11 ms·

Refuse to let your doctor record you

167 points by speckx 7mo ago

josefritzishere 7mo ago
This is a hard no.
- BonerWiener 7mo ago
  [dead]
pclowes 7mo ago
I understand the concerns and I am not sure I would allow myself to be recorded until I knew more. However, I do think we are in a situation where everybody knows that healthcare costs need to come down that doctors and medical professionals are spread too thin, forced to see evermore patients in the same number of hours, and yet for every attempt to improve efficiency there is a “no, not that way“ response.
- johndhi 7mo ago
  yes, this!
- bluefirebrand 7mo ago
  > for every attempt to improve efficiency there is a “no, not that way“ response They've tried everything except "train and hire more doctors" and they're just all out of ideas aside from "erode patients rights and lower overall quality of care"
  - pclowes 7mo ago
    The economics of medical school cost, time, and capped residency spots (some would argue this is price-fixing with artificial scarcity) make it hard to just “make more doctors”. Combine this with a highly litigious society that always demands a full doctor (when for 90% of things an NP or PA would do) plus inverted population pyramid all exacerbate the problem. We need more doctors now and it takes 12 years to make a doctor and by then the boomer cohorts aging and medical needs will peak. Finally, even if we could do that, the top of the funnel candidate is substantially weaker with lower test scores and higher need for remedial classes. And for the good candidates, the ROI of medical school is not as good as it once was.
    - bluefirebrand 7mo ago
      Sure. All of that can be true and yet it's still something we need to do better about Just saying "it's really hard so we won't do it" isn't exactly an option when it comes to providing healthcare. :/
- pj_mukh 7mo ago
  Yes, and also almost all of these issues could be ascribed to all digital medical record-keeping. The fact that AI transcribed it matters relatively little.
- winrid 7mo ago
  "healthcare company lowers cost instead of absorbing new found profits" sounds like an Onion headline
  - awakeasleep 7mo ago
    news on inter-dimensional cable
    - reaperducer 7mo ago
      news on inter-dimensional cable Is that channel available on Blippo+?
- midtake 7mo ago
  Is that why healthcare costs are up, or is it because of the insurance mafia?
  - jimbokun 7mo ago
    It’s the doctors. Insurance company profit margins are capped by law and if anything their incentives are to pay the hospitals less. US physician salaries are astronomical compared to anywhere else in the world.
    - christophilus 7mo ago
      [dead]
    - cpburns2009 7mo ago
      Profit margins are capped by percentage. That creates the perverse intensive for insurance companies to pursue ever increasing costs in order to increase profits.
      - ars 7mo ago
        You are forgetting about competition, increasing costs means directly increasing premiums, and higher premiums means lower business.
        cpburns2009 7mo ago
        What competition? When enrollment comes around or you switch jobs you get maybe two insurance providers to choose from.
      - jimbokun 7mo ago
        But they don’t do this. They fight tooth and nail to keep the claims paid to doctors and hospitals low.
- gosub100 7mo ago
  How do you know it's not the other way around? Give consent to incorporate another technology that will keep wages the same but allow them to treat more patients and extract more profit for the shareholders?
- hyperific 7mo ago
  I definitely agree that medical professionals are spread too thin and automation seems like it would be a boon but, as the article points out, the introduction of automation likely won't translate to more doctor-patient time it'll translate to doctors seeing more patients. The solution not only introduces a problem (decreased privacy) but could reinforce the existing problem it's trying to solve.
  - hamandcheese 7mo ago
    > it'll translate to doctors seeing more patients. This is also a good thing. Even in supposedly developed parts of the world like San Francisco it can be difficult to find a PCP that is taking new patients.
    - reptilian 7mo ago
      Where healthcare is concerned, America is not what anyone considers "first world". Your healthcare system is more backward than most third world nations. I would rather leave the US than receive medical treatment there. I have never even considered trusting the US healthcare system. When I lived there I would rather fly home and get treated (in a third world country) than lose all my savings getting inadequate care in the US. I know people who have been through large and expensive treatment plans in the global south, who paid less for the complete treatment than Americans pay for the ambulance getting you to the hospital.
      - mmonaghan 7mo ago
        I think its two systems masquerading as one - employed-and-insured and everyone else. If you're the former, it works great. If you're the latter, it can be mediocre to BRUTAL. Medical debt is our #1 or 2 cause of bankruptcy iirc. Regardless of which class you are, if you can access the care, our outcomes are the best in the world for most things.
        kelnos 7mo ago
        > If you're the former, it works great. I don't think that's true at all. "Insured" doesn't mean just one thing. There are many different kinds of insurance, levels of plans, etc. Most insurance companies will do their best to deny claims or push more responsibility onto the patient. My insurance is very good, but I see a therapist weekly and my insurance only covers about 40% of the cost. I'm fortunate that ~$500/mo isn't a problem for me, but many people in the US would find that impossible. A few months ago I went to the ER for what turned out to be gallstones, and was still on the hook for $200 of that visit. And I took a Lyft the the hospital; I don't want to think about what my out-of-pocket cost had been if I'd needed an ambulance. Last summer I hurt my hand in a bicycle accident, and went to PT once a week for 6 weeks. I had to pay a $35 co-pay for each visit; that's $210 for a single injury. And this is with fairly good insurance. Many, many insured Americans just have so-so insurance. From what I hear of most healthcare systems in countries that do this right, most (if not all) of this stuff would have been completely free. > If you're the latter, it can be mediocre to BRUTAL Yup, and in a way that's an even worse indictment, that really puts us in worse-than-third-world territory.
- dheera 7mo ago
  How about this: 1. I have health insurance 2. The point of insurance is they're supposed to pay for shit 3. You figure out how to get them to pay for shit, sign an agreement that removes me of any patient responsibility of the balance bill, and assure me in writing that I will owe $0 no matter what Then you can record me.
  - gedy 7mo ago
    Insurance, like a lot of subsidies turns into "we will take all of that, and still make sure your share is at the limits of your carrying capacity"
- marricks 7mo ago
  > I do think we are in a situation where everybody knows that healthcare costs need to come down that doctors and medical professionals are spread too thin The problem is over optimization AND lack of people. As soon as there's an excuse for less staff because we have "digital record keeping" we're going to have less money and even less staff. Having in person or remote notetakers is a great entry level job to do before you become a doctor. It could be boring but at least the terms are familiar and you get to know the person you're working with. It's not like healthcare is an impossible problem to solve that needs more tech, we just refuse to spend money on people and (inexplicably) cannot help but dump tons of money into tech.
  - toast0 7mo ago
    > The problem is over optimization not lack of people or resources. As soon as there's an excuse for less staff because we have "digital record keeping" we're going to have less money and even less staff. At least in my area, it seems like lack of people is a problem. Sometimes it's lack of people because the pay is too low, but more of it it's lack of people because the pool of qualified people is too small. And increasing pay increases healthcare costs, and healthcare costs are already very high. If digital tools allow the available staff to see more patients while delivering the same level of care (and without burning out the providers), then that means more capacity and less times people want to see a doctor, but can't. Similar arguments for same number of patients ans greater level of care. If it's more patients, but worse level of care, then it becomes tricky.
    - jimbokun 7mo ago
      The lack of people is too low because the organization tasked with accrediting new doctors has a financial incentive to its current members to keep the pool of doctors low.
    - marricks 7mo ago
      Holy wow, I meant to say lack of people is the problem. Edited to reflect that.
  - pclowes 7mo ago
- hansvm 7mo ago
  If I paid all my doctors $1200/hr and doubled how much time they spend with or on me, that'd still pale in comparison to healthcare expenditures attributed to me between actual insurance payments and actual money leaving my bank account. Doctors being spread too thin is very much a separate issue.
  - deleted 7mo ago
    [deleted]
- vlovich123 7mo ago
  One massive way to reduce healthcare costs is to remove caps from becoming a doctor; as long as you pass the tests and meet the requirements, why are we turning doctors away? So that existing doctors can be paid well above the market rate. There's a reason there's so many doctors in politics - it's very important for them to protect this business model.
  - bonsai_spool 7mo ago
    > There's so many doctors in politics - it's very important for them to protect this business model. Uh... politics is almost uniformly lawyers and business people. Also tests are the table-stakes to being a doctor (like leet code and programming).
    - vlovich123 7mo ago
      Tests are table stakes but quotas are how they ensure there’s fewer doctors than is needed to meet demand to ensure doctors get paid large salaries. While you’re not wrong, there are far more doctors in politics at all levels (including influential fundraising) than engineers and teachers.
