Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit?
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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..
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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 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, Emily’s physical therapist (who knows some about her research) said, “Before we get started,...
(buttondown.com)
@emilymbender Usually I ask my doctor to turn that off.
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@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..
@emilymbender 🧵 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 🧵 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, it’s likely to get to the point that it’s too much of a hassle to ask and they stop asking. They’ll 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 naïve. Medical providers, and the medical industry in general, are notoriously the worst at being informed about tech; worse than any industry short of lawyers. That’s 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 🧵 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. 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.
@meltedcheese @emilymbender It’s very likely this feature was introduced into the medical office patient management software. It’s 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, Emily’s physical therapist (who knows some about her research) said, “Before 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
I’m 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, it’s likely to get to the point that it’s too much of a hassle to ask and they stop asking. They’ll 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, Emily’s physical therapist (who knows some about her research) said, “Before we get started,...
(buttondown.com)
@emilymbender Yes, I was asked to sign a consent (stuck in with the other standard consents) authorizing the doctor’s 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
I’ve suspected this at the vet office, too. At first, they asked (and I declined). Then at subsequent visits they didn’t ask, but I could see the waves jumping on their monitor which made me wonder….
Anyway, our sweet Sydney passed this week so that won’t be an issue anymore….
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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 (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.
