Have you been asked by a medical provider recently for consent to have an "AI" scribe record your visit?
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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.
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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 i was a declined. when she asked, i said because
1. the companies used sites with CSAM and other abuses
2. it’s 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
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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 opted out at my physical therapist last week. They told me all their patients who work in tech have opted out.
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@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….@kimgadsdon @emilymbender I'm so sorry about Sydney's passing. I lost my Yorkie, Penelope, in 2024 so I know the wonderful joy that a Yorkie provides and the seemingly unbearable loss when they're gone.
I hope the happy memories give you a bit of comfort.
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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
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.
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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 Really helpful. Thanks for sharing.
I often reason about it this way. There are very few things like this where, if you opt out this time, you can’t opt in next time. On the other hand, there are LOTS of situations, this being a good example, where opting out after you opted in is substantially more effort (or even impossible).
Opting out by default is usually a safe thing to do. You can always opt in later if you change your mind.
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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 multiple times in fact. And I hate it.
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Yep. And I said no. She initially said not to worry because it's all deleted afterwards. I said that, no, it is not. That's not how LLM's work. All that data remains in there somewhere and can be hacked, plus I don't want anything about me used to train those things on principal. She didn't argue.
@Mikal @emilymbender
It's pinky promised by LLM vendors to the healthIT vendors selling to hospitals that data sent to their servers for the purpose of LLM input is not retained or used outside of inference.HealthIT vendors are then happy to believe this at face value so they can sell AI hype to hospital execs desperate to force their clinicians to shove more patients through at any cost and slash labor costs.
Docs are told it's fine by IT who was told it's fine by the CIO who was told...
