Each physician is a author, or that’s what I used to consider. From the primary days of medical college, my classmates and I discovered how you can write, albeit for a specific function and in keeping with strict guidelines — a sort of writing that wasn’t essentially lovely, and even significantly fascinating. But it surely was writing.
I nonetheless have a few of these earnest makes an attempt from my first yr:
Ms. T was as soon as a daily attendee at her church, however she now limits her time exterior of the house as a result of she will be able to’t be away from her oxygen tank for various hours. (She has moveable O2, however doesn’t know how you can use it.)
Over time my notes developed (or devolved) from fastidiously wrought narratives to a template of fillable fields and checkboxes. (Location of lump: proper breast. Period: 1 week. Tenderness: none.) There’s merely no time for something however the naked details required by the billers, payers, and attorneys. It doesn’t matter what our attendings taught us, the affected person’s story is — alas — irrelevant.
However, the method of note-writing (what many extra precisely name “charting” or “documentation”) nonetheless has a degree. I might even argue that the method is the purpose — as a result of it forces me to decelerate, mirror, and make which means of the occasions and conversations that happen within the examination room, and the relationships I construct there. Till very lately, each physician, prefer it or not, had to do that work: the work of a author.
However now, immediately, we discover ourselves at a crossroads: For the primary time, many people have the choice to outsource note-writing to synthetic intelligence. A course of that when required devoted time and a spotlight (usually divided and rushed consideration) can now occur in actual time, with out us being concerned in any respect. For me, the erasure of this explicit, ritualized means of meaning-making represents a profound blow to the humanity of my work and my relationships with my sufferers.
Like most docs, I work at a quick tempo — not essentially by alternative — and my affected person encounters are extremely bodily and intimate. Even throughout a routine pap smear or a contraception seek the advice of, it’s commonplace for my sufferers to share deeply private details about their lives, typically to cry. (Weight achieve since menopause. Intercourse painful. Husband untrue greater than as soon as.) These aren’t the type of encounters the place I can discuss and kind on the identical time.
I’d, due to this fact, have develop into an early and enthusiastic adopter of the AI scribe, a know-how whose alleged function is to permit me to dedicate my undivided consideration to sufferers. Certainly, in a single managed care setting the place I apply, my colleagues are always praising their new AI scribes (which the management and administration have made extraordinary efforts to roll out over the previous yr), primarily as a result of the scribes “save a lot time.” Throughout the media and in dialog with different docs, a lot of the responses I hear are enthusiastic (albeit cautiously so).
However as a physician who may be very a lot a author, I really feel a way of dread and even grief at this new choice (or strain) to outsource my note-writing to AI. The note-writing course of — even clicking by means of these checkbox- and template-driven varieties — remains to be how I make which means of occasions, conversations, and relationships. Once I sit down to jot down a be aware, I’m greater than merely a technician who is aware of how you can carry out a process, interpret a lab consequence, or prescribe a medicine; I’m a human being who can combine my affected person’s story into what I do know in regards to the human physique and the human expertise, and who can distill that understanding into phrases. (Generally when the child cries, she needs to expire of the home and never come again.)
This course of doesn’t simply profit me; it additionally advantages my sufferers. A part of the work of nurturing any relationship — together with the doctor-patient relationship — happens exterior of the face-to-face interplay, when every celebration goes our separate methods. This solitary, intentional work can take completely different varieties for various individuals. As a physician, an vital approach I maintain and deepen my relationships with my sufferers is by writing about them. That is the very course of that the AI scribe asks me — or forces me — to surrender.
However what precisely would I be giving up? To be clear: I haven’t but tried utilizing an AI scribe, nor a human scribe, in my decade or so of apply, though I believe I could quickly don’t have any alternative. On the managed care setting the place I work, the eight-hour clinic day is split into back-to-back 15-minute appointment slots — with 4 15-minute “affected person administration” slots dispersed all through the day to permit clinicians to atone for documentation. As soon as AI scribes have been absolutely built-in into commonplace clinic workflows, it appears all too apparent what we are able to anticipate to occur to these “protected” chunks of time: They’ll disappear, solely to get replaced by 4 (or extra) further affected person appointments. Why ought to directors defend docs’ time for note-writing when we’ve AI scribes to jot down notes for us? Why, certainly, ought to we be paid to do something apart from these duties for which we are able to code and invoice: performing exams and procedures, prescribing medicines, ordering and deciphering checks? What worth is being positioned on my capability for reflection and meaning-making, and on my relationships with my sufferers? The reply is apparent: The worth of that point, and of that very human work, is being quickly lowered to zero.
Possibly not each physician is a author. Actually not all will mourn, as I’ll, the day they relinquish their note-writing to AI scribes. Some will proceed to make which means of their work in different wealthy and useful methods: instructing on morning rounds, main tumor board conferences, taking a stroll across the hospital car parking zone on the finish of a protracted day. They could even discover they’ve extra time for this stuff now that they will depend on AI to jot down their notes for them.
However for me, note-writing remains to be the place the meaning-making occurs—at the very least within the finite hours of my clinic day. It saddens me that the well being care system during which I work expects me, and should quickly power me, to outsource this profound, deeply human course of. I don’t consider for a second that this variation is about “defending” my time or sanity. I consider it’s about squeezing a couple of extra billable items from what stays of my treasured, solitary time during which to suppose, to mirror, to be human.
Christine Henneberg is a practising doctor and a author whose debut novel, “I Belief Her Utterly,” is forthcoming in Could 2025.
