Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit?
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@EverydayMoggie @emilymbender That…would honestly scare me more than the initial request, I think. How are you a medical provider and you don’t know what happens when a patient refuses to consent??
@WhiteCatTamer @EverydayMoggie @emilymbender In California, if you refuse, they are legally obligated not to record. California is a two-party consent state. You cannot record anyone's voice for any reason without their consent.
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Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit? Us, too. And we have **thoughts**
Why you should refuse to let your doctor record you
By: Emily M. Bender and Decca Muldowney At a recent appointment, Emily’s physical therapist (who knows some about her research) said, “Before we get started,...
(buttondown.com)
Yes, and of course said no.
But then I discovered they used AI transcribing when adding notes to my journal, after the meetings, as it was full of obvious errors. So needed to lecture them again about my right it is not used on my medical record.
What makes this even worse is that they all know how bad it works, as it is frequently reported in media about complaints from the medical community about horrific errors, as well as inefficiency this overhyped piece of crap creates.
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Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit? Us, too. And we have **thoughts**
Why you should refuse to let your doctor record you
By: Emily M. Bender and Decca Muldowney At a recent appointment, Emily’s physical therapist (who knows some about her research) said, “Before we get started,...
(buttondown.com)
@emilymbender Agree. GPs are low availability now, saying no to this means being viewed as difficult, maybe ejected from patient roster. So you can't really say no.
Also in two visits where reports were prepped from specialists, there were errors from AI transcription mishearing that I think a human would not have made (age cited quite differently in different paragraphs, a operation claimed as had which was spoken as DID NOT have, etc) Correction required my time, effort, Dr disfavor 🫤 -
@emilymbender "he fullest version would be too long, so we're not actually doing informed consent?"
No, that is not what is being said there. Unlike a blog post, I am restricted in space. I explicitly said that is is a valid concern. A basic research consent form is 8+ pages of legalese and I'm afraid that the future solution will be to add it as a checkbox for 30 pages of text at check-in that nobody reads and doesn't actually inform better. And again, my point #1.
@P__X You are not restricted in space -- you wrote a whole thread.
My point is: if patients do not know what they are consenting to, it is not consent. If it is not possible in the context of the visit to convey the detail, then we shouldn't do the thing.
I encourage you to read the rest of the replies to my post, including the quotes, to see the lack of consent and how that is landing.
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Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit? Us, too. And we have **thoughts**
Why you should refuse to let your doctor record you
By: Emily M. Bender and Decca Muldowney At a recent appointment, Emily’s physical therapist (who knows some about her research) said, “Before we get started,...
(buttondown.com)
1. At my last vet visit, there was a small typed notice across the exam room from the person/animal seating area that said AI is now being used by the practice for all visits, and to assume that if staff are in the room, recording is happening.
2. At my last primary provider visit, I asked the medical assistant if AI was being used, and if she could opt me out. She agreed.
When the PA came into the exam room, her first words were that I needed to prioritize my questions/issues, as she would only be able to deal with two, since she would have to manually chart the whole visit.
(I had come hoping for a prescription refill and two referrals for specialist care.) -
@emilymbender I've noticed a lot of this use in veterinary medicine recently as well, just FYI.
@rbmath @emilymbender I have noticed this too, at my local vet. They have signs at the front desk and in all the rooms about it and letting people know they can opt out. One of the problems is how people tend to react when you say you want to opt out.
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@BoydStephenSmithJr That ... isn't really consent.
@emilymbender @BoydStephenSmithJr i actively refuse to go to a local provider chain because of the Terms of their EHR software. It basically kept the right to do what it wanted with data.
I always think of how few people would care enough to do that level of reading as well as have the education to catch the nuance and resources to choose another practice.
That is not to shame anyone! It is asking a lot of an individual to do that
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Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit? Us, too. And we have **thoughts**
Why you should refuse to let your doctor record you
By: Emily M. Bender and Decca Muldowney At a recent appointment, Emily’s physical therapist (who knows some about her research) said, “Before we get started,...
(buttondown.com)
@emilymbender i wrote a note to my medical clinic addressing similar concerns when i saw the ai sign in the office but i have medical anxiety and didn't feel up to addressing it at the time. the passive sign assumed consent. the office assistant replied and said they could put a permanent note on my chart that i did not consent to the ai scribe.
then the next time my doctor called, he acted like his feelings were hurt and he had thought i would have told him to his face, and then made me feel guilty about refusing the ai assistant due to his workload. now i'm feeling hesitant to see him even though he's my new doctor that i liked
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@randocity @emilymbender I am in zcanada. No HIPAa, but we do tend to go where the US goes on a lot of things.
@commonst @randocity @emilymbender
Very definitely happening in Canada, too. Speech-to-text is not new, particularly in specialties like radiology, but until recently, those systems which had to be individually trained to each voice and pre-loaded with context and lexicon, were limited to clinician dictation.
