressful 12-minute appointment” is some gold standard we should preserve.

ranger_danger• 3 months ago

Have you tried recording the interactions with doctors for your own benefit?

k2xl2• 3 months ago

Yes. It was great for when I had a major surgery last year and had a bazillion questions for the surgeon. But I don't always remember to. My parents definitely don't even think about it.

nubinetwork• 3 months ago

Dead link (or it was?)

adit_ya1• 3 months ago

Almost every point follows the same structure:

"Here is a real concern about implementation" → "Therefore you should refuse entirely"

This skips the middle step of "therefore we should implement it well."

I'm not convinced that we should be allowing doctors to record patient visits at this stage yet, but I'm really not convinced by these points, which largely don't hold up under closer examination.

A few that stuck out:

"Privacy" - Labs are routinely sent to third-party companies, and we don't do informed consent for that. The third-party argument isn't unique to recording.

"False promise of efficiency" - This doesn't really have anything to do with patients at all. It's a criticism of medical office management, not of physician-patient interactions. Telling patients to refuse a tool because management might exploit the productivity gains is asking patients to fight a labor battle on the provider's behalf.

"Consent can't be revoked mid-visit" - Consent typically can't be revoked in the middle of an appendectomy, or halfway through administering a vaccine either. Practical irrevocability is a normal feature of informed consent, not a special problem unique to recording. Proper consent processes in medical offices are a broader issue than consent about voice recordings specifically. Had the authors made the point that providers are being asked to obtain consent for tools whose technical implementation and privacy risks fall outside the provider's own domain knowledge — that would be a stronger argument. But that isn't quite the point they made, and their current framing doesn't wholly convince.

afandian• 3 months ago

I think the "therefore we should implement it well" is not forgotten, it's elided because we don't think it's likely to happen.

Tech-naïve people think that we can build super duper encryption systems.

The more jaded amongst us know that people can get sloppy or complacent, it's rare to see a regulatory system that truly incentivises good practice, data breaches will happen eventually, and no-one will be held accountable.

This is a big one in recent memory: https://www.theguardian.com/uk-news/2020/jun/10/babylon-heal...

parliament323• 3 months ago

Labs are routinely sent to third-party companies

Labs are real businesses that do real things, and would have actual impact for a breach. Meanwhile any idiot can vibe-code a thin shim between a microphone and ChatGPT in a weekend, promise they're HIPAA-compliant, and start selling. Medical professionals have no obligation to do any diligence, and there's no reason for them to not just buy whoever-is-cheapest. They're not even close to the same thing.

kube-system7• 3 months ago

There might be some real concern about the cognitive and patient-interaction impacts of speech recognition being used... but on the other hand, it's more likely that details are missed when information is captured manually.

And the privacy/informed consent concerns here are silly, they apply to any of your charted data... and if you're going to any office that doesn't use the latest technology, your patient information is probably being sent between offices over fax anyway.

burnte32• 3 months ago

I'm a healthcare CIO of 12 years, and I've evaluated 4 and deployed 2 of these tools, one of which is currently deployed at my currently healthcare employer. I am very measured on AI but the results I've seen from these virtual scribes is HUGE. In every case we have IMMEDIATELY seen improvements in patient NPS scores, provider satisfaction, and note quality. Notes are more standardized as well as more verbose and detailed, which makes it easier for future providers to understand the case. These better notes reduce our claim rejection rate.

And what converted me was direct patient response. Across the board patient feedback is extremely positive, with the most common comment being along the lines of "I really felt like the doctor connected with me better and they were more present in the visit."

These AI scribes really DO improve patient care, I've seen it with my own eyes.

t-kalinowski• 3 months ago

Counterpoint from a doctor: https://substack.com/inbox/post/189714240

Scribes _feel_ good in the short-term, but it's not clear if they're actually good on longer time horizons.

bonsai_spool4• 3 months ago

Counterpoint from a doctor: https://substack.com/inbox/post/189714240

That article is clearly LLM-assisted if not vibe-written, which is the height of irony given the context.

Note that the CIO is talking about patient satisfaction, which is a distinct target. I agree about the long-run benefit being unclear.

sigmar• 3 months ago

"I am not saying ambient scribes are bad technology."

is this a counterpoint? he just seems to be wary of the risk, without a firm position and decided to personally stop using it. people often overestimate their own skills and think their own charting is better than that of others, that doesn't mean the tech doesn't work.

jimbokun5• 3 months ago

In an article critiquing over-use of AI assistants, the author confesses at the end this article itself was authored partly by Claude that introduced errors in the citations, lol.

Nonetheless, I come away from this article with the sense the ambient devices automating documentation of an encounter are still a net win, with caveats about the need for the doctor to polish the note ti reflect his or her own narrative voice.

razingeden• 3 months ago

the two places they come in handy:

1) in the event you find yourself partially or totally disabled but the records don’t really make a good case for it and your provider has a dismissive attitude about filling out additional documentation to substantiate what they failed to in your records.

You’re not necessarily going to get approved for FMLA, STD, LTD, SS etc based on a diagnosis or test results alone. They will nitpick over say, heart failure, as if that’s magically and spontaneously going to go away. If you’re telling your provider that you’re limited by things like oh I don’t know, “I’m only awake for 2-4 hours before I need to sleep again” or “some days I just can’t do it and sleep 20 hours” but it’s not in your chart… expect denials and clarifications and a huge burden on you to prove why it’s limiting.

2) continuity of care, so you don’t end up explaining everything from the top to a specialist or having them run all these tests and procedures from square one — when there’s months long backlogs , and we already did all this and you need treatment - but - there wasn’t much to work with in your referring chart.

You might not appreciate the “intrusion” if you’re healthy and just worried about your privacy.

If/When things go south and you find yourself fighting these entities for a year or two or three while they nitpick and delay and deny and drag their feet , you’ll be glad an “AI” kept up meticulous records because this is phenomenally stressful and an endless burden on you when they don’t.

