When I worked in a hospital the nurses had to chart, writing detailed notes about patient care and vital signs into each patient’s record. These charts served two purposes: first was a history of patient care for their doctor to read. Second was a record of care for the billing office to charge. The nurses hated it. It was a tedious part of the nurse’s job. For their part, doctors too had to record their interactions with patients. Most had small dictation machines (micro-cassette recorders) they would use to capture their thoughts for an office clerk to later transcribe. Writing at The New York Times, Dr. Helen Ouyang describes how the process has changed, and possibly not for the better.
Nowadays programs called A.I. scribe record patient encounters in the background and passively create a concise record of the patient visit. All the doctor has to do is proofread the account and correct any errors. Past research has found that about one-third of transcriptions have some type of errors, which is to be expected when patients mumble, and their thoughts are not well organized. Dr. Ouyang describes initial feelings of relief about not having to sit down and attempt to recall everything that was said. She describes the reduction in stress to have a report that just requires proofing. Perhaps an AI scribe would alleviate the need for doctors to have their face buried in a laptop while discussing conditions with their patients. Dr. Ouyang had this to say:
So, when the hospital where I work as an E.R. doctor debuted artificial-intelligence assistants — they listen in the background through our phones as we meet with patients, then churn out polished, in-depth notes — I was eager to try them out. I had already heard about their potential, having spoken a couple of years earlier to the chief executive of a leading A.I. medical-scribe company. As he described his product, I imagined the doctor I would become: a better, more attentive healer, someone able to unhurriedly devote more time to patients at their bedsides instead of furiously typing at her computer. (Selfishly, I also envisioned improved interactions with my own physician, whom I see once a year, always with her eyes glued to her screen as her fingers click away on a keyboard.)
Then she came to the realization that transitioning from carefully listening physicians to passive proofreader changes the way doctors think about their patients’ conditions. Patient encounters do not always unfold in a linear way. Experts say patients should compose their thoughts and even make a list of questions to ask or symptoms to discuss. They rarely do. Often the discussion is a hodgepodge of random thoughts, streams of consciousness from which physicians later must connect the dots. Dr. Ouyang added:
But then the process began to discomfit me, as I slowly realized that editing a note I did not create does not demand the same of me as writing a note. I was no longer thinking through the interaction with a patient and the meaning of the information I had gathered from the visit. I was checking a version that had already been made for me.
This distinction seemed small at first. The notes had been generated from my encounters, from the things that were said in the exam room. And I was still revising and proofreading the A.I.’s output afterward. Over time, though, I have come to see how much of my own thinking had been bound up in the writing process itself.
The question becomes how to use productivity enhancing AI scribes without shortcutting clinical reasoning. Or will AI take over clinical reasoning, and the doctor just becomes a prop doing little more than what a messenger would do? Many doctors worry about the future role of physicians in an AI-powered health care system. Should the training of physicians change to fill roles we cannot yet fathom? At this point in time, it is difficult to know how doctors will collaborate with AI systems in the future. Yet it is easy to see Dr. Ouyang’s point. The process of composing their thoughts and documenting patient encounters is part of the process of clinical reasoning and physician decision-making. Something is lost when a computer spits out what it hears and a doctor no longer must carefully recall what was said and the possible meaning.
Read more at NYT: How A.I. Might Change the Way Doctors Think