      - bonsai_spool 7mo ago
        > While you’re not wrong, there are far more doctors in politics at all levels (including influential fundraising) than engineers and teachers. I don't think you're right about this (not that it matters) but what's your source of data? What is an 'engineer'? A PE? Someone who coded once? The 'quotas' for doctors don't exist, this is one of the stories people on the internet tell themselves.
- kelnos 7mo ago
  The problem is that (as addressed by the article), any efficiency wins end up pushing more patients on the provider. So if you used to have a 15-minute appointment, and five minutes of that were spent with the doctor writing down notes, with AI transcription, now you'll have a 10-minute appointment, and the doctor will be forced to see two more patients per hour.
- sys_64738 7mo ago
  > I understand the concerns and I am not sure I would allow myself to be recorded until I knew more. Which is your choice obviously. But your doctor can also drop you as a patient and that will happen eventually if you say No too many times.
scrawl 7mo ago
> The false promise of efficiency [...] that is extremely unlikely to mean more time with each patient. Instead, it will mean more patients. nit: that is a real efficiency gain. seeing more patients sounds better on the face of it.
- woopwoop 7mo ago
  That's not a nit. There's not much left of the articles point once you take this on board.
- apparent 7mo ago
  Exactly. It means that if you've ever tried to get an appt and been told there's a 4 month waiting list, AI could help get you in sooner. That is a real win.
deleted 7mo ago
[deleted]
walrus01 7mo ago
It's interesting how lots of service providers of all sorts will insist that you agree to their Terms of Service, Acceptable Use Policy, End User License Agreement (or whatever they want to call it) before engaging with you, but when the consumer insists on enforcing their own personal policy in the opposite direction such as refusing consent to recording or feeding your PII into some opaque AI system, suddenly it's a problem.
deleted 7mo ago
[deleted]
k2xl 7mo ago
I think the post conflates two issues: 1. AI-generated charting. 2. The existence of a reliable record of the visit. I am skeptical of the first in some cases (i.e. bias), but strongly in favor of the second. My father is 80 and has Parkinson’s. He routinely leaves appointments unsure of what the doctor said, what changed, or what he is supposed to do next. Even when I attend with him, we sometimes disagree afterward about what exactly was recommended. This happens with pediatric appointments too. My wife and I occasionally remember instructions differently: medication timing, symptoms to watch for, when to call back, whether something was “normal” or needed follow-up. That is a care quality problem, not just a convenience problem. The risks are real: privacy, consent, retention, training use, liability, and automation bias. But those argue for strict controls, not for a blanket refusal. Make it opt-in, give the patient access, prohibit training without explicit consent, keep retention short, and require clear auditability. I do not want opaque AI quietly rewriting the medical record. But I also do not think “everyone relies on memory after a stressful 12-minute appointment” is some gold standard we should preserve.
- ranger_danger 7mo ago
  Have you tried recording the interactions with doctors for your own benefit?
  - k2xl 7mo ago
    Yes. It was great for when I had a major surgery last year and had a bazillion questions for the surgeon. But I don't always remember to. My parents definitely don't even think about it.
nubinetwork 7mo ago
Dead link (or it was?)
adit_ya1 7mo ago
Almost every point follows the same structure: > "Here is a real concern about implementation" → "Therefore you should refuse entirely" This skips the middle step of "therefore we should implement it well." I'm not convinced that we should be allowing doctors to record patient visits at this stage yet, but I'm really not convinced by these points, which largely don't hold up under closer examination. A few that stuck out: "Privacy" - Labs are routinely sent to third-party companies, and we don't do informed consent for that. The third-party argument isn't unique to recording. "False promise of efficiency" - This doesn't really have anything to do with patients at all. It's a criticism of medical office management, not of physician-patient interactions. Telling patients to refuse a tool because management might exploit the productivity gains is asking patients to fight a labor battle on the provider's behalf. "Consent can't be revoked mid-visit" - Consent typically can't be revoked in the middle of an appendectomy, or halfway through administering a vaccine either. Practical irrevocability is a normal feature of informed consent, not a special problem unique to recording. Proper consent processes in medical offices are a broader issue than consent about voice recordings specifically. Had the authors made the point that providers are being asked to obtain consent for tools whose technical implementation and privacy risks fall outside the provider's own domain knowledge — that would be a stronger argument. But that isn't quite the point they made, and their current framing doesn't wholly convince.
- afandian 7mo ago
  I think the "therefore we should implement it well" is not forgotten, it's elided because we don't think it's likely to happen. Tech-naïve people think that we can build super duper encryption systems. The more jaded amongst us know that people can get sloppy or complacent, it's rare to see a regulatory system that truly incentivises good practice, data breaches will happen eventually, and no-one will be held accountable. This is a big one in recent memory: https://www.theguardian.com/uk-news/2020/jun/10/babylon-health-data-breach-gp-app-users-able-to-see-other-peoples-consultations https://www.theguardian.com/uk-news/2020/jun/10/babylon-heal...
- parliament32 7mo ago
  > Labs are routinely sent to third-party companies Labs are real businesses that do real things, and would have actual impact for a breach. Meanwhile any idiot can vibe-code a thin shim between a microphone and ChatGPT in a weekend, promise they're HIPAA-compliant, and start selling. Medical professionals have no obligation to do any diligence, and there's no reason for them to not just buy whoever-is-cheapest. They're not even close to the same thing.
kube-system 7mo ago
There might be some real concern about the cognitive and patient-interaction impacts of speech recognition being used... but on the other hand, it's more likely that details are missed when information is captured manually. And the privacy/informed consent concerns here are silly, they apply to any of your charted data... and if you're going to any office that doesn't use the latest technology, your patient information is probably being sent between offices over fax anyway.
burnte 7mo ago
I'm a healthcare CIO of 12 years, and I've evaluated 4 and deployed 2 of these tools, one of which is currently deployed at my currently healthcare employer. I am very measured on AI but the results I've seen from these virtual scribes is HUGE. In every case we have IMMEDIATELY seen improvements in patient NPS scores, provider satisfaction, and note quality. Notes are more standardized as well as more verbose and detailed, which makes it easier for future providers to understand the case. These better notes reduce our claim rejection rate. And what converted me was direct patient response. Across the board patient feedback is extremely positive, with the most common comment being along the lines of "I really felt like the doctor connected with me better and they were more present in the visit." These AI scribes really DO improve patient care, I've seen it with my own eyes.
- t-kalinowski 7mo ago
  Counterpoint from a doctor: https://substack.com/inbox/post/189714240 https://substack.com/inbox/post/189714240 Scribes _feel_ good in the short-term, but it's not clear if they're actually good on longer time horizons.
  - razingeden 7mo ago
    the two places they come in handy: 1) in the event you find yourself partially or totally disabled but the records don’t really make a good case for it and your provider has a dismissive attitude about filling out additional documentation to substantiate what they failed to in your records. You’re not necessarily going to get approved for FMLA, STD, LTD, SS etc based on a diagnosis or test results alone. They will nitpick over say, heart failure, as if that’s magically and spontaneously going to go away. If you’re telling your provider that you’re limited by things like oh I don’t know, “I’m only awake for 2-4 hours before I need to sleep again” or “some days I just can’t do it and sleep 20 hours” but it’s not in your chart… expect denials and clarifications and a huge burden on you to prove why it’s limiting. 2) continuity of care, so you don’t end up explaining everything from the top to a specialist or having them run all these tests and procedures from square one — when there’s months long backlogs , and we already did all this and you need treatment - but - there wasn’t much to work with in your referring chart. You might not appreciate the “intrusion” if you’re healthy and just worried about your privacy. If/When things go south and you find yourself fighting these entities for a year or two or three while they nitpick and delay and deny and drag their feet , you’ll be glad an “AI” kept up meticulous records because this is phenomenally stressful and an endless burden on you when they don’t. So, their AI slop can vomit out all this extra info on why insurance companies should pay them or why your condition is in fact disabling, and now their AI slop can comb through it looking for all that. Because they will try to avoid paying or approving any kind of leave or benefits if it’s not there And god forbid you hand them a form where they’re being asked to explain themselves. 50/50 on them being eager to help out or rolling their eyes and saying something really nasty about the imposition. And then even when they do that, they almost never file a copy in your chart so your chart STILL doesn’t substantiate your claims. I’m all for an “ai” doing the progress notes in a case where the facility or provider can’t be fucked to do so. Happily that’s not true of my current provider, who just, does that anyway (?) But I’ve been around enough to know they’re an exception. Even when providers are on your side and mean well, and want to bend over backwards to help you in any way they can — and I want to just acknowledge that’s the situation I’m in today — honestly , sometimes they just forget some of the details when they do their notes. That’s why some places make the provider do it in real time while they’re talking to you, so they didn’t forget something relevant thirty minutes later. The other side of the coin here may be that some providers find that distracting or off putting to be typing away like a stenographer while they’re examining you… I think it would be fair to say this can all be tedious and a burden for both patients and providers. There’s just a world of difference between a provider who wants to do this to provide excellency in care, and a provider who wants to do this because they resent it and think it’s beneath them.