So, their AI slop can vomit out all this extra info on why insurance companies should pay them or why your condition is in fact disabling, and now their AI slop can comb through it looking for all that. Because they will try to avoid paying or approving any kind of leave or benefits if it’s not there

And god forbid you hand them a form where they’re being asked to explain themselves. 50/50 on them being eager to help out or rolling their eyes and saying something really nasty about the imposition. And then even when they do that, they almost never file a copy in your chart so your chart STILL doesn’t substantiate your claims. I’m all for an “ai” doing the progress notes in a case where the facility or provider can’t be fucked to do so.

Happily that’s not true of my current provider, who just, does that anyway (?) But I’ve been around enough to know they’re an exception. Even when providers are on your side and mean well, and want to bend over backwards to help you in any way they can — and I want to just acknowledge that’s the situation I’m in today — honestly , sometimes they just forget some of the details when they do their notes.

That’s why some places make the provider do it in real time while they’re talking to you, so they didn’t forget something relevant thirty minutes later. The other side of the coin here may be that some providers find that distracting or off putting to be typing away like a stenographer while they’re examining you…

I think it would be fair to say this can all be tedious and a burden for both patients and providers. There’s just a world of difference between a provider who wants to do this to provide excellency in care, and a provider who wants to do this because they resent it and think it’s beneath them.

burnte32• 3 months ago

I think every single provider should evaluate them for themselves. Some providers are absolutely better of without them and we don't make anyone use them.

mmooss4• 3 months ago

If I allow it, is the data from my meeting sent offsite at any stage, for example to an LLM service (e.g., Anthropic, OpenAI, etc.)? Or do the LLM vendors (or any others) have access to the internal data at any stage?

burnte32• 3 months ago

If I allow it,

Which is your right, every patient can ask the provider to not use it.

is the data from my meeting sent offsite at any stage

Yes, no one stores medical records on-prem any more. EMR systems are not like Quickbooks running on an 8 year old terminal server.

for example to an LLM service

Yes, that's literally what an AI transcriber is, an LLM.

(e.g., Anthropic, OpenAI, etc.)?

No. The recording goes (in realtime) to our vendor's infra where it is live transcribed, then summarized and returned. When complete only the finished note is saved, never the recording or transcript.

Or do the LLM vendors (or any others) have access to the internal data at any stage?

Obviously, you can't pricess data you can't access, but the contractual and regulatory environment means that data can't be used for additional training without lots of consents. We do not participate in training activities at all. I won't allow it.

yding• 3 months ago

When you evaluated the tools, what stood out between which ones were better or worse?

burnte32• 3 months ago

A few things. I'm price sensitive, so pricing was huge for me. The worst company also had the worst prices. I tried to ask them questions about how their backend works and they refused to answer. I spoke with the CEO and he said he couldn't reveal their "secret sauce". I said, "if you secret sauce is what infra providers you use and not your proprietary code, then you don't HAVE secret sauce and you're just reselling [Cloud Provider's Product]." Turns out that's exactly what they were doing. They were using Google Cloud for recording capture, and AWS for speech to text and then summary generation. I told them we would not ever be working with them.

For me the big things are price, ease of use, and data protection policies. I need to know the data never leaves the US, and I need to know what processors will touch it. Then if it meets those needs we'll do clinical demos and tests to get provider feedback. That's where we learn if it is clinically accurate. About half of them suck in the accuracy department.

What stands out to me the most is that the best companies have tended to be the small guys who have a strong grasp ion the entire stack and have somewhat simple apps. They focus on the tech, and have a minimal UI that just focuses on the main tasks and they don't spend engineering time on fancy pretty bells and whistles. If you see a simple UI, that's a good sign to me. Once you hit the big guys the quality goes down. Dragon Medical One is great for straight text to speech, but Dragon with Copilot for medical is really bad.

cromka2• 3 months ago

But WHY not do this on premises? WHY?

dsr_4• 3 months ago

Money.

16bytes2• 3 months ago

Why would you want to have anything on prem?

Have you seen what that looks like in a hospital system?

burnte32• 3 months ago

We're not prompt engineers or app developers. In a year or two when I can buy an on-prem hosted version I'll do that.

jubilanti2• 3 months ago

I still don't want a fucking audio recorder in my doctor's office or a fucking AI that sits in between me and my doctor.

I am intentionally cursing to express my anger at this casual betrayal of medical trust.

kube-system7• 3 months ago

It is standard practice to ask patients whether or not they want the scribe used, and in many cases required by law.

oliwarner4• 3 months ago

Notes need writing though.

You can do that by recording and transcribing (many methods) or your doctor has to write on the fly, or worse, has their head in their computer while you talk in their general direction.

Letting doctors talk and examine and not write is a wholly better experience.

Offsite third parties are the problem here. If this was done automatically without data leaving the room, is there a problem? Do you have the same objections to how your digital notes are stored?

tclancy2• 3 months ago

This feels wild to me. I think I am pretty well privacy obsessed, but I don't see it here (fwiw, my wonderful doctor has been using these services for years; originally with overseas human labor, now with AI). First off it presupposes some level of privacy with one's GP that I would only want from a therapist. I don't want health information going beyond my doctor? What about him talking to specialists or getting another opinion in the break room?

Ship's sailed on that level of privacy anyway the second you bill an insurance carrier in the US. I am willing to take this particular risk if something I said two years ago pops up to help explain what I am currently experiencing. I understand not everyone is me and I am lucky to be in relatively good health and not have anything going on that might put employment, etc at risk so I can understand where some people may want to refuse. But the knee-jerk "FUCK NO BECAUSE PRIVACY" is almost as bad as writing a post based on a side plot in The Pitt when said side plot was 110% heightening the stress between Dr. Robby and Dr. Al Hashimi, not a goddamn double-blind study of the effectiveness of AI transcripto-bots.

And if you're going to take lessons from The Pitt about medical record transcription, why isn't it Dr. Santos repeatedly falling asleep while transcribing records?

EvanAnderson6• 3 months ago

I still don't want a fucking audio recorder in my doctor's office ...

If I got a copy of the raw recording I might consider it. Maybe. Having that audio recording would be valuable to me.

It's very irksome medical providers I visit have signs posted prohibiting audio and video recording by patients. My medical appointments aren't exceedingly complex, but a reference audio recording would be handy.

