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, Emilyâs physical therapist (who knows some about her research) said, âBefore 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:
𧔠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, Emilyâs physical therapist (who knows some about her research) said, âBefore 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:
𧔠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
𧔠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..
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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, Emilyâs physical therapist (who knows some about her research) said, âBefore we get started,...
(buttondown.com)
@emilymbender I tried to subscribe to that newsletter and it said "this e-mail address can not be subscribed" Why does it not like my email address?
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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, Emilyâs physical therapist (who knows some about her research) said, âBefore we get started,...
(buttondown.com)
@emilymbender Usually I ask my doctor to turn that off.
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@emilymbender
𧔠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..
@emilymbender 𧔠3/5 ...than remembering 3-4 days later. I often use the transcript and not the AI summary, like for my dictated exam where the AI does a consistently subpar job.
For the primary problem I rarely use any text from the AI assessment. I only use it as a 2ndry check to make sure documented/took care of everything I needed to.
5) The AI scribe doesn't impact how I talk, except for me dictating my exam for the transcript, which patients tend to like as they "hear" what I see...
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@emilymbender 𧔠3/5 ...than remembering 3-4 days later. I often use the transcript and not the AI summary, like for my dictated exam where the AI does a consistently subpar job.
For the primary problem I rarely use any text from the AI assessment. I only use it as a 2ndry check to make sure documented/took care of everything I needed to.
5) The AI scribe doesn't impact how I talk, except for me dictating my exam for the transcript, which patients tend to like as they "hear" what I see...
@emilymbender 4/5
6) most of my patients have speech disturbances and I have a bit of an accent. Model just does fine.
7) It IS more efficient if used for more complex visits. If I used it for all visits, it would be a net negative on efficiency.
Charting is part of care, yes, but what I tell my trainees: "He/she never spent time with his kids....but they wrote wonderful notes" said nobody ever on anybody's eulogy. -
I will walk out if they insist. And file a complaint with whatever their institution's management is.
@Mikal @jrdepriest @emilymbender Unfortunately, itâs likely to get to the point that itâs too much of a hassle to ask and they stop asking. Theyâll simply collect it without your knowledge or consent.
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@emilymbender there are signs at the doctor's offoce saying you can refuse, but when I did I got a lecture on how this helps, and acting like I had no clue what I was talking about. I mentioned I worked in tech and it was dismissed. As I am in an area with few doctors accepting new patients at the moment.... how do I really refuse?
My therapist asked for permission, I declined, and after my session we got into a long conversation about why. At least they were curious about it.
@commonst @emilymbender Medical providers are one to point fingers at patients for being tech naĂŻve. Medical providers, and the medical industry in general, are notoriously the worst at being informed about tech; worse than any industry short of lawyers. Thatâs actually why HIPAA exists.
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@emilymbender 4/5
6) most of my patients have speech disturbances and I have a bit of an accent. Model just does fine.
7) It IS more efficient if used for more complex visits. If I used it for all visits, it would be a net negative on efficiency.
Charting is part of care, yes, but what I tell my trainees: "He/she never spent time with his kids....but they wrote wonderful notes" said nobody ever on anybody's eulogy.@emilymbender 𧔠5/5
9) I usually spend ~75-90 min w/ a patient at a 1st visit. It's hard for most people to remember a convo like that. Being able to print them a summary at is very helpful and a net plus that improves care. There are alternative ways but most less efficient.
10) Visit slots have long been allotted w/ after hours documentation in mind, so it would take a revamp on the RVU system for that to yield higher clinical loads. Providers tend to ran on max anyway.
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@emilymbender Agreed. Iâm sorry that I miscommunicated. => I am the one who âlecturedâ 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, thatâs a good thing. Patients should have the info, as you say, to make their own decisions.
@meltedcheese @emilymbender Itâs very likely this feature was introduced into the medical office patient management software. Itâs likely being pushed hard by the developers. It might even offer a kickback scenario for the doctors who record the most. Doctors are not going to argue with free money, but they will argue with patients if they stand to lose that kickback money.
This suggests a deeper journalistic dive into that patient mgmt. software might be justified.
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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, Emilyâs physical therapist (who knows some about her research) said, âBefore we get started,...
(buttondown.com)
@emilymbender Im fortunate my gp doesn't even trust the national health database.
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@anne_twain @emilymbender I agree, but I imagine it will limit their liability if something happens to my data, intended or not.
I was too "invested" / tired to resist. I don't have an excuse. I will try to do better.
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@DrSarahHolstein @emilymbender
Iâm going to have to start asking. Ugh. -
@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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@Mikal @jrdepriest @emilymbender Unfortunately, itâs likely to get to the point that itâs too much of a hassle to ask and they stop asking. Theyâll simply collect it without your knowledge or consent.
@randocity @jrdepriest @emilymbender
I think that kind of depends on things like state laws. California for example is a two party consent state so I think recording someone without asking might actually be a criminal offense. Plus they have to have some sort of device and that is likely to be visible. Either way, I think that's why we need to push back immediately and make sure they understand that this is not acceptable.
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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, Emilyâs physical therapist (who knows some about her research) said, âBefore we get started,...
(buttondown.com)
@emilymbender Yes, I was asked to sign a consent (stuck in with the other standard consents) authorizing the doctorâs practice to use an AI scribe. I left the room, went up to the front desk and told them I would not sign the consent under any circumstances. They looked a little surprised, but agreed to have one of the techs act as a scribe as normal. Glad I stood my ground - there is no way in Hell I would let a Doc use AI for anything medical related
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@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.
@wwahammy @emilymbender
Iâve suspected this at the vet office, too. At first, they asked (and I declined). Then at subsequent visits they didnât ask, but I could see the waves jumping on their monitor which made me wonderâŠ.
Anyway, our sweet Sydney passed this week so that wonât be an issue anymoreâŠ.
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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, Emilyâs physical therapist (who knows some about her research) said, âBefore we get started,...
(buttondown.com)
@emilymbender
My (now former) therapist sprang this on me.Your points about the note taking being part of the care rang very true. Also, the what might be missed.
It also changed the interaction significantly. I was not overly concerned about the privacy of the contents, but the pauses where the therapist had to think for a moment and write notes gave me a quiet space and time to think. That disappeared.
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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, Emilyâs physical therapist (who knows some about her research) said, âBefore we get started,...
(buttondown.com)
yes i was a declined. when she asked, i said because
1. the companies used sites with CSAM and other abuses
2. itâs spyware. each prompt acts like a honey-pot. since you are giving them the info, it by-passes HIPPA. in turn they get to use and sell that info however they please
3. as an antifascist activist, it puts my life in danger by giving companies ran by fascists access to my whole medical history.
my MD was shocked. they had no idea about the spyware angle or CSAM