varispeed 7mo ago
I always agree if this is for academic purposes, if it helps with research etc. I can't see why I shouldn't. We are just meat that will expire one day.
xxpor 7mo ago
This was extremely unconvincing for me. The site is now 500ing for me, so I can't fully quote it, but the arguments about privacy just fall flat. You don't know about Epic's, or GE's, or Philips' security either. You have to trust the institution of HIPPA et al overall to at least make things right. I really don't care if my recording becomes training data. I would rather be spoken to like I'm not an idiot. Use technical terms please. I want precision. Calling the US healthcare system underfunded might be the most wild part of the whole thing. We spend 5.3 trillion dollars a year. That's 17% of the entire economy.
- jll29 7mo ago
  > You don't know about Epic's, or GE's, or Philips' security either. The argument that a new vendor's security is probably not worse than others misses the point that by opting in, there is one more database/vendor/server where sensitive data about you resides, and which eventually will get hacked. It's usually just a question not whether, but when. For instance, in the UK, on this very day news reported half a million British people's medical data has been offered for sale on Alibaba, the "Chinese E-Bay". Trivial security advice is to "reduce the attack surface", i.e. to reduce the chances of getting hit by reduce one's presence in places where personal data is concentrated (thus making an attractive target for hackers). For example, when the German healthcare system launched its central electronic patient record, I opted out. One more system that, once hacked, won't have anything on me stored in it.
  - xxpor 7mo ago
    >For example, when the German healthcare system launched its central electronic patient record, I opted out. One more system that, once hacked, won't have anything on me stored in it. I'll be sure to say a prayer at your funeral when you died due to an unknown drug interaction because of the lack of knowledge of your medical history in the emergency department of the random city you happen to be traveling through and get in a car accident. I don't think people are good at estimating tail risks, let alone the 2nd order effects of them. If you opt out of the AI transcription, do you think the doc will spend a bunch of time doing it by hand for free? No, you'll just have a worse record.
impatient_bacon 7mo ago
Oof yea I just got surprised by this at a vet appointment for my dog, weirded me out. I just went along with it to get the visit over with and I can see the benefit of having an accurate record of the visit, but we'll have to come to terms to the reality of this invasive surveillance as a society at some point I imagine.
dlcarrier 7mo ago
I'm more concerned about a record being made in general, than how it is made. If were to be affected by a tragedy and visit a psychologist or psychiatrist to receive support, it would likely require a diagnosis of depression to get insurance coverage, and having that on my record could make it more difficult and costly to legally fly an airplane or own a gun, and who knows what else.
- titanomachy 7mo ago
  This is an insane attitude. Get help if you need it. Having periods of depression on your medical record doesn’t make your life more difficult, unless maybe you’re trying to be a spy or an astronaut or something.
  - kelnos 7mo ago
    This is actually a problem with e.g. airline pilots. They'll hide conditions (especially mental health issues) that they know could trigger a suspension or re-evaluation of their ability to fly. Even if those conditions are entirely treatable and wouldn't actually affect their ability to fly during/after treatment. So your statement is factually incorrect: in some common professions, your medical record can make your life significantly more difficult.
    - AngryData 7mo ago
      Yep, a bipolar diagnosis will get a commercial pilot grounded for life so they avoid any diagnosis or treatment even if it would help them immensely. And I certainly don't feel safer knowing pilots are avoiding mental health care.
  - dlcarrier 7mo ago
    It's insane that anyone should have to have that attitude, but also completely reasonable. A Germanwings pilot killed himself and everyone on his flight, because he didn't seek treatment for depression, as he was expressly warned that regulations require he lose his job and be banned from his career, for doing so. The regulations intent was to keep suicidal pilots from flying, but in practice its primary effect is to keep suicidal pilots from seeking official care. The same is true for gun possession in multiple US states, which can preclude those who carry a gun in the line of duty from working in their careers. Air traffic controllers and EMTs are often affected by similar regulations as pilots and officers, too. There is a significant push in many jurisdictions for stricter health limits on drivers licenses, and we could easily end up with similar regulations there.
deleted 7mo ago
[deleted]
the_gipsy 7mo ago
I live in a country with free public healthcare. In a recent doctor's visit, the doctor was interviewing me while a nurse was typing into the computer. Presumably so that the doctor would have more time to attend patients and so that she wouldn't get distracted. It's fascinating how this translates to the idea that in the USA, this should mean "more time with patients", but in reality also means "more patients", but is somehow bad because the is a monetary drive.
- jimbokun 7mo ago
  The big AI companies are in deep trouble if the general public ever figures this out.
- jrockway 7mo ago
  Doctors have always been into "more patients", though. To some extent, if you're a doctor, the upper bound on your pay is how much you charge * how many patients you see. This is why you occasionally get seen well after your appointment time; people are double booked because some % reliability doesn't show up, but sometimes everyone DOES show up to their appointment and now it's your problem. So if AI scribes mean "less double booking" then that's kind of a win/win. Less patient time is wasted. Doctors can make more money by seeing more people on a given day. Seems fair.
  - kelnos 7mo ago
    That's not how it works, though. People/companies that find efficiency gains don't sit back and relax the rest of the time. They do more work with the extra time they have. So in your example, they'll continue to double-book, and reduce the total time spent with each patient (since they can be more efficient with each patient) and book more patients per day.
cromka 7mo ago
This is seriously a good example of a domain that should enforce on-premises AI. Doctors absolutely can afford to buy an NVIDIA workstation. Transcribing text is not exactly super demanding, comparatively speaking. When did we even stop considering non-cloud services? If AI boomed 10 years ago, we wouldn't even be discussing this.
- Matumio 7mo ago
  I know some European "automatic scribe" projects of the government sector. Their IT buys a physical GPU server hosted locally. Pretty sure it wouldn't be accepted otherwise (or maybe I'm just naive, but it sure is a topic they care about). The software stack is mostly open source, I think. It sure as hell doesn't talk to a big American cloud provider. (Well, the transcription service doesn't. Who knows what they do with the automated transcript. Probably the same thing they did with the manual transcript.)
- ButlerianJihad 7mo ago
  Physicians, like lawyers, may still understand enough Latin to know what "invidia" means, and therefore never touch that crap with a ten-foot-pole. https://en.wiktionary.org/wiki/invidia#Latin https://en.wiktionary.org/wiki/invidia#Latin Sent from my Chromebook with Intel® iRIS® Xe Graphics
- quantumwoke 7mo ago
  It's not just transcribing text, there is also a post processing step to turn it from an interview transcript into an actionable summary.
daedrdev 7mo ago
HIPPA exists and has a lot of teeth. Given this extensive liability, I trust that if anything does go wrong they will be punished. Recordings might dramatically improve patient outcomes, and so I will let them
- bonsai_spool 7mo ago
  HIPPA does not exist. HIPAA has laughably vague rules. It's not protecting much, and you probably have better protection through tort law wrt your private information.
- parliament32 7mo ago
  HIPAA enforces nothing other than a pinky-swear-promise of compliance. There are hundreds, if not thousands, of middlemen who sell SaaS like this to medical professionals. If one suffers a breach then shuts down, your doctor will just switch to the next one in line with no consequences because "they promised they were compliant". Meanwhile all your medical details will end up in a public dataset forevermore.
- carefulfungi 7mo ago
  Until you need insurance. Or a professional license that involves a review of your medical record. Or the government just wants the data. Or the records are subpoenaed to be used against you in court. You are trusting that illegitimate uses of this data will be punished. However, there are many authorized uses that will hurt you in the long term. It is rarely to your advantage to accumulate extensive recorded medical records. Even pre-existing insurance denials could return in the US. Don't let systems record what they don't need. They aren't your friend.