I suppose I could exercise civil disobedience and just record anyway since it's not illegal in my state. Still, it irks me.

kstrauser• 3 months ago

I still don't want a fucking audio recorder in my doctor's office

Why? Doctors have the strictest privacy regulations I know of. It's the one place where I'd be least uncomfortable with a recording, because there's nothing they can do with it other than use it to provide healthcare to me.

or a fucking AI that sits in between me and my doctor.

The expected arrangement is that the AI would be alongside you and your doctor, so that your doctor can spend time interacting with you instead of playing transcriptionist and dictating your statement into your chart.

burnte32• 3 months ago

I still don't want a fucking audio recorder in my doctor's office

Which would you prefer, your doctor remembering everything, or making verbal notes into a microcassette tape recorder that is transcribed by a human later (sometimes the doctor, sometimes someone else)? What if your doctor had a medical assistance in the room and spoke out loud and that medical assistant wrote down everything, is that ok?

or a fucking AI that sits in between me and my doctor.

It sits next to the doctor helping them focus on you by transcribing the session, it doesn't do anything the doctor can't and definitely doesn't do anything the doctor SHOULD. No decision making is done, only transcription and summarization which is then checked by the doctor. We do not let AI make decisions.

childintime• 3 months ago

I'm kind of the exact opposite: I don't want a doctor between me and my medical AI. Because he limits my agency to heal myself and his value add should be optional, when I need him, after I explored self-treatment options and realize I need a non-patronizing third party to step in.

In my whole life I have experienced the mzungu paradox happening: (mzungu) professionals promise to do a good job, get well paid regardless of results, and in the end most often I end up having to solve everything myself.

Mzungu is the word for white people, though here it is used in the sense of white collar people, which is appropriate as they are all exponents of the white collar financial tribe, the faith in professionalism now vying for world power. Note: power, not competence.

wl• 3 months ago

I got an erroneous Type II diabetes diagnosis dropped into the note by the AI scribe at my last appointment because my PCP discussed the A1C test he was ordering. Would not recommend. That isn't to say that manually typed notes or speech to text dictated notes are perfect (dot phrases have ended up "documenting" plenty of conversations that never happened), but a false diagnosis of a chronic disease seems like a really bad failure.

burnte32• 3 months ago

got an erroneous Type II diabetes diagnosis dropped into the note by the AI scribe at my last appointment because my PCP discussed the A1C test he was ordering.

No, you got an inaccurate diagnoses because your doctor didn't do their job. It's the provider's job to check notes, and this would have gotten that provider a visit with their clinical director at my org.

dsr_4• 3 months ago

Pre-AI voice recognition (2018), followed by 2 human reviews

https://jamanetwork.com/journals/jamanetworkopen/fullarticle...

=> the error rate was 7.4% in the version generated by speech recognition software, 0.4% after transcriptionist review, and 0.3% in the final version signed by physicians. Among the errors at each stage, 15.8%, 26.9%, and 25.9% involved clinical information, and 5.7%, 8.9%, and 6.4% were clinically significant, respectively.

AI "scribes" in a perfectly replicable best-of-all-worlds scenario (2025): https://bmjdigitalhealth.bmj.com/content/1/1/e000092

=> Omissions dominated error counts (83.8%, p<<0.001), with CAISs varying widely in error frequency and severity, and a median of 1–6 omissions per consultation (depending on CAIS). Although less frequent, hallucinations and factual inaccuracies were more often clinically serious. No tested CAIS produced error-free summaries.

On the gripping hand, people who work in the management end of the US healthcare industry can't be trusted with healthcare or information security to begin with.

joshstrange• 3 months ago

On the gripping hand,

It’s been a year or so since I last read The Mote In Gods Eye/The Gripping Hand but I randomly was thinking of this morning. Very funny that I would see a reference to it the same day.

kube-system7• 3 months ago

Errors can be a significant problem in manual charting as well.

I know a medical professional who does a similar evaluation process to what is outlined in your second link to human written charts. They then use that feedback to guide the department on how to improve their charting.

So, don't presume that those error rates cited in those studies should be compared to a baseline rate of zero. If you review human-written charts, you will often also not have an error rate of zero.

justbees2• 3 months ago

My dad likes to joke around and his doctor uses some kind of transcription service. Time for fun!

His doctor asked him about using drugs and he made a joke that was something like "I only use coke" - meaning coca-cola. Of course his doctor knew he was kidding about drinking too much soda because he eats/drinks too much sugar. So they had a little laugh and moved on.

BUT now it's in his medical transcripts. My mom said it "transcribed" it as something like "the patient responded he has used cocaine recently".

I guess his doctor doesn't go in and actually fix things or even read over what the transcription says...

Also both of my parents have accents and have reported really weird transcriptions that don't match what they actually said.

So now my mom has told my dad he can't make jokes with the doctor anymore because even if the doctor knows he's joking it's going to get noted down as a "fact".

burnte32• 3 months ago

That article is from 8 years ago, accuracy is dramatically better today. We see a few percent error rate.

From the 2025 study: Conclusions The CAISs demonstrate high levels of summarisation accuracy. However, there is great disparity between the currently available CAIS products and, while some perform well, none are perfect. Clinicians should therefore maintain vigilance, particularly checking omitted psychosocial details and medications, and scrutinising plausible-sounding insertions. Purchasers and regulators should be aware of the significant performance disparities identified, reinforcing the need for careful evaluation and selection of CAIS products.

This is exactly what I say and how we teach our people to use it. At the end of the day the human is responsible for the accuracy. We do have providers who decline to use AI because they don't want to double check it, and that's fine by us.

On the gripping hand, people who work in the management end of the US healthcare industry can't be trusted with healthcare or information security to begin with.

No, this blanket statement is far to overly broad. Health insurers are by far the least trustworthy. Provider organizations are a very, very different group. In my 12 years I have never had a PHI breach or leak that wasn't a human making a mistake. No hacks, no credential breaches, no backdoors or zero days, no network infrastructure penetrations. Two former employers had breaches years after I left which I think speaks well to my track record. I take security incredibly seriously. Our patients are the most important part of my job.

sonofhans• 3 months ago

I’ve been in tech and medicine too. Consider that any “HUGE” effect in this context is likely exaggerated, especially for something as prosaic as a note-taking assistant.

