I Was an Enthusiastic Early Adopter of AI Scribes. Here’s Why I Stopped
This is fascinating, and also entirely understandable:
There is something else the ambient scribe disrupts that receives almost no attention in the literature: the hidden architecture of the GP [General Practice] consultation as a therapeutic and diagnostic instrument in itself.
The general practice consultation is not simply an information-gathering exercise followed by a decision. The process of how information is gathered — what is asked, in what order, how ambiguity is held or resolved, what the clinician chooses to make explicit — is itself diagnostic. The GP who listens to a patient describe fatigue and quietly decides not to ask about mood yet, who files something away for a later question, who notes a hesitation as clinically significant: this is not inefficiency. This is the craft.
The ambient scribe passively records all of this without understanding any of it. It captures the conversation but not the clinical intelligence embedded in its architecture. And — more critically — it changes the conversation itself. Knowing that everything will be recorded, patients speak differently. They raise more. They venture into territory they might previously have held back, trusting that the thoroughness of the record will carry the weight of what they’ve shared.
This is, in many ways, a good thing. In others, it is a transfer of clinical responsibility that we have not acknowledged: the patient has disclosed more, the scribe has recorded more, and the GP is now accountable for all of it, whether or not they had the clinical bandwidth to assess it in the moment.
I exceeded my time. I over-ran my surgeries. I accumulated more documented problems per consultation than I could safely manage. [...]
Clinical reasoning is a skill that is built through practice, and a significant part of that practice is documentation. The act of writing up a consultation — deciding what to include, how to frame the assessment, what language to use — is not an administrative afterthought. It is a learning process. It is how junior doctors and GP registrars build the illness scripts and pattern libraries that will underpin their expert practice for the rest of their careers.
If registrars are trained from the outset with ambient scribing as the norm, we may be producing a generation of highly competent conversationalists who have never fully developed the cognitive discipline of clinical synthesis. The scribe will have done that work for them.
Tags: documentation workflow medicine health general-practice scribing note-taking diagnosis consultation notes via:markdennehy