jimt1234 7mo ago
This situation is real. I've had the same doctor my entire adult life (~25 years). We've got a pretty informal relationship. I even saw her hammered at a bar one night, and had to give her a ride home because her friends were also drunk AF. Anyway, a few years ago, during an annual checkup, she asked how my family was doing and I made a joke about my brother drinking too much. A few weeks later I started receiving pamphlets in the mail about treating alcoholism, ads for rehab centers. I just brushed it off, didn't make any connection. Then, the next year, during my annual checkup, my doctor wasn't available, so I got a different doctor, someone I'd never talked to in my life. She immediately started asking me about my drinking. I fired back, asking WTF she was talking about. She said, "Oh, well your file says alcoholism runs in your family.", and then started lecturing me about getting over the shame of alcoholism is the first step to beating it. I don't even drink. No one in my family drinks other than my brother. He was drinking a lot at that time because he favorite NFL team (LA Rams) was doing really well, and he was celebrating a lot. And it was just a joke. The next year, during my annual checkup, I gave my doctor a load of crap, telling her to record nothing I say unless I explicitly tell her to. She tried to defend the system, but she agreed. I'm still upset that my "file" still mentions alcoholism.
- jll29 7mo ago
  > "Oh, well your file says alcoholism runs in your family." Medics often use private notes when handing over patients, where they share information that the patients themselves are not intended to see (and in many countries, not permitted to see). In particular, such records are used to share warnings if patients have been in any way "difficult".
OutOfHere 7mo ago
Why do we even need to consult doctors anymore? Just let the AI decide. Docs should be freed up for up for doing physical tests and interventions, or otherwise for providing more training data for the AI in cases where the AI isn't producing results or when a second look is urgently needed in an emergency situation.
pavel_lishin 7mo ago
Down for me, but Internet Archive grabbed a copy: https://web.archive.org/web/20260424151739/https://buttondown.com/maiht3k/archive/why-you-should-refuse-to-let-your-doctor-record/ https://web.archive.org/web/20260424151739/https://buttondow...
jll29 7mo ago
Advice: Regardless of whether you opt in or out, you should only permit anyone to record you if you get a copy of the recording for your own records.
jcalvinowens 7mo ago
Honestly, my recent experience with this was really positive: the doctor actually said the technical stuff out loud to me for the first time in my life, in a way I could easily ask polite questions about and discuss with them. In my case it was something very not sensitive, removing a benign tumor in a finger, which I have no problem telling the whole world about (I was awake for the surgery and got to watch, it was a incredibly fascinating experience that I want to write more about some day). But I can imagine it would feel much more invasive if the subject were more sensitive.
tristanb 7mo ago
This is a really great way to get yourself worse care.
gitowiec 7mo ago
What a fucking absurd. I used to go to the shrink a lot. First it was a man, he never took any notes and he remembered everything. Second was a woman, she was taking notes but never had any problems with that!
moralestapia 7mo ago
Lol, this essay is missing (or starting from the assumption) that text-to-speech algorithms do a good work, even state of the art. That is far from correct and the main reason why I would oppose to this is that the AI might incorrectly record something in the transcript that completely derails my diagnosis and treatment. There's a big difference between: "I have had nausea for the past three days" and "I have not had nausea for the past three days" And I'm being generous with my example.
apparent 7mo ago
> But, especially given the underfunded nature of the US health system, that is extremely unlikely to mean more time with each patient. Instead, it will mean more patients. So that means if I try to make an appt, I'll have an easier time getting one? Sounds good, I guess.
0xbadcafebee 7mo ago
I think this is just humans not understanding things and irrationally being afraid of one thing more than another thing. You're afraid of someone listening to you; you're not afraid of someone copying the documents that detail every single aspect of your health (EHR records). Healthcare records are probably the most strongly protected personal information in the world. Remember that most of the data about you is not protected by law. Credit reports, ISP records (including your SS#), your entire email archive, Google Drive, etc could get leaked, and for the most part there's no legal consequence. But if a record of you having the flu in 3rd grade gets leaked by a 3rd party connected to health record keeping, there are real consequences (not only for the leak, but even for not reporting it). If anything, I want everything I say to be recorded and kept on file for later reference. The danger of speech-to-text engine transcribing incorrectly is real, but that doesn't mean I don't want the notes there. I just want the audio included with the text. Both will be useful to refer to later on, especially as STT models improve their accuracy (we've seen amazing leaps in accuracy in just 1 year). However, we do need to ensure that these records are protected from government over-reach. Currently the government can request your health records, without notifying you, for a slew of reasons. This enables the government to go on a fishing expedition, doing the equivalent of an unreasonable search of private information, and you will have no notification and no way to respond. We must create laws that provide stronger privacy rights for sensitive health information to resist government overreach. Another legal hole is 3rd party apps that collect sensitive health information, but aren't provided by your doctor. Your step-tracking, heart-monitoring app is not protected by HIPAA. Same for employer health records.
dawnerd 7mo ago
I have been loving my new doctors recording and making everything available in the patient portal. No more trying to remember what they said. That’s huge, especially when dealing with elderly patients and being able to have their caregivers have access to it.
rolph 7mo ago
a premptive notification to health care team. "to whom may be concerned." [Doctor Stan dinghere, as a patient i have no trust or confidence regarding the security and integrity of my personal information in regards to AI scribing. for this reason i will scribe for you, as that is the most accurate account of what i intend to communicate with you. i will refrain from verbal communication and will provide on the spot written communication with respect to health care interaction. ]
croisillon 7mo ago
my boss fell in love with a software that invites itself to team calls, then retranscripts and summarizes... so the whole office has that automatically in ; once in a while my colleagues and i look into that report, it's sometimes hilariously wrong, most of the times just useless
ivraatiems 7mo ago
It's definitely NOT a false promise of efficiency, at least, not in all or many cases. My wife is a physician, and when permitted by patients, uses one of these tools. It's been an enormous time-saver for her. She works a 32-hour week, meaning 32 hours of seeing patients. Before these tools, she was regularly spending an extra 8 to 16 hours, e. g. two full work days, writing notes and sending messages. That time has been more than cut in half. She would never give up the tool if she didn't have a choice. According to her, it is reasonably accurate, but all notes must be manually reviewed (not just as in her organization requires that, but also as in if she didn't, it would be obvious due to its mistakes). The biggest issue is with things like names and medications, stuff that isn't present in ordinary English, as well as mishearing the results of diagnostic tests, numbers, etc. It's rare for patients to refuse it.
16bytes 7mo ago
This is absolutely horrible advice. If you do this you will over time experience worse health care. Documentation errors have always been an issue. They were when there were paper charts, or human transcriptionists, or when manually typing into the EMR, or when using speech recognition (which is AI/ML!) to do the typing for you. Not all e-scribes use LLMs, but most of them do rely on ambient audio recordings for speech recognition, which nowadays runs entirely locally. That text then needs to be processed into your clinical documentation, and there are tons of ways to do that (including LLM processing). The author has obviously never talked to clinicians or hospital administrators about the challenges of maintaining clinical documentation, and knows little to nothing about the reality of software that runs in clinical contexts.
randusername 7mo ago
In the US the purpose of the portal and all the typing and record-keeping is insurance justification and liability. This is probably not the reassurance anyone wanted to hear if they were worried about crap transcriptions leading to crap care. This is my absolute least favorite category of AI innovations: people patting themselves on the back for becoming more efficient in their inefficiency.
ares623 7mo ago
Can you say "No thank you. But can I record this conversation myself?"
hoherd 7mo ago
Just today Claude admitted to me that it may have hallucinated a detail in a response when I asked about it. Do you want that possibility in your medical record?
AbstractH24 7mo ago
There’s only one speciality i mind the use of AI - psychotherapy. In that case, I’m paying them to engage with and observe me. Not to identify the correct treatment plan based on a variety of different data points (tests, my history, family history, research, etc) And even in psychotherapy I have no problem with a LLM being used to compile notes after the session. Just don’t want it present in the session and used for analyzing it. (My therapist asks me almost once a month if I’d mind. I thought it was because my notetaker is entering the Zoom meeting, but last week I called him out cause I was almost certain I disabled it. Curious if he’ll ask again.)