As a patient sitting with a doctor, I don’t care how standardized the notes are. I don’t care about anyone’s NPS score. I do want the doctor to connect with me, but I also remember not too long ago when doctors did this anyway, without any assistance from robots.

reaperducer4• 3 months ago

I also remember not too long ago when doctors did this anyway, without any assistance from robots.

Or with assistance from other humans.

The last time I had surgery, every time I met with the surgeon (about six times), he had an intern following him around with a Thinkpad, typing in everything said.

The intern has the ability to understand context, idiomatic expressions, emotion, and a dozen other important and useful things that an AI transcription will never capture.

nitwit005• 3 months ago

If there is a large effect, I'd expect it's excitement about a new thing.

Positive survey feedback certainly isn't a bad sign, but people can get very excited about cool new technologies, even ones that ultimately fail.

burnte32• 3 months ago

I’ve been in tech and medicine too. Consider that any “HUGE” effect in this context is likely exaggerated, especially for something as prosaic as a note-taking assistant.

Imagine your doctor head down writing down everything you say. Now imagine your doctor looking you in the eye and listening intently. Which do you think feels better to the patient? That is "huge". Anything that helps improve patient care with little effort and cost IS HUGE to us. That feeling of the doctor being present and invested helps patient outcomes. THAT is also huge, even if it's a few percent.

We're healing people, we're not looking for a unicorn startup, a few percent improvement IS HUGE to us.

As a patient sitting with a doctor, I don’t care how standardized the notes are.

Yes you do, better notes mean better care because the next time your seen your records are clean, understandable, and compliant with regulations and best practices. Better notes mean doctors are following protocols. Better notes mean fewer claim rejections, and fewer claim rejections means less money wasted arguing with insurance companies. Better notes mean the data is more easily used for research, as well, which leads to new treatments and better outcomes.

I don’t care about anyone’s NPS score.

Ever had a doctor with a bad bedside manner? Missed a diagnosis? Skips appointments on fridays? Tracking NPS scores can help with that. Every data point is useful, and patient satisfaction is massive.

I do want the doctor to connect with me,

Ok, well, most people DO want this, most people DO want to have a good relationship with their doctor where they feel heard and cared about rather than just another widget on a conveyor belt.

but I also remember not too long ago when doctors did this anyway, without any assistance from robots.

I also remember when doctors weren't constantly overruled by insurance companies. Ever heard of a Prior Auth? That's when your doctor writes a prescription or an order and then the insurance company makes the doctor call them back and say "yes, I did this on purpose, yes the patient really needs this." Then a bureaucrat at the insurance company will decide if the doctor is right or not. Usually those bureaucrats aren't even doctors. That's illegal, but happens every day.

Anything I can do to help my doctors provide better care for our patients, I'll do. I've dealt with scribes for 12 years and I genuinely think these AI scribes are a genuinely amazing use of the technology. We don't have to hire human scribes, and our doctors are freed up to deal with the patient thanks to a documentation helper.

I evaluated quite a number of these tools before we rolled any out. I've been researching these for two years. Dragon with Copilot is not a good tool, for example. There was another we evaluated, I just did a search on them and their story today is wildly different than it was 18 months ago when I discovered they were lying through their teeth about the tech. I see they claim to have secured a $70m round in 2024 (which I know is a lie) and more since, so maybe they can actually do what they say now but I couldn't trust them, so I kept evaluating.

I'm not an AI truster, AI isn't a panacea, but it DOES have uses, and this is one I've seen make a positive difference. I'm not an insurer, I work for providers, my goal is helping my docs provide the best care, so I promise I'm not going to roll out bullshit tech or things that would endanger our patients. My reputation is on the line, and I take that incredibly seriously too.

eclark• 3 months ago

Be careful with initial impressions of metrics. We as humans have a heavy tenancy to anchor to our first judgments or impression. We see a win and assume the win is long term, with no downsides, and dependent on the new information/change.

So combine that with the Hawthorne effect and new business or health initiatives that can look great simply because participants notice change and notice the increased attention. However many human patterns have a tendency to regress to the mean.

Personally I have seen this a lot with developer tools and DevOps. A new SEV/incident/disaster happens and everyone rushes to create or onboard to a tool that would help. Around the office everyone raves about it and is sure that it would fix all issues. And the number of commits goes up, or the number of SEV's in an area decreases for a while. People were paying attention, after a while the tool starts to slow down or not be as used. It's got rough edges that weren't seen or scenarios that were supposed to be supported never get fully integrated. Eventually the patterns regress, but with more tools and more complexity.

- https://pmc.ncbi.nlm.nih.gov/articles/PMC1936999/

- https://arxiv.org/abs/2102.12893

burnte32• 3 months ago

We as humans have a heavy tenancy to anchor to our first judgments or impression.

One of my lifelong guiding quotes: The first principle is that you must not fool yourself, and you are the easiest person to fool. - Richard P. Feynman

We see a win and assume the win is long term, with no downsides, and dependent on the new information/change.

Not me. I've had a hard life and I've worked incredibly hard to get here. I'm a little more loss-averse and focus on what can go wrong, not what went right. It's far too easy for us to become complacent. All in all I'm not your average CIO at all. I'm extremely technical, got my experience as an IT consultant for years and learned business by doing. Since moving from consultancy to employed life, I took the time to get several certifications and even did an MBA about a decade ago.

ryandrake2• 3 months ago

improvements in patient NPS scores, provider satisfaction, and note quality

How are note quality improvements measured? Vibe-notes might be more verbose and better sounding (which would explain the NPS and satisfaction metrics), but still not actually match the doctor's actual words or intent. Are the AI-generated notes actually compared with ground truth to prove they are accurate?

burnte32• 3 months ago

How are note quality improvements measured?

Every provider is under an Assistant Clinical Director, and they report to the Clinical Directors, who report to the CMO. ACDs see fewer patients than regular providers because they have more admin time. That admin time is used to check charts. We don't review every chart, but a pretty good sampling. I meet with them monthly to talk about tech issues, and that's where I helped them create templates for notes that we can have the system output in that same format. We'll tweak the formats as needed, or the ACDs will talk with a provider about changes in how they handle the patient.

