Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit?
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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 Great article. The privacy of my protected health information is my immediate concern. There are many ways it can and does leak. It’s not the provider’s fault, it is in the whole chain of info systems backing them up. Using an LLM multiplies the risk. Training data is EXTREMELY valuable. There is no way the recording or transcript are getting deleted. It’s getting sold. The incentives are all wrong to ensure HIPAA compliance.
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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 by a couple of specialists who it has taken a lot of time/money to get in to see, so I've felt almost coerced into agreeing as I didn't want to risk them declining to see me so I consented against my better judgement.
Do you think there are other ways we can fight this outside of directly declining consent in these situations? One of the providers I see who has been using one for ~2 years now is the only person I've been able to see locally who can prescribe a tightly controlled medication, so I'm quite reluctant to risk the (tenuous) relationship I have established (I already don't feel like I can be completely open and honest with her, and fear what may happen if I decline the use of the scribe).
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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)
Refuse! Don't do the doctor's job of taking notes, let alone support their choice to have AI transcribe notes for them. The accuracy rate is poor, but incorrect notes would still be used to treat you.
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@emilymbender Yes. I think this is becoming quite common. Medical groups are providing this service through enterprise-wide medical information systems. I was grateful to be asked. I’ll just add that doctors do not like lectures from patients.
@meltedcheese given my frankly dreadful and queerphobic/allistic centric medical experience in the supposedly 'better' NHS in the UK - I don't care for doctor's fee-fees about being 'lectured'.
At least 2-3 cases in my life where doctor's egos over a patient daring to contradict them cos 'I'm the trained medical professional here' has meant they refused to accept something that down the line was proven scientifically to be 100% correct.
Like my NCGS, apparently all in my head...until someone did a double blind study and it was grudging acceptance that I wasn't lying about my gluten issues...they totally missed my neurodivergence even with me being taken as a child to the GP with classic issues over hyperfocus and not hearing my parents. Putting me on child doses of my inhaler as an adult cos I argued over them removing steroidal drugs from repeats without asking.
Have been gaslit by other doctors over THEIR COLLEAGUES diagnoses as well.
So yeah...fuck them. Lectures kept me alive so far. Do not trust.
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@meltedcheese Nowhere am I suggesting that patients lecture their doctors, though?
This information can help patients make decisions for themselves about this. If consent is being requested (as it should be), then 'no' is a complete sentence.
@emilymbender Agreed. I’m sorry that I miscommunicated. => I am the one who “lectured” and only because AI is my area of deep expertise. If I can convince a doctor or two to at least ask the right questions and consult with other doctors before simply accepting the use of LLM technology, that’s a good thing. Patients should have the info, as you say, to make their own decisions.
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@meltedcheese given my frankly dreadful and queerphobic/allistic centric medical experience in the supposedly 'better' NHS in the UK - I don't care for doctor's fee-fees about being 'lectured'.
At least 2-3 cases in my life where doctor's egos over a patient daring to contradict them cos 'I'm the trained medical professional here' has meant they refused to accept something that down the line was proven scientifically to be 100% correct.
Like my NCGS, apparently all in my head...until someone did a double blind study and it was grudging acceptance that I wasn't lying about my gluten issues...they totally missed my neurodivergence even with me being taken as a child to the GP with classic issues over hyperfocus and not hearing my parents. Putting me on child doses of my inhaler as an adult cos I argued over them removing steroidal drugs from repeats without asking.
Have been gaslit by other doctors over THEIR COLLEAGUES diagnoses as well.
So yeah...fuck them. Lectures kept me alive so far. Do not trust.
@radioclash You are a good example of being your own best advocate. Good health to you.
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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've been asked multiple times, and I always chicken out when they ask and say yes, I think it's the power imbalance, and I don't think it's fair.
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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 have been asked multiple times by medical providers this year if I would consent to AI transcription, and I have said no every time. I'm tempted to ask next time if they have information from an independent audit of the system performance and privacy policy
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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've spotted medically significant errors in the transcription during the session. It's galling.
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@BoydStephenSmithJr @emilymbender Brought to you by the Consently(TM) platform
@crowbriarhexe @emilymbender SimplePractice actually, but close enough. It is widely used, and I don't know if this is a problem with the system in general or if it is a misconfiguration by this particular practice.
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@deborahh @emilymbender I just forwarded this article to my doctors office. Hopefully those using it will read it.
@JoBlakely @emilymbender good idea. I bookmarked it.
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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@dair-community.social I had to bring my cat to the 24 hour emergency vet hospital recently (he's okay now!!) and they had this.
What was somewhat galling was that I was not directly asked; instead, there was a sign in the exam room informing us that the vets would be using "AI transcription" and that we could 'opt out'. When the on call vet came in he mentioned that he'd need to get his phone before we started. I asked if it was to use the "AI transcription", to which he said yes and I said I wasn't okay with that.
Bad enough at the doctors (and I'm already worried I've somehow auto opted in to it when using virtual appointments), but the freaking emergency vet???... -
@jlouiseau @emilymbender exactly
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@emilymbender@dair-community.social see that block buttton? FUCKING USE IT THEN, SELF-IMPORTANT SHINY LIGHTS ON A SCREEN!
@the_turtle Tell me you're a dude without telling me you're a dude. Sheesh.
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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 My provider always asks and always said that the days "doesn't leave our server." Are there really transcription/summarizing AIs that are completely local?
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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 Thanks for the write-up! How do you feel about human scribes? I've been saying "yes to human scribes, no to AI scribes" for a while now, but your list makes me realize a lot of the concerns apply there, too.
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@emilymbender @rbmath Within the last few months I've been asked for consent to care, and consent to record. At the time, I assumed "record" meant saving the audio for reference when writing up notes... now I'm going to have to specifically ask what "record" means, if data is transmitted, what happens to the recording, etc.
I *might* be okay with automated transcription if it's done locally but no guarantee of that.
Should have been more vigilant.
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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 do share a lot of AI skepticism, but physician perspective (I use it about 25-30% of visits), there are many highly speculative aspects of this take:
🧵 1/5
1) Point #1 is valid, however, the same data safety questions can be asked regarding other integrated systems. Like where is your EMR data stored, how does your radiology data integrate (reviewed in 3rd party software), etc.
2) Consent: valid concern, but the fullest version would be a long EULA-like text with a checkbox... -
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 my visit notes for one doctor said that I verbally consented to having the appointment recorded. I did not, nor was I ever asked. Not happy about that.
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@emilymbender I do share a lot of AI skepticism, but physician perspective (I use it about 25-30% of visits), there are many highly speculative aspects of this take:
🧵 1/5
1) Point #1 is valid, however, the same data safety questions can be asked regarding other integrated systems. Like where is your EMR data stored, how does your radiology data integrate (reviewed in 3rd party software), etc.
2) Consent: valid concern, but the fullest version would be a long EULA-like text with a checkbox...@emilymbender
🧵 2/5... so more text doesn't equate w/ being more informed. Also, consent is revokable, the recording can be stopped and deleted before it gets processed.3) i discuss life/death stuff w/ patients. It has no more effect than having students around. if i find the topic sensitive, or the patient seems uncomfortable I pause/stop the recording.
4) I spend a lot of time trying to remember discussions if notes aren't closed same day (impossible..). It's more accurate to fix errors..