167 points by speckx 7mo ago

josefritzishere 7mo ago

This is a hard no.

BonerWiener 7mo ago
[dead]

pclowes 7mo ago

I understand the concerns and I am not sure I would allow myself to be recorded until I knew more. However, I do think we are in a situation where everybody knows that healthcare costs need to come down that doctors and medical professionals are spread too thin, forced to see evermore patients in the same number of hours, and yet for every attempt to improve efficiency there is a “no, not that way“ response.

johndhi 7mo ago
yes, this!
bluefirebrand 7mo ago
> for every attempt to improve efficiency there is a “no, not that way“ response They've tried everything except "train and hire more doctors" and they're just all out of ideas aside from "erode patients rights and lower overall quality of care"
- pclowes 7mo ago
  The economics of medical school cost, time, and capped residency spots (some would argue this is price-fixing with artificial scarcity) make it hard to just “make more doctors”. Combine this with a highly litigious society that always demands a full doctor (when for 90% of things an NP or PA would do) plus inverted population pyramid all exacerbate the problem. We need more doctors now and it takes 12 years to make a doctor and by then the boomer cohorts aging and medical needs will peak. Finally, even if we could do that, the top of the funnel candidate is substantially weaker with lower test scores and higher need for remedial classes. And for the good candidates, the ROI of medical school is not as good as it once was.
  - bluefirebrand 7mo ago
    Sure. All of that can be true and yet it's still something we need to do better about Just saying "it's really hard so we won't do it" isn't exactly an option when it comes to providing healthcare. :/
pj_mukh 7mo ago
Yes, and also almost all of these issues could be ascribed to all digital medical record-keeping. The fact that AI transcribed it matters relatively little.
winrid 7mo ago
"healthcare company lowers cost instead of absorbing new found profits" sounds like an Onion headline
- awakeasleep 7mo ago
  news on inter-dimensional cable
  - reaperducer 7mo ago
    news on inter-dimensional cable Is that channel available on Blippo+?
midtake 7mo ago
Is that why healthcare costs are up, or is it because of the insurance mafia?
- jimbokun 7mo ago
  It’s the doctors. Insurance company profit margins are capped by law and if anything their incentives are to pay the hospitals less. US physician salaries are astronomical compared to anywhere else in the world.
  - christophilus 7mo ago
    [dead]
  - cpburns2009 7mo ago
    Profit margins are capped by percentage. That creates the perverse intensive for insurance companies to pursue ever increasing costs in order to increase profits.
    - ars 7mo ago
      You are forgetting about competition, increasing costs means directly increasing premiums, and higher premiums means lower business.
      - cpburns2009 7mo ago
        What competition? When enrollment comes around or you switch jobs you get maybe two insurance providers to choose from.
    - jimbokun 7mo ago
      But they don’t do this. They fight tooth and nail to keep the claims paid to doctors and hospitals low.
gosub100 7mo ago
How do you know it's not the other way around? Give consent to incorporate another technology that will keep wages the same but allow them to treat more patients and extract more profit for the shareholders?
hyperific 7mo ago
I definitely agree that medical professionals are spread too thin and automation seems like it would be a boon but, as the article points out, the introduction of automation likely won't translate to more doctor-patient time it'll translate to doctors seeing more patients. The solution not only introduces a problem (decreased privacy) but could reinforce the existing problem it's trying to solve.
- hamandcheese 7mo ago
  > it'll translate to doctors seeing more patients. This is also a good thing. Even in supposedly developed parts of the world like San Francisco it can be difficult to find a PCP that is taking new patients.
  - reptilian 7mo ago
    Where healthcare is concerned, America is not what anyone considers "first world". Your healthcare system is more backward than most third world nations. I would rather leave the US than receive medical treatment there. I have never even considered trusting the US healthcare system. When I lived there I would rather fly home and get treated (in a third world country) than lose all my savings getting inadequate care in the US. I know people who have been through large and expensive treatment plans in the global south, who paid less for the complete treatment than Americans pay for the ambulance getting you to the hospital.
    - mmonaghan 7mo ago
      I think its two systems masquerading as one - employed-and-insured and everyone else. If you're the former, it works great. If you're the latter, it can be mediocre to BRUTAL. Medical debt is our #1 or 2 cause of bankruptcy iirc. Regardless of which class you are, if you can access the care, our outcomes are the best in the world for most things.
      - kelnos 7mo ago
        > If you're the former, it works great. I don't think that's true at all. "Insured" doesn't mean just one thing. There are many different kinds of insurance, levels of plans, etc. Most insurance companies will do their best to deny claims or push more responsibility onto the patient. My insurance is very good, but I see a therapist weekly and my insurance only covers about 40% of the cost. I'm fortunate that ~$500/mo isn't a problem for me, but many people in the US would find that impossible. A few months ago I went to the ER for what turned out to be gallstones, and was still on the hook for $200 of that visit. And I took a Lyft the the hospital; I don't want to think about what my out-of-pocket cost had been if I'd needed an ambulance. Last summer I hurt my hand in a bicycle accident, and went to PT once a week for 6 weeks. I had to pay a $35 co-pay for each visit; that's $210 for a single injury. And this is with fairly good insurance. Many, many insured Americans just have so-so insurance. From what I hear of most healthcare systems in countries that do this right, most (if not all) of this stuff would have been completely free. > If you're the latter, it can be mediocre to BRUTAL Yup, and in a way that's an even worse indictment, that really puts us in worse-than-third-world territory.
dheera 7mo ago
How about this: 1. I have health insurance 2. The point of insurance is they're supposed to pay for shit 3. You figure out how to get them to pay for shit, sign an agreement that removes me of any patient responsibility of the balance bill, and assure me in writing that I will owe $0 no matter what Then you can record me.
- gedy 7mo ago
  Insurance, like a lot of subsidies turns into "we will take all of that, and still make sure your share is at the limits of your carrying capacity"
marricks 7mo ago
> I do think we are in a situation where everybody knows that healthcare costs need to come down that doctors and medical professionals are spread too thin The problem is over optimization AND lack of people. As soon as there's an excuse for less staff because we have "digital record keeping" we're going to have less money and even less staff. Having in person or remote notetakers is a great entry level job to do before you become a doctor. It could be boring but at least the terms are familiar and you get to know the person you're working with. It's not like healthcare is an impossible problem to solve that needs more tech, we just refuse to spend money on people and (inexplicably) cannot help but dump tons of money into tech.
- toast0 7mo ago
  > The problem is over optimization not lack of people or resources. As soon as there's an excuse for less staff because we have "digital record keeping" we're going to have less money and even less staff. At least in my area, it seems like lack of people is a problem. Sometimes it's lack of people because the pay is too low, but more of it it's lack of people because the pool of qualified people is too small. And increasing pay increases healthcare costs, and healthcare costs are already very high. If digital tools allow the available staff to see more patients while delivering the same level of care (and without burning out the providers), then that means more capacity and less times people want to see a doctor, but can't. Similar arguments for same number of patients ans greater level of care. If it's more patients, but worse level of care, then it becomes tricky.
  - jimbokun 7mo ago
    The lack of people is too low because the organization tasked with accrediting new doctors has a financial incentive to its current members to keep the pool of doctors low.
  - marricks 7mo ago
    Holy wow, I meant to say lack of people is the problem. Edited to reflect that.
- pclowes 7mo ago
hansvm 7mo ago
If I paid all my doctors $1200/hr and doubled how much time they spend with or on me, that'd still pale in comparison to healthcare expenditures attributed to me between actual insurance payments and actual money leaving my bank account. Doctors being spread too thin is very much a separate issue.
- deleted 7mo ago
  [deleted]
vlovich123 7mo ago
One massive way to reduce healthcare costs is to remove caps from becoming a doctor; as long as you pass the tests and meet the requirements, why are we turning doctors away? So that existing doctors can be paid well above the market rate. There's a reason there's so many doctors in politics - it's very important for them to protect this business model.
- bonsai_spool 7mo ago
  > There's so many doctors in politics - it's very important for them to protect this business model. Uh... politics is almost uniformly lawyers and business people. Also tests are the table-stakes to being a doctor (like leet code and programming).
  - vlovich123 7mo ago
    Tests are table stakes but quotas are how they ensure there’s fewer doctors than is needed to meet demand to ensure doctors get paid large salaries. While you’re not wrong, there are far more doctors in politics at all levels (including influential fundraising) than engineers and teachers.
    - bonsai_spool 7mo ago
      > While you’re not wrong, there are far more doctors in politics at all levels (including influential fundraising) than engineers and teachers. I don't think you're right about this (not that it matters) but what's your source of data? What is an 'engineer'? A PE? Someone who coded once? The 'quotas' for doctors don't exist, this is one of the stories people on the internet tell themselves.
kelnos 7mo ago
The problem is that (as addressed by the article), any efficiency wins end up pushing more patients on the provider. So if you used to have a 15-minute appointment, and five minutes of that were spent with the doctor writing down notes, with AI transcription, now you'll have a 10-minute appointment, and the doctor will be forced to see two more patients per hour.
sys_64738 7mo ago
> I understand the concerns and I am not sure I would allow myself to be recorded until I knew more. Which is your choice obviously. But your doctor can also drop you as a patient and that will happen eventually if you say No too many times.