Also, we look at denial reasons. Any time a claim is rejected by a payor for note related reasons it gets a full review from clinical staff other than the original provider.

Vibe-notes might be more verbose and better sounding (which would explain the NPS and satisfaction metrics), but still not actually match the doctor's actual words or intent.

That's the great thing about these, they listen to the entire visit, they hear everything that happens, make a full transcript, then create a summary. It's not a situation where the doc talks for 30 seconds into a mic then the AI fleshes it out, it's the exact opposite. We're using AI to distill the visit into the note, not expand a small note into a larger one. We're not generating data, we're condensing it. Doctors must read each note, and they are legally liable for the note quality. Doctors are highly competitive and image conscious, so they're actually a great backstop for accuracy. If they notice inaccuracies in their summaries, I ASSUME you I personally hear about each and every one. I'm ok with that, though, the buck stops at my desk.

Are the AI-generated notes actually compared with ground truth to prove they are accurate?

Yes. A doctor could lose their license, so every provider checks their notes, and our CMO and clinical oversight staff take that extremely seriously.

parliament323• 3 months ago

Good, I'm glad. Now find a way to do it in-house. Shipping our conversation to some random-ass fly-by-night SaaS who pinky-swear-promises they're HIPAA-compliant is a non-starter for a medical professional I'd actually want to give money to.

burnte32• 3 months ago

I'd love to find a way to do it in house, but we're not large enough, and our core competency is healthcare, not prompt engineering. I'd rather pay a company I've evaluated and trust until I can bring a version of the tool in house. I expect in a couple of years we'll have on-prem options and I will absolutely do that if I can. I'm an on-prem-first guy. If you have good staff then it's generally cheaper and faster for many things.

quantumwoke3• 3 months ago

It's crazy that the hospitals justify this approach. The major scribes are literally connecting Llama to Whisper and that's it.

Jamesbeam2• 3 months ago

This ad was brought to you by the AI scribe industry, Dr.Nicks favorite tool.

burnte32• 3 months ago

Notice how I didn't state any names? I'm not here to be a free ad. I'm just saying they're actually good tools, if you vet them right. Microsoft Dragon Copilot is not good, for example. We piloted that and had an 11% retention rate after 3 months. Trash product.

invalidptr• 3 months ago

How do you control for quality variation between patients? In my experience, AI note taking tools display a clear bias against participants who are {quieter, ESL, women, ...}. How can you evaluate whether these biases show up in a medical setting?

burnte32• 3 months ago

Check some other replies I've given. Our clinical management team does that, quite in depth.

zaptheimpaler• 3 months ago

Yep I would agree as a patient. My current doctor types so slow that 6 out of the 10 short minutes in an appointment just disappear while he types. Even with other docs who can touch type, it will free them up to focus completely on the appointment and reduce the hours they spend charting afterwards.

kakacik• 3 months ago

As a husband of wife who is GP, I would add a general long term issue - cognitive overload. GPs have to be almost-expert in everything, my wife is doing everything from preliminary cancer diagnosis and treatment, heart attack diagnosis to psychiatric care and many other places in between which should be normally covered by specialists. But there are simply not enough of them here for many tasks here (Switzerland). Any mistake can be potentially fatal to the patient, easily, trivially.

The amount of self-imposed stress and responsibility compared to puny insignificant software dev roles like mine is staggering. And its every single day, no easy day, ever.

On top of that, 3-4 hours daily just doing paperwork for insurances, legal, judges etc. that has to be flawless. LLms can help massively here, but it would be great if they are opt-in for patient (and thus he can get better focus of doctor / longer time spent / lower meeting cost), and if they could be local-only. Absolutely nobody from anywhere in Europe wants to send any data to US nor any of their closer servers, that game is closed for good.

kelnos9• 3 months ago

Even with how overworked GPs are, what makes you think that the LLMs will have a lower error rate? Or that errors the GP makes will be more severe than the LLM's errors?

carefulfungi3• 3 months ago

Once you've had your medical records used against you by a third party, you start being much more careful about what you share with your doctors about yourself.

There is no trust in a Dr's office. What they record gets handed to companies who have interests adversarial to yours. Basically like talking to the police. If you, as a patient, think an automated recording is helping you long term, you are naive.

burnte32• 3 months ago

You encountered bad providers, not bad tools. Don't blame the hammer if you hit your thumb, and don't blame the hammer if someone ELSE hits your thumb.

ygjb• 3 months ago

Not to be antagonistic, but a healthcare CIO in which country? This is very relevant because outside of the US, I think it is probably fair that most people who are most active on HN are from countries with public health care, and stronger consumer protection and privacy laws.

The healthcare outcomes are absolutely critical in evaluating the use and value of these tools, but there are second and third order effects from using the tools that need to be contextualized with the specific motivations of executives endorsing the tools.

burnte32• 3 months ago

Not to be antagonistic, but a healthcare CIO in which country?

USA. I should have said that.

and stronger consumer protection and privacy laws.

No, they may have stricter privacy laws outside of healthcare, but HIPAA is extremely strict and heavily enforced. In 2018 our legal team asked me if we were GDPR compliant if we accepted cash pay clients from Europe. I said from the healthcare side we're already adherent, and the department you'll have problems with is marketing because HIPAA already meets or exceeds GDPR rules. Same for CCPA in California.

I've been the legal Data Security and Privacy Officer in 5 healthcare orgs, I'm more scared of OIG and HHS than I am of the EU.

specific motivations of executives endorsing the tools.

My job doesn't include profit motives, and I'm extremely strict. Privacy and regulatory compliance trumps profit ideas. Yes, this tool absolutely helps us not have to pay for human scribes, but we weren't going to employ them anyway. Human scribes are EXPENSIVE. Usually the alternative was a microcassette recorder, or a digital recorder that produced digital files. Then we'd have to send those files, securely, to a licensed medical transcriptionist, then ensure the recording is destroyer and the transcript comes back, and then the doctor uses that to chart. These tools mean we skip most of that, so it's faster, cheaper, and more secure. It IS good for business, but frankly, so is good patient care.

tengbretson• 3 months ago

Were those surveys performed before or after the patient received the bill?