At least my last specialist asked, identified that it was “AI” and purely for transcription, not summary or diagnostics. But I’m worried.
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Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit? Us, too. And we have **thoughts**
Why you should refuse to let your doctor record you
By: Emily M. Bender and Decca Muldowney At a recent appointment, Emily’s physical therapist (who knows some about her research) said, “Before we get started,...
(buttondown.com)
That would have been useful to know last week. They totally deceived me, and said they were just recording the conversation. -
@emilymbender
Evidence shows litigation decrease if Drs have scribes. A Dr isn’t allowed to remember things in defence. It’s said “If it is not documented, it didn’t happen” even if it did happen & recall can be verified.The direct effect:
1: more litigation = more insurance cost for the Dr & thus higher consult fees.
2: Drs who have psychological & emotional injury from spurious claims reduce/stop practice.So there is high motivation for having a scribe.
As some others pointed out - that evidence is based on recorded encounters being transcribed by humans, or possibly by non-AI speech-to-text.
Nobody has yet studied the resulting practice effects of AI/LLM-based interpretation. Recording, transcription, and interpretation are separate realms and skill sets and “AI” is either unnecessary or unproven in all 3.
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Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit? Us, too. And we have **thoughts**
Why you should refuse to let your doctor record you
By: Emily M. Bender and Decca Muldowney At a recent appointment, Emily’s physical therapist (who knows some about her research) said, “Before we get started,...
(buttondown.com)
@emilymbender @DevlinLeathercraft The orthopedic surgeon who will be taking care of my trigger thumb asked to record our last session. I can't remember whether I asked him if an AI was going to transcribe it, but I will next time.
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@WhiteCatTamer @EverydayMoggie @emilymbender In California, if you refuse, they are legally obligated not to record. California is a two-party consent state. You cannot record anyone's voice for any reason without their consent.
@EverydayMoggie @starluna @WhiteCatTamer @emilymbender enter smart glasses disruption
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@emilymbender My biggest concern is the potential for psychiatric violence. Inaccurate medical notes produced by these systems could very easily be used as evidence of psychosis or some other kind of psychopathology, leading to forced medical treatment. Having already experienced some of that system, it really worries me. I don’t let medical providers use these systems with me.
I just read (in a JAMA newsletter, I'll try to track it down -- it's not in my email or trash) about a Doctor who as been an early adapter. He did it "right", going over the notes in the evening to clean up the errors in transcription.
He found:
1) He could just focus on the patient, rather then the screen.
2) He got off track and was less focused, and spent more time with the patients without providing better information.
3) Most importantly, when someone came back 6 months later for a follow up, he realized that the notes were not that good. Accurate, but without insight -- they read like someone else had written them and did not help him recall what was going on. -
I just read (in a JAMA newsletter, I'll try to track it down -- it's not in my email or trash) about a Doctor who as been an early adapter. He did it "right", going over the notes in the evening to clean up the errors in transcription.
He found:
1) He could just focus on the patient, rather then the screen.
2) He got off track and was less focused, and spent more time with the patients without providing better information.
3) Most importantly, when someone came back 6 months later for a follow up, he realized that the notes were not that good. Accurate, but without insight -- they read like someone else had written them and did not help him recall what was going on. -
@M3L155A @meltedcheese @emilymbender For clarification, when I say that insurers aren’t deriving benefits from AI directly, I mean specifically the AI that’s being used in doctors offices, learning from patient recordings.
It is very possible, however, that insurance companies are using AI in their own internal systems, but those AI systems are entirely separate from AI used in doctor’s office patient systems.
@randocity @M3L155A @emilymbender For now, they are separate. What could possibly go wrong if they become part of automating the workflow between providers and insurance com? Quite a bit from the patients POV.
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That's it! Thanks, and clearly you've already seen it. And I miss remembered where I saw it.
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I've just passed your paper and Dr Gooch's along to the most recent Dr to ask me about using an AI scribe. Give them some heads up, as well as data when responding to management.
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@EverydayMoggie @starluna @WhiteCatTamer @emilymbender enter smart glasses disruption
I didn't notice any visible recording devices in the office. At the time I assumed this meant the recording capability was just software running on their existing medical computers, which would mean there was no simple way to see if it was recording you or not.
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I didn't notice any visible recording devices in the office. At the time I assumed this meant the recording capability was just software running on their existing medical computers, which would mean there was no simple way to see if it was recording you or not.
@EverydayMoggie @Kierkegaanks @WhiteCatTamer @emilymbender That is definitely what makes all of these tools problematic. I would like to believe that somebody in risk management has raised this flag, at least for the California medical facilities, but so many of those people are also captured by the AI hype that they've lost all of their critical faculties.