scrawl 7mo ago

> The false promise of efficiency [...] that is extremely unlikely to mean more time with each patient. Instead, it will mean more patients. nit: that is a real efficiency gain. seeing more patients sounds better on the face of it.

woopwoop 7mo ago
That's not a nit. There's not much left of the articles point once you take this on board.
apparent 7mo ago
Exactly. It means that if you've ever tried to get an appt and been told there's a 4 month waiting list, AI could help get you in sooner. That is a real win.

deleted 7mo ago

[deleted]

walrus01 7mo ago

It's interesting how lots of service providers of all sorts will insist that you agree to their Terms of Service, Acceptable Use Policy, End User License Agreement (or whatever they want to call it) before engaging with you, but when the consumer insists on enforcing their own personal policy in the opposite direction such as refusing consent to recording or feeding your PII into some opaque AI system, suddenly it's a problem.

deleted 7mo ago

[deleted]

k2xl 7mo ago

I think the post conflates two issues: 1. AI-generated charting. 2. The existence of a reliable record of the visit. I am skeptical of the first in some cases (i.e. bias), but strongly in favor of the second. My father is 80 and has Parkinson’s. He routinely leaves appointments unsure of what the doctor said, what changed, or what he is supposed to do next. Even when I attend with him, we sometimes disagree afterward about what exactly was recommended. This happens with pediatric appointments too. My wife and I occasionally remember instructions differently: medication timing, symptoms to watch for, when to call back, whether something was “normal” or needed follow-up. That is a care quality problem, not just a convenience problem. The risks are real: privacy, consent, retention, training use, liability, and automation bias. But those argue for strict controls, not for a blanket refusal. Make it opt-in, give the patient access, prohibit training without explicit consent, keep retention short, and require clear auditability. I do not want opaque AI quietly rewriting the medical record. But I also do not think “everyone relies on memory after a stressful 12-minute appointment” is some gold standard we should preserve.

ranger_danger 7mo ago
Have you tried recording the interactions with doctors for your own benefit?
- k2xl 7mo ago
  Yes. It was great for when I had a major surgery last year and had a bazillion questions for the surgeon. But I don't always remember to. My parents definitely don't even think about it.

nubinetwork 7mo ago

Dead link (or it was?)

adit_ya1 7mo ago

Almost every point follows the same structure: > "Here is a real concern about implementation" → "Therefore you should refuse entirely" This skips the middle step of "therefore we should implement it well." I'm not convinced that we should be allowing doctors to record patient visits at this stage yet, but I'm really not convinced by these points, which largely don't hold up under closer examination. A few that stuck out: "Privacy" - Labs are routinely sent to third-party companies, and we don't do informed consent for that. The third-party argument isn't unique to recording. "False promise of efficiency" - This doesn't really have anything to do with patients at all. It's a criticism of medical office management, not of physician-patient interactions. Telling patients to refuse a tool because management might exploit the productivity gains is asking patients to fight a labor battle on the provider's behalf. "Consent can't be revoked mid-visit" - Consent typically can't be revoked in the middle of an appendectomy, or halfway through administering a vaccine either. Practical irrevocability is a normal feature of informed consent, not a special problem unique to recording. Proper consent processes in medical offices are a broader issue than consent about voice recordings specifically. Had the authors made the point that providers are being asked to obtain consent for tools whose technical implementation and privacy risks fall outside the provider's own domain knowledge — that would be a stronger argument. But that isn't quite the point they made, and their current framing doesn't wholly convince.

afandian 7mo ago
I think the "therefore we should implement it well" is not forgotten, it's elided because we don't think it's likely to happen. Tech-naïve people think that we can build super duper encryption systems. The more jaded amongst us know that people can get sloppy or complacent, it's rare to see a regulatory system that truly incentivises good practice, data breaches will happen eventually, and no-one will be held accountable. This is a big one in recent memory: https://www.theguardian.com/uk-news/2020/jun/10/babylon-health-data-breach-gp-app-users-able-to-see-other-peoples-consultations https://www.theguardian.com/uk-news/2020/jun/10/babylon-heal...
parliament32 7mo ago
> Labs are routinely sent to third-party companies Labs are real businesses that do real things, and would have actual impact for a breach. Meanwhile any idiot can vibe-code a thin shim between a microphone and ChatGPT in a weekend, promise they're HIPAA-compliant, and start selling. Medical professionals have no obligation to do any diligence, and there's no reason for them to not just buy whoever-is-cheapest. They're not even close to the same thing.

kube-system 7mo ago

There might be some real concern about the cognitive and patient-interaction impacts of speech recognition being used... but on the other hand, it's more likely that details are missed when information is captured manually. And the privacy/informed consent concerns here are silly, they apply to any of your charted data... and if you're going to any office that doesn't use the latest technology, your patient information is probably being sent between offices over fax anyway.

burnte 7mo ago

I'm a healthcare CIO of 12 years, and I've evaluated 4 and deployed 2 of these tools, one of which is currently deployed at my currently healthcare employer. I am very measured on AI but the results I've seen from these virtual scribes is HUGE. In every case we have IMMEDIATELY seen improvements in patient NPS scores, provider satisfaction, and note quality. Notes are more standardized as well as more verbose and detailed, which makes it easier for future providers to understand the case. These better notes reduce our claim rejection rate. And what converted me was direct patient response. Across the board patient feedback is extremely positive, with the most common comment being along the lines of "I really felt like the doctor connected with me better and they were more present in the visit." These AI scribes really DO improve patient care, I've seen it with my own eyes.

t-kalinowski 7mo ago
Counterpoint from a doctor: https://substack.com/inbox/post/189714240 https://substack.com/inbox/post/189714240 Scribes _feel_ good in the short-term, but it's not clear if they're actually good on longer time horizons.
- razingeden 7mo ago
  the two places they come in handy: 1) in the event you find yourself partially or totally disabled but the records don’t really make a good case for it and your provider has a dismissive attitude about filling out additional documentation to substantiate what they failed to in your records. You’re not necessarily going to get approved for FMLA, STD, LTD, SS etc based on a diagnosis or test results alone. They will nitpick over say, heart failure, as if that’s magically and spontaneously going to go away. If you’re telling your provider that you’re limited by things like oh I don’t know, “I’m only awake for 2-4 hours before I need to sleep again” or “some days I just can’t do it and sleep 20 hours” but it’s not in your chart… expect denials and clarifications and a huge burden on you to prove why it’s limiting. 2) continuity of care, so you don’t end up explaining everything from the top to a specialist or having them run all these tests and procedures from square one — when there’s months long backlogs , and we already did all this and you need treatment - but - there wasn’t much to work with in your referring chart. You might not appreciate the “intrusion” if you’re healthy and just worried about your privacy. If/When things go south and you find yourself fighting these entities for a year or two or three while they nitpick and delay and deny and drag their feet , you’ll be glad an “AI” kept up meticulous records because this is phenomenally stressful and an endless burden on you when they don’t. So, their AI slop can vomit out all this extra info on why insurance companies should pay them or why your condition is in fact disabling, and now their AI slop can comb through it looking for all that. Because they will try to avoid paying or approving any kind of leave or benefits if it’s not there And god forbid you hand them a form where they’re being asked to explain themselves. 50/50 on them being eager to help out or rolling their eyes and saying something really nasty about the imposition. And then even when they do that, they almost never file a copy in your chart so your chart STILL doesn’t substantiate your claims. I’m all for an “ai” doing the progress notes in a case where the facility or provider can’t be fucked to do so. Happily that’s not true of my current provider, who just, does that anyway (?) But I’ve been around enough to know they’re an exception. Even when providers are on your side and mean well, and want to bend over backwards to help you in any way they can — and I want to just acknowledge that’s the situation I’m in today — honestly , sometimes they just forget some of the details when they do their notes. That’s why some places make the provider do it in real time while they’re talking to you, so they didn’t forget something relevant thirty minutes later. The other side of the coin here may be that some providers find that distracting or off putting to be typing away like a stenographer while they’re examining you… I think it would be fair to say this can all be tedious and a burden for both patients and providers. There’s just a world of difference between a provider who wants to do this to provide excellency in care, and a provider who wants to do this because they resent it and think it’s beneath them.