Getting billed for a "dietary consult" because your doctor may have asked you what you had for lunch due to the coding intensity of these scribes is asinine.

burnte32• 3 months ago

Were those surveys performed before or after the patient received the bill?

In America this doesn't matter, everyone's bills are insane.

Getting billed for a "dietary consult" because your doctor may have asked you what you had for lunch due to the coding intensity of these scribes is asinine.

For what we do it's also illegal. We can only charge for services the patient consents to, and we're obligated through federal and state regulations to provide transparent pricing and estimates, so we couldn't do surprise billing if we wanted to. not that we do! We actually find it better to avoid trying to capture every single procedure code like that because it drives up rejections and thus collection costs. We'd rather bill and collect the straight procedure with no bullshit.

No, the transcript will never result in a bill that is different than the service the provider rendered.

kelnos9• 3 months ago

How have you evaluated the error rate? It's unreasonable to expect that these systems will not commit any errors at all. Have any errors resulted in adverse patient outcomes?

Also consider that these aren't usually just transcription services. They also interpret what the doctor and patient are saying. Presumably they also offer summaries as well.

Unless the doctor immediately reviews the transcript, interpretation, and summary after each visit, and manually corrects any inconsistencies, these sorts of things will just go unnoticed, with incorrect things being a part of a person's permanent medical history.

See a comment below[0] where a joke made by the patient about "doing coke" (as in coca-cola) was interpreted by the AI as "the patient used cocaine recently". That sort of error has horrifying implications. If the doctor didn't catch that, I imagine that note could have all sorts of negative consequences for the patient, including insurance rejections and possible legal action if any of this data leaks.

And it's funny that you say that patients feel more comfortable and like the doctor connects with them more: after people (both patients and doctors) figure out this weakness of these systems, they will have to start self-censoring and speaking in an impersonal, neutral way in order to avoid mistakes like the above.

[0] https://news.ycombinator.com/item?id=47893185

burnte32• 3 months ago

I have, it's a metric I check in on ever month with my providers. It's a few percent, and the exact reason our official policy requires all users (including providers) to check AI output for accuracy. It's heavily enforced by our CMO. We teach our people to think of it like a scribe, and just like with a scribe you need to check it because you're legally on the hook.

m463• 3 months ago

One question I have: can they sell or share your transcripts?

burnte32• 3 months ago

No, they're not even stored. We wouldn't allow it, we don't even allow the data to be used for training.

CyberDildonics• 3 months ago

Saying something is good over and over doesn't mean much without saying why it accomplishes that.

AbstractH242• 3 months ago

Is there a risk this will simply shorten appointment times and increase caseloads in the long term? Leading to doctors being more burnt out and less engaged and making these improvements transient at best?

Feels like historically that’s where every other optimization that reduced a MD’s “busy work” led. Particularly adding more paraprofessionals of various kinds into the patient’s interaction.

varispeed• 3 months ago

I always agree if this is for academic purposes, if it helps with research etc. I can't see why I shouldn't. We are just meat that will expire one day.

xxpor2• 3 months ago

This was extremely unconvincing for me. The site is now 500ing for me, so I can't fully quote it, but the arguments about privacy just fall flat. You don't know about Epic's, or GE's, or Philips' security either. You have to trust the institution of HIPPA et al overall to at least make things right.

I really don't care if my recording becomes training data.

I would rather be spoken to like I'm not an idiot. Use technical terms please. I want precision.

Calling the US healthcare system underfunded might be the most wild part of the whole thing. We spend 5.3 trillion dollars a year. That's 17% of the entire economy.

jll293• 3 months ago

You don't know about Epic's, or GE's, or Philips' security either.

The argument that a new vendor's security is probably not worse than others misses the point that by opting in, there is one more database/vendor/server where sensitive data about you resides, and which eventually will get hacked. It's usually just a question not whether, but when.

For instance, in the UK, on this very day news reported half a million British people's medical data has been offered for sale on Alibaba, the "Chinese E-Bay". Trivial security advice is to "reduce the attack surface", i.e. to reduce the chances of getting hit by reduce one's presence in places where personal data is concentrated (thus making an attractive target for hackers).

For example, when the German healthcare system launched its central electronic patient record, I opted out. One more system that, once hacked, won't have anything on me stored in it.

xxpor2• 3 months ago

For example, when the German healthcare system launched its central electronic patient record, I opted out. One more system that, once hacked, won't have anything on me stored in it.

I'll be sure to say a prayer at your funeral when you died due to an unknown drug interaction because of the lack of knowledge of your medical history in the emergency department of the random city you happen to be traveling through and get in a car accident.

I don't think people are good at estimating tail risks, let alone the 2nd order effects of them. If you opt out of the AI transcription, do you think the doc will spend a bunch of time doing it by hand for free? No, you'll just have a worse record.

impatient_bacon• 3 months ago

Oof yea I just got surprised by this at a vet appointment for my dog, weirded me out. I just went along with it to get the visit over with and I can see the benefit of having an accurate record of the visit, but we'll have to come to terms to the reality of this invasive surveillance as a society at some point I imagine.

dlcarrier2• 3 months ago

I'm more concerned about a record being made in general, than how it is made. If were to be affected by a tragedy and visit a psychologist or psychiatrist to receive support, it would likely require a diagnosis of depression to get insurance coverage, and having that on my record could make it more difficult and costly to legally fly an airplane or own a gun, and who knows what else.

titanomachy• 3 months ago

This is an insane attitude.

Get help if you need it. Having periods of depression on your medical record doesn’t make your life more difficult, unless maybe you’re trying to be a spy or an astronaut or something.

kelnos9• 3 months ago

This is actually a problem with e.g. airline pilots. They'll hide conditions (especially mental health issues) that they know could trigger a suspension or re-evaluation of their ability to fly. Even if those conditions are entirely treatable and wouldn't actually affect their ability to fly during/after treatment.

So your statement is factually incorrect: in some common professions, your medical record can make your life significantly more difficult.

dlcarrier2• 3 months ago

It's insane that anyone should have to have that attitude, but also completely reasonable.

