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.

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.

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.

> 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.

"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.

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.