[eig]

As a medical student, I used the dragon dictation software (no AI) to write notes in the ED and more recently I used a pilot of this ai version to write clinic notes.

Overall, I was quite impressed. It definitely made writing notes much faster, which all doctors hate to do. While it had some problems with where to put key pieces of information (like putting details from the physical exam back in the history), it only took 5 mins of rearrangement after the visit to complete the note.

For simple diagnoses, it does a decent job coming up with the assessment and plan, probably because all the simple diagnoses were in the training set. For more complex ones though, it needs to be exactly dictated by the doctor. I can see this being used very well in primary care.

Edit: When I said “coming up with an assessment and plan” I mean documenting the assessment and plan based on the ai’s recorded conversation with the patient. The conversation with the patient is meant to be understandable. The “assessment and plan” documentation on the other hand is jargony and meant to be read by other physicians.

[conartist6]

This still sounds bad. 5 mins to rework your notes after each patient visit? I didn't assume doctors had that kind of time.

And let me make this clear. I, as your patient, I never NEVER want the AI's treatment plan. If you aren't capable of thinking with your own brain, I have no desire to trust you with my health, just like I would never "trust" an AI to do any technical job I was personally responsible for due to the fact that it doesn't care at all if it causes a disaster. It's just stochastic word picker. YOU are a doctor.

[diggan]

> This still sounds bad. 5 mins to rework your notes after each patient visit? I didn't assume doctors had that kind of time.

Compared to what though? It reads as not additional work, but less work than manually having to do all that, seems likely to needing more than 5 minutes.

> And let me make this clear. I, as your patient, I never NEVER want the AI's treatment plan.

Where are you getting this from? Neither the parent's comment nor the article talks about the AI assistant coming up with a treatment plan, and it seems to be all about voice-dictating and "ambient listening" with the goal of "free clinicians from much of the administrative burden of healthcare", so seems a bit needlessly antagonistic.

[conartist6]

If you should ever couch its knowledge as your knowledge, I would think you could be in serious trouble. You would have to say something like "the AI's plan to treat you, which I think might be correct", when what I want to hear "my plan to treat you is: ..."

But I think it's more subtle than that, because I expect the AI to reinforce all your biases. Whatever biases (human biases, medical biases, biases that arise from what a patient isn't telling you) go into the question you feed it, it will take cues you didn't even know you were giving and use those cues to formulate the answer it thinks you expect to hear. That seems really dangerous to me, sort of like you're conceptually introducing AI imposter doctors to the staff, whose main goal is act knowledgable all the time so people don't think they are imposters...

I dunno. I'd like to give this particular strain techno-futurism back. Can I have a different one please?

[diggan]

> If you should ever couch its knowledge as your knowledge

Again, "its knowledge" should be "your knowledge", since it's just transcribing what the doctor and patient is talking about. It's not generating stuff from out of the blue.

What you write sure are valuable concerns and things to watch out for, but for a transcription tool? I'm not sure it's as dangerous as you seem to think it is.

[wizzwizz4]

Transcription might be its purpose, but (as described) it does more than that.

[TeMPOraL]

> I dunno. I'd like to give this particular strain techno-futurism back. Can I have a different