A Germanwings pilot killed himself and everyone on his flight, because he didn't seek treatment for depression, as he was expressly warned that regulations require he lose his job and be banned from his career, for doing so. The regulations intent was to keep suicidal pilots from flying, but in practice its primary effect is to keep suicidal pilots from seeking official care.

The same is true for gun possession in multiple US states, which can preclude those who carry a gun in the line of duty from working in their careers. Air traffic controllers and EMTs are often affected by similar regulations as pilots and officers, too.

There is a significant push in many jurisdictions for stricter health limits on drivers licenses, and we could easily end up with similar regulations there.

the_gipsy• 3 months ago

I live in a country with free public healthcare. In a recent doctor's visit, the doctor was interviewing me while a nurse was typing into the computer. Presumably so that the doctor would have more time to attend patients and so that she wouldn't get distracted.

It's fascinating how this translates to the idea that in the USA, this should mean "more time with patients", but in reality also means "more patients", but is somehow bad because the is a monetary drive.

jimbokun5• 3 months ago

The big AI companies are in deep trouble if the general public ever figures this out.

jrockway• 3 months ago

Doctors have always been into "more patients", though. To some extent, if you're a doctor, the upper bound on your pay is how much you charge * how many patients you see. This is why you occasionally get seen well after your appointment time; people are double booked because some % reliability doesn't show up, but sometimes everyone DOES show up to their appointment and now it's your problem.

So if AI scribes mean "less double booking" then that's kind of a win/win. Less patient time is wasted. Doctors can make more money by seeing more people on a given day. Seems fair.

kelnos9• 3 months ago

That's not how it works, though. People/companies that find efficiency gains don't sit back and relax the rest of the time. They do more work with the extra time they have.

So in your example, they'll continue to double-book, and reduce the total time spent with each patient (since they can be more efficient with each patient) and book more patients per day.

cromka2• 3 months ago

This is seriously a good example of a domain that should enforce on-premises AI. Doctors absolutely can afford to buy an NVIDIA workstation. Transcribing text is not exactly super demanding, comparatively speaking. When did we even stop considering non-cloud services? If AI boomed 10 years ago, we wouldn't even be discussing this.

Matumio• 3 months ago

I know some European "automatic scribe" projects of the government sector. Their IT buys a physical GPU server hosted locally. Pretty sure it wouldn't be accepted otherwise (or maybe I'm just naive, but it sure is a topic they care about). The software stack is mostly open source, I think. It sure as hell doesn't talk to a big American cloud provider. (Well, the transcription service doesn't. Who knows what they do with the automated transcript. Probably the same thing they did with the manual transcript.)

ButlerianJihad2• 3 months ago

Physicians, like lawyers, may still understand enough Latin to know what "invidia" means, and therefore never touch that crap with a ten-foot-pole.

https://en.wiktionary.org/wiki/invidia#Latin

Sent from my Chromebook with Intel® iRIS® Xe Graphics

quantumwoke3• 3 months ago

It's not just transcribing text, there is also a post processing step to turn it from an interview transcript into an actionable summary.

daedrdev• 3 months ago

HIPPA exists and has a lot of teeth. Given this extensive liability, I trust that if anything does go wrong they will be punished. Recordings might dramatically improve patient outcomes, and so I will let them

bonsai_spool4• 3 months ago

HIPPA does not exist.

HIPAA has laughably vague rules. It's not protecting much, and you probably have better protection through tort law wrt your private information.

parliament323• 3 months ago

HIPAA enforces nothing other than a pinky-swear-promise of compliance. There are hundreds, if not thousands, of middlemen who sell SaaS like this to medical professionals. If one suffers a breach then shuts down, your doctor will just switch to the next one in line with no consequences because "they promised they were compliant". Meanwhile all your medical details will end up in a public dataset forevermore.

carefulfungi3• 3 months ago

Until you need insurance. Or a professional license that involves a review of your medical record. Or the government just wants the data. Or the records are subpoenaed to be used against you in court. You are trusting that illegitimate uses of this data will be punished. However, there are many authorized uses that will hurt you in the long term. It is rarely to your advantage to accumulate extensive recorded medical records.

Even pre-existing insurance denials could return in the US.

Don't let systems record what they don't need. They aren't your friend.

jimt12342• 3 months ago

This situation is real. I've had the same doctor my entire adult life (~25 years). We've got a pretty informal relationship. I even saw her hammered at a bar one night, and had to give her a ride home because her friends were also drunk AF. Anyway, a few years ago, during an annual checkup, she asked how my family was doing and I made a joke about my brother drinking too much. A few weeks later I started receiving pamphlets in the mail about treating alcoholism, ads for rehab centers. I just brushed it off, didn't make any connection. Then, the next year, during my annual checkup, my doctor wasn't available, so I got a different doctor, someone I'd never talked to in my life. She immediately started asking me about my drinking. I fired back, asking WTF she was talking about. She said, "Oh, well your file says alcoholism runs in your family.", and then started lecturing me about getting over the shame of alcoholism is the first step to beating it. I don't even drink. No one in my family drinks other than my brother. He was drinking a lot at that time because he favorite NFL team (LA Rams) was doing really well, and he was celebrating a lot. And it was just a joke.

The next year, during my annual checkup, I gave my doctor a load of crap, telling her to record nothing I say unless I explicitly tell her to. She tried to defend the system, but she agreed. I'm still upset that my "file" still mentions alcoholism.

jll293• 3 months ago

"Oh, well your file says alcoholism runs in your family."

Medics often use private notes when handing over patients, where they share information that the patients themselves are not intended to see (and in many countries, not permitted to see). In particular, such records are used to share warnings if patients have been in any way "difficult".

OutOfHere• 3 months ago

Why do we even need to consult doctors anymore? Just let the AI decide. Docs should be freed up for up for doing physical tests and interventions, or otherwise for providing more training data for the AI in cases where the AI isn't producing results or when a second look is urgently needed in an emergency situation.

pavel_lishin• 3 months ago

Down for me, but Internet Archive grabbed a copy: https://web.archive.org/web/20260424151739/https://buttondow...

jll293• 3 months ago

Advice: Regardless of whether you opt in or out, you should only permit anyone to record you if you get a copy of the recording for your own records.

jcalvinowens• 3 months ago

Honestly, my recent experience with this was really positive: the doctor actually said the technical stuff out loud to me for the first time in my life, in a way I could easily ask polite questions about and discuss with them.