varispeed 7mo ago

I always agree if this is for academic purposes, if it helps with research etc. I can't see why I shouldn't. We are just meat that will expire one day.

xxpor 7mo ago

This was extremely unconvincing for me. The site is now 500ing for me, so I can't fully quote it, but the arguments about privacy just fall flat. You don't know about Epic's, or GE's, or Philips' security either. You have to trust the institution of HIPPA et al overall to at least make things right. I really don't care if my recording becomes training data. I would rather be spoken to like I'm not an idiot. Use technical terms please. I want precision. Calling the US healthcare system underfunded might be the most wild part of the whole thing. We spend 5.3 trillion dollars a year. That's 17% of the entire economy.

jll29 7mo ago
> You don't know about Epic's, or GE's, or Philips' security either. The argument that a new vendor's security is probably not worse than others misses the point that by opting in, there is one more database/vendor/server where sensitive data about you resides, and which eventually will get hacked. It's usually just a question not whether, but when. For instance, in the UK, on this very day news reported half a million British people's medical data has been offered for sale on Alibaba, the "Chinese E-Bay". Trivial security advice is to "reduce the attack surface", i.e. to reduce the chances of getting hit by reduce one's presence in places where personal data is concentrated (thus making an attractive target for hackers). For example, when the German healthcare system launched its central electronic patient record, I opted out. One more system that, once hacked, won't have anything on me stored in it.
- xxpor 7mo ago
  >For example, when the German healthcare system launched its central electronic patient record, I opted out. One more system that, once hacked, won't have anything on me stored in it. I'll be sure to say a prayer at your funeral when you died due to an unknown drug interaction because of the lack of knowledge of your medical history in the emergency department of the random city you happen to be traveling through and get in a car accident. I don't think people are good at estimating tail risks, let alone the 2nd order effects of them. If you opt out of the AI transcription, do you think the doc will spend a bunch of time doing it by hand for free? No, you'll just have a worse record.

impatient_bacon 7mo ago

Oof yea I just got surprised by this at a vet appointment for my dog, weirded me out. I just went along with it to get the visit over with and I can see the benefit of having an accurate record of the visit, but we'll have to come to terms to the reality of this invasive surveillance as a society at some point I imagine.

dlcarrier 7mo ago

I'm more concerned about a record being made in general, than how it is made. If were to be affected by a tragedy and visit a psychologist or psychiatrist to receive support, it would likely require a diagnosis of depression to get insurance coverage, and having that on my record could make it more difficult and costly to legally fly an airplane or own a gun, and who knows what else.

titanomachy 7mo ago
This is an insane attitude. Get help if you need it. Having periods of depression on your medical record doesn’t make your life more difficult, unless maybe you’re trying to be a spy or an astronaut or something.
- kelnos 7mo ago
  This is actually a problem with e.g. airline pilots. They'll hide conditions (especially mental health issues) that they know could trigger a suspension or re-evaluation of their ability to fly. Even if those conditions are entirely treatable and wouldn't actually affect their ability to fly during/after treatment. So your statement is factually incorrect: in some common professions, your medical record can make your life significantly more difficult.
  - AngryData 7mo ago
    Yep, a bipolar diagnosis will get a commercial pilot grounded for life so they avoid any diagnosis or treatment even if it would help them immensely. And I certainly don't feel safer knowing pilots are avoiding mental health care.
- dlcarrier 7mo ago
  It's insane that anyone should have to have that attitude, but also completely reasonable. A Germanwings pilot killed himself and everyone on his flight, because he didn't seek treatment for depression, as he was expressly warned that regulations require he lose his job and be banned from his career, for doing so. The regulations intent was to keep suicidal pilots from flying, but in practice its primary effect is to keep suicidal pilots from seeking official care. The same is true for gun possession in multiple US states, which can preclude those who carry a gun in the line of duty from working in their careers. Air traffic controllers and EMTs are often affected by similar regulations as pilots and officers, too. There is a significant push in many jurisdictions for stricter health limits on drivers licenses, and we could easily end up with similar regulations there.

deleted 7mo ago

[deleted]

the_gipsy 7mo ago

I live in a country with free public healthcare. In a recent doctor's visit, the doctor was interviewing me while a nurse was typing into the computer. Presumably so that the doctor would have more time to attend patients and so that she wouldn't get distracted. It's fascinating how this translates to the idea that in the USA, this should mean "more time with patients", but in reality also means "more patients", but is somehow bad because the is a monetary drive.

jimbokun 7mo ago
The big AI companies are in deep trouble if the general public ever figures this out.
jrockway 7mo ago
Doctors have always been into "more patients", though. To some extent, if you're a doctor, the upper bound on your pay is how much you charge * how many patients you see. This is why you occasionally get seen well after your appointment time; people are double booked because some % reliability doesn't show up, but sometimes everyone DOES show up to their appointment and now it's your problem. So if AI scribes mean "less double booking" then that's kind of a win/win. Less patient time is wasted. Doctors can make more money by seeing more people on a given day. Seems fair.
- kelnos 7mo ago
  That's not how it works, though. People/companies that find efficiency gains don't sit back and relax the rest of the time. They do more work with the extra time they have. So in your example, they'll continue to double-book, and reduce the total time spent with each patient (since they can be more efficient with each patient) and book more patients per day.

cromka 7mo ago

This is seriously a good example of a domain that should enforce on-premises AI. Doctors absolutely can afford to buy an NVIDIA workstation. Transcribing text is not exactly super demanding, comparatively speaking. When did we even stop considering non-cloud services? If AI boomed 10 years ago, we wouldn't even be discussing this.

Matumio 7mo ago
I know some European "automatic scribe" projects of the government sector. Their IT buys a physical GPU server hosted locally. Pretty sure it wouldn't be accepted otherwise (or maybe I'm just naive, but it sure is a topic they care about). The software stack is mostly open source, I think. It sure as hell doesn't talk to a big American cloud provider. (Well, the transcription service doesn't. Who knows what they do with the automated transcript. Probably the same thing they did with the manual transcript.)
ButlerianJihad 7mo ago
Physicians, like lawyers, may still understand enough Latin to know what "invidia" means, and therefore never touch that crap with a ten-foot-pole. https://en.wiktionary.org/wiki/invidia#Latin https://en.wiktionary.org/wiki/invidia#Latin Sent from my Chromebook with Intel® iRIS® Xe Graphics
quantumwoke 7mo ago
It's not just transcribing text, there is also a post processing step to turn it from an interview transcript into an actionable summary.

daedrdev 7mo ago

HIPPA exists and has a lot of teeth. Given this extensive liability, I trust that if anything does go wrong they will be punished. Recordings might dramatically improve patient outcomes, and so I will let them

bonsai_spool 7mo ago
HIPPA does not exist. HIPAA has laughably vague rules. It's not protecting much, and you probably have better protection through tort law wrt your private information.
parliament32 7mo ago
HIPAA enforces nothing other than a pinky-swear-promise of compliance. There are hundreds, if not thousands, of middlemen who sell SaaS like this to medical professionals. If one suffers a breach then shuts down, your doctor will just switch to the next one in line with no consequences because "they promised they were compliant". Meanwhile all your medical details will end up in a public dataset forevermore.
carefulfungi 7mo ago
Until you need insurance. Or a professional license that involves a review of your medical record. Or the government just wants the data. Or the records are subpoenaed to be used against you in court. You are trusting that illegitimate uses of this data will be punished. However, there are many authorized uses that will hurt you in the long term. It is rarely to your advantage to accumulate extensive recorded medical records. Even pre-existing insurance denials could return in the US. Don't let systems record what they don't need. They aren't your friend.

