Sean was fast, but, despite his fingers flurrying across the keyboard, he couldn’t keep pace. There were awkward pauses, his patient left hanging on the line while he typed, and plenty of disjointed occasions when he had to ask her to repeat herself because his attention had lagged behind.
“What are medical notes for?” I asked, when he’d finished the call. This was a couple of years ago, and I was sitting in with Sean for a training shift. We decided medical notes should be a record of a doctor’s thinking: the differential diagnosis and management plan, together with the salient positives and negatives that had led to those conclusions, including the patient’s ideas, concerns and expectations. What they shouldn’t be is a verbatim transcript.
“Try listening,” I suggested. “Save your typing till the end – by then you’ll know what the important stuff is and that’s all you’ll write down.” He emailed a while later, saying both the quality and speed of his consultations had been transformed. What he had thought of as a time-saving technique had been counterproductive.
I’ve thought of Sean since moving to Canada, where I’ve been trying out an “ambient scribe”. The AI software listens to a consultation and produces a distillation. It’s impressively capable of disentangling the multiple problems raised during a typical encounter and ordering things into a logical structure. A couple of my new colleagues are big fans and employ it routinely. Despite the apparent wizardry, though, I’ve stopped using it.
I’ve not noticed it omitting anything crucial, but it suffers from what I think of as Sean Syndrome – the notes it produces are verbose and formulaic. Lots of information, not enough clarity and meaning. I find myself having to insert my deliberations: how and why I came to the conclusions I did; why I decided on one course of action and discounted other possible options.
And it is not to be trusted. Canadians are a friendly lot and most of my patients are keen to know my story; I’ve lost count of the number of patients it has asserted have recently moved here from the UK. Like nature, it abhors a vacuum. I’ve caught it recording findings of examinations I haven’t performed and detailing advice I haven’t given. The company that makes it advises users to check its output carefully. For me, the time spent reading and editing outweighs any productivity gains.
Ambient scribes appear to be a central plank of the UK government’s new ten-year plan for the NHS, their time-saving potential mooted to be the equivalent of recruiting 2,000 GPs. Anything that enables clinicians to focus on properly communicating with their patients is to be welcomed, but the technology is currently too unsophisticated to improve productivity. Doctors will need to invest time and effort to ensure accuracy and relevancy to the output, or else patient records are going to become weighed down with screeds of formulaic verbiage spiced with the occasional AI hallucination.
The enthusiasm for ambient scribes reminds me of the brouhaha when symptom-checker apps such as Babylon’s “GP at Hand” appeared eight years ago. The then health secretary, Matt Hancock, excitedly envisioned a future in which human doctors were barely needed – arguably a factor in why the Tories were complacent about declining GP numbers.
Patients, too, are soon to be tech turbo-charged. Wes Streeting, the current Health Secretary, recently announced that the NHS app is to incorporate a “My Companion” tool. This will provide generic information about diagnoses and procedures – all readily available on the internet now – but AI-augmented to prompt and guide patients with questions to ask during their consultations. If only there were some way of getting both AIs to talk directly to each other. They could be left churning out reams of formulaic questions and answers, and filing the resultant material to the records to be ignored. Doctor and patient could, meanwhile, return to communicating, connecting and collaborating as unique and complex human beings. You never know, we might get a whole lot more done.
[See also: Just raise tax]
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This article appears in the 09 Jul 2025 issue of the New Statesman, The Harbinger