In my case it was something very not sensitive, removing a benign tumor in a finger, which I have no problem telling the whole world about (I was awake for the surgery and got to watch, it was a incredibly fascinating experience that I want to write more about some day).

But I can imagine it would feel much more invasive if the subject were more sensitive.

tristanb• 3 months ago

This is a really great way to get yourself worse care.

gitowiec• 3 months ago

What a fucking absurd. I used to go to the shrink a lot. First it was a man, he never took any notes and he remembered everything. Second was a woman, she was taking notes but never had any problems with that!

moralestapia• 3 months ago

Lol, this essay is missing (or starting from the assumption) that text-to-speech algorithms do a good work, even state of the art.

That is far from correct and the main reason why I would oppose to this is that the AI might incorrectly record something in the transcript that completely derails my diagnosis and treatment.

There's a big difference between:

"I have had nausea for the past three days"

and

"I have not had nausea for the past three days"

And I'm being generous with my example.

apparent2• 3 months ago

But, especially given the underfunded nature of the US health system, that is extremely unlikely to mean more time with each patient. Instead, it will mean more patients.

So that means if I try to make an appt, I'll have an easier time getting one? Sounds good, I guess.

0xbadcafebee• 3 months ago

I think this is just humans not understanding things and irrationally being afraid of one thing more than another thing. You're afraid of someone listening to you; you're not afraid of someone copying the documents that detail every single aspect of your health (EHR records).

Healthcare records are probably the most strongly protected personal information in the world. Remember that most of the data about you is not protected by law. Credit reports, ISP records (including your SS#), your entire email archive, Google Drive, etc could get leaked, and for the most part there's no legal consequence. But if a record of you having the flu in 3rd grade gets leaked by a 3rd party connected to health record keeping, there are real consequences (not only for the leak, but even for not reporting it).

If anything, I want everything I say to be recorded and kept on file for later reference. The danger of speech-to-text engine transcribing incorrectly is real, but that doesn't mean I don't want the notes there. I just want the audio included with the text. Both will be useful to refer to later on, especially as STT models improve their accuracy (we've seen amazing leaps in accuracy in just 1 year).

However, we do need to ensure that these records are protected from government over-reach. Currently the government can request your health records, without notifying you, for a slew of reasons. This enables the government to go on a fishing expedition, doing the equivalent of an unreasonable search of private information, and you will have no notification and no way to respond. We must create laws that provide stronger privacy rights for sensitive health information to resist government overreach. Another legal hole is 3rd party apps that collect sensitive health information, but aren't provided by your doctor. Your step-tracking, heart-monitoring app is not protected by HIPAA. Same for employer health records.

dawnerd• 3 months ago

I have been loving my new doctors recording and making everything available in the patient portal. No more trying to remember what they said. That’s huge, especially when dealing with elderly patients and being able to have their caregivers have access to it.

rolph• 3 months ago

a premptive notification to health care team.

"to whom may be concerned."

[Doctor Stan dinghere, as a patient i have no trust or confidence regarding the security and integrity of my personal information in regards to AI scribing.

for this reason i will scribe for you, as that is the most accurate account of what i intend to communicate with you.

i will refrain from verbal communication and will provide on the spot written communication with respect to health care interaction. ]

croisillon• 3 months ago

my boss fell in love with a software that invites itself to team calls, then retranscripts and summarizes... so the whole office has that automatically in ; once in a while my colleagues and i look into that report, it's sometimes hilariously wrong, most of the times just useless

ivraatiems• 3 months ago

It's definitely NOT a false promise of efficiency, at least, not in all or many cases.

My wife is a physician, and when permitted by patients, uses one of these tools. It's been an enormous time-saver for her. She works a 32-hour week, meaning 32 hours of seeing patients. Before these tools, she was regularly spending an extra 8 to 16 hours, e. g. two full work days, writing notes and sending messages. That time has been more than cut in half. She would never give up the tool if she didn't have a choice.

According to her, it is reasonably accurate, but all notes must be manually reviewed (not just as in her organization requires that, but also as in if she didn't, it would be obvious due to its mistakes). The biggest issue is with things like names and medications, stuff that isn't present in ordinary English, as well as mishearing the results of diagnostic tests, numbers, etc.

It's rare for patients to refuse it.

16bytes2• 3 months ago

This is absolutely horrible advice. If you do this you will over time experience worse health care.

Documentation errors have always been an issue. They were when there were paper charts, or human transcriptionists, or when manually typing into the EMR, or when using speech recognition (which is AI/ML!) to do the typing for you.

Not all e-scribes use LLMs, but most of them do rely on ambient audio recordings for speech recognition, which nowadays runs entirely locally. That text then needs to be processed into your clinical documentation, and there are tons of ways to do that (including LLM processing).

The author has obviously never talked to clinicians or hospital administrators about the challenges of maintaining clinical documentation, and knows little to nothing about the reality of software that runs in clinical contexts.

randusername• 3 months ago

In the US the purpose of the portal and all the typing and record-keeping is insurance justification and liability.

This is probably not the reassurance anyone wanted to hear if they were worried about crap transcriptions leading to crap care.

This is my absolute least favorite category of AI innovations: people patting themselves on the back for becoming more efficient in their inefficiency.

ares623• 3 months ago

Can you say "No thank you. But can I record this conversation myself?"

hoherd• 3 months ago

Just today Claude admitted to me that it may have hallucinated a detail in a response when I asked about it. Do you want that possibility in your medical record?

AbstractH242• 3 months ago

There’s only one speciality i mind the use of AI - psychotherapy.

In that case, I’m paying them to engage with and observe me. Not to identify the correct treatment plan based on a variety of different data points (tests, my history, family history, research, etc)

And even in psychotherapy I have no problem with a LLM being used to compile notes after the session. Just don’t want it present in the session and used for analyzing it.

(My therapist asks me almost once a month if I’d mind. I thought it was because my notetaker is entering the Zoom meeting, but last week I called him out cause I was almost certain I disabled it. Curious if he’ll ask again.)

Refuse to let your doctor record you

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