I Tried Out an AI Scribe. My Advice? Temper Your Expectations

I’m Dr Kenny Lin. I am a family physician and associate director of the Lancaster General Hospital Family Medicine Residency, and I blog at Common Sense Family Doctor.

Two months ago, I began using the Nuance Dragon Ambient eXperience (DAX) Copilot, an ambient artificial intelligence (AI) scribe that my health system offered to its primary care clinicians. Colleagues who had participated in a pilot of the tool assured us that it was easy to use and would save us lots of clinical documentation time. 

A recent American Medical Association survey found that a majority of physicians ranked “addressing administrative burdens through automation” as their top priority for the use of AI in practice. Ambient scribes can allow physicians to give their full attention to patients and reduce time-consuming after-hours work by drafting office notes, and AI may eventually save even more time by generating replies to patient portal messages and retrieving unstructured data from electronic charts — which can be as difficult to navigate as the paper charts of years past. Administrative overload has driven many talented primary care physicians out of medicine prematurely. 

In my two decades of practice, I have been fortunate to usually finish my notes before leaving the office. My motivation for trying out the AI scribe wasn’t to save time or cognitive work, but to satisfy my curiosity about what it could do. As someone who enjoys writing, I take a certain pride in my ability to turn a disorganized conversation that touches on multiple issues into a clean, problem-oriented narrative that the patient or another clinician can easily follow. Could AI accomplish this task?

For my first test case of the AI scribe, I met with a retired physician whom I had befriended years before he became my patient. We spent at least half of the visit catching up on vacations and our children’s activities. When we got around to what brought him to the office, we continued in a kind of shorthand, relying on shared knowledge from a prior visit. I thought my scribe wouldn’t be able to make heads or tails of the conversation. 

As it turned out, I underestimated the scribe! The resulting note required some editing, but the software correctly selected and organized the essential clinical details. However, that positive first impression was gradually tempered by subsequent experiences. 

I have minor complaints. Although I instructed the scribe to use a bulleted notation that vaguely resembles my own clinical notetaking, the format it uses is so generic that I can no longer tell the difference between my notes and those of my colleagues who are using the scribe. Also, its efficiency at filtering out everything that it doesn’t consider medically relevant directly conflicts with my longtime habit of deliberately including personal information in the note (eg, “patient’s daughter is expecting their first grandchild next spring”) so that I can ask about it next time. Studies that have evaluated physicians’ experiences using this particular scribe have reported similar benefits and reservations.

Further, the scribe hasn’t actually saved me any time. I've found that the AI scribe is best suited for visits with patients who have several chronic or acute problems. In this setting, it can confirm or correct my imperfect recall. But frankly, I don’t need or use it for visits with built-in templates like well-child checks and preoperative evaluations, or for simple problems like colds or back pain. I also can’t use it for visits that require an interpreter (though I hear that a version that recognizes Spanish is in the pipeline).

If your practice or organization plans on implementing an ambient scribe, I'd recommend having reasonable expectations. Be prepared to sacrifice some of your "voice" in exchange for less time spent typing. Make sure that each note accurately reflects your clinical reasoning and honors the unique qualities of each patient. And most important, advocate for AI to be one part of a comprehensive approach to improving work experience and preventing burnout. 

In the words of internist and informaticist John Thomas Menchaca, MD, "AI will not shrink ballooning patient panels or outmaneuver overloaded schedules. … Primary care clinicians will only reap the benefits of AI if it is implemented in organizations that sincerely prioritize clinician well-being and patient care."