jimt1234 7mo ago

This situation is real. I've had the same doctor my entire adult life (~25 years). We've got a pretty informal relationship. I even saw her hammered at a bar one night, and had to give her a ride home because her friends were also drunk AF. Anyway, a few years ago, during an annual checkup, she asked how my family was doing and I made a joke about my brother drinking too much. A few weeks later I started receiving pamphlets in the mail about treating alcoholism, ads for rehab centers. I just brushed it off, didn't make any connection. Then, the next year, during my annual checkup, my doctor wasn't available, so I got a different doctor, someone I'd never talked to in my life. She immediately started asking me about my drinking. I fired back, asking WTF she was talking about. She said, "Oh, well your file says alcoholism runs in your family.", and then started lecturing me about getting over the shame of alcoholism is the first step to beating it. I don't even drink. No one in my family drinks other than my brother. He was drinking a lot at that time because he favorite NFL team (LA Rams) was doing really well, and he was celebrating a lot. And it was just a joke. The next year, during my annual checkup, I gave my doctor a load of crap, telling her to record nothing I say unless I explicitly tell her to. She tried to defend the system, but she agreed. I'm still upset that my "file" still mentions alcoholism.

jll29 7mo ago
> "Oh, well your file says alcoholism runs in your family." Medics often use private notes when handing over patients, where they share information that the patients themselves are not intended to see (and in many countries, not permitted to see). In particular, such records are used to share warnings if patients have been in any way "difficult".

OutOfHere 7mo ago

Why do we even need to consult doctors anymore? Just let the AI decide. Docs should be freed up for up for doing physical tests and interventions, or otherwise for providing more training data for the AI in cases where the AI isn't producing results or when a second look is urgently needed in an emergency situation.

pavel_lishin 7mo ago

Down for me, but Internet Archive grabbed a copy: https://web.archive.org/web/20260424151739/https://buttondown.com/maiht3k/archive/why-you-should-refuse-to-let-your-doctor-record/ https://web.archive.org/web/20260424151739/https://buttondow...

jll29 7mo ago

Advice: Regardless of whether you opt in or out, you should only permit anyone to record you if you get a copy of the recording for your own records.

jcalvinowens 7mo ago

Honestly, my recent experience with this was really positive: the doctor actually said the technical stuff out loud to me for the first time in my life, in a way I could easily ask polite questions about and discuss with them. In my case it was something very not sensitive, removing a benign tumor in a finger, which I have no problem telling the whole world about (I was awake for the surgery and got to watch, it was a incredibly fascinating experience that I want to write more about some day). But I can imagine it would feel much more invasive if the subject were more sensitive.

tristanb 7mo ago

This is a really great way to get yourself worse care.

gitowiec 7mo ago

What a fucking absurd. I used to go to the shrink a lot. First it was a man, he never took any notes and he remembered everything. Second was a woman, she was taking notes but never had any problems with that!

moralestapia 7mo ago

Lol, this essay is missing (or starting from the assumption) that text-to-speech algorithms do a good work, even state of the art. That is far from correct and the main reason why I would oppose to this is that the AI might incorrectly record something in the transcript that completely derails my diagnosis and treatment. There's a big difference between: "I have had nausea for the past three days" and "I have not had nausea for the past three days" And I'm being generous with my example.

apparent 7mo ago

> But, especially given the underfunded nature of the US health system, that is extremely unlikely to mean more time with each patient. Instead, it will mean more patients. So that means if I try to make an appt, I'll have an easier time getting one? Sounds good, I guess.

0xbadcafebee 7mo ago

I think this is just humans not understanding things and irrationally being afraid of one thing more than another thing. You're afraid of someone listening to you; you're not afraid of someone copying the documents that detail every single aspect of your health (EHR records). Healthcare records are probably the most strongly protected personal information in the world. Remember that most of the data about you is not protected by law. Credit reports, ISP records (including your SS#), your entire email archive, Google Drive, etc could get leaked, and for the most part there's no legal consequence. But if a record of you having the flu in 3rd grade gets leaked by a 3rd party connected to health record keeping, there are real consequences (not only for the leak, but even for not reporting it). If anything, I want everything I say to be recorded and kept on file for later reference. The danger of speech-to-text engine transcribing incorrectly is real, but that doesn't mean I don't want the notes there. I just want the audio included with the text. Both will be useful to refer to later on, especially as STT models improve their accuracy (we've seen amazing leaps in accuracy in just 1 year). However, we do need to ensure that these records are protected from government over-reach. Currently the government can request your health records, without notifying you, for a slew of reasons. This enables the government to go on a fishing expedition, doing the equivalent of an unreasonable search of private information, and you will have no notification and no way to respond. We must create laws that provide stronger privacy rights for sensitive health information to resist government overreach. Another legal hole is 3rd party apps that collect sensitive health information, but aren't provided by your doctor. Your step-tracking, heart-monitoring app is not protected by HIPAA. Same for employer health records.

dawnerd 7mo ago

I have been loving my new doctors recording and making everything available in the patient portal. No more trying to remember what they said. That’s huge, especially when dealing with elderly patients and being able to have their caregivers have access to it.

rolph 7mo ago

a premptive notification to health care team. "to whom may be concerned." [Doctor Stan dinghere, as a patient i have no trust or confidence regarding the security and integrity of my personal information in regards to AI scribing. for this reason i will scribe for you, as that is the most accurate account of what i intend to communicate with you. i will refrain from verbal communication and will provide on the spot written communication with respect to health care interaction. ]

croisillon 7mo ago

my boss fell in love with a software that invites itself to team calls, then retranscripts and summarizes... so the whole office has that automatically in ; once in a while my colleagues and i look into that report, it's sometimes hilariously wrong, most of the times just useless

ivraatiems 7mo ago

It's definitely NOT a false promise of efficiency, at least, not in all or many cases. My wife is a physician, and when permitted by patients, uses one of these tools. It's been an enormous time-saver for her. She works a 32-hour week, meaning 32 hours of seeing patients. Before these tools, she was regularly spending an extra 8 to 16 hours, e. g. two full work days, writing notes and sending messages. That time has been more than cut in half. She would never give up the tool if she didn't have a choice. According to her, it is reasonably accurate, but all notes must be manually reviewed (not just as in her organization requires that, but also as in if she didn't, it would be obvious due to its mistakes). The biggest issue is with things like names and medications, stuff that isn't present in ordinary English, as well as mishearing the results of diagnostic tests, numbers, etc. It's rare for patients to refuse it.

16bytes 7mo ago

This is absolutely horrible advice. If you do this you will over time experience worse health care. Documentation errors have always been an issue. They were when there were paper charts, or human transcriptionists, or when manually typing into the EMR, or when using speech recognition (which is AI/ML!) to do the typing for you. Not all e-scribes use LLMs, but most of them do rely on ambient audio recordings for speech recognition, which nowadays runs entirely locally. That text then needs to be processed into your clinical documentation, and there are tons of ways to do that (including LLM processing). The author has obviously never talked to clinicians or hospital administrators about the challenges of maintaining clinical documentation, and knows little to nothing about the reality of software that runs in clinical contexts.

randusername 7mo ago

In the US the purpose of the portal and all the typing and record-keeping is insurance justification and liability. This is probably not the reassurance anyone wanted to hear if they were worried about crap transcriptions leading to crap care. This is my absolute least favorite category of AI innovations: people patting themselves on the back for becoming more efficient in their inefficiency.

ares623 7mo ago

Can you say "No thank you. But can I record this conversation myself?"

hoherd 7mo ago

Just today Claude admitted to me that it may have hallucinated a detail in a response when I asked about it. Do you want that possibility in your medical record?

AbstractH24 7mo ago

There’s only one speciality i mind the use of AI - psychotherapy. In that case, I’m paying them to engage with and observe me. Not to identify the correct treatment plan based on a variety of different data points (tests, my history, family history, research, etc) And even in psychotherapy I have no problem with a LLM being used to compile notes after the session. Just don’t want it present in the session and used for analyzing it. (My therapist asks me almost once a month if I’d mind. I thought it was because my notetaker is entering the Zoom meeting, but last week I called him out cause I was almost certain I disabled it. Curious if he’ll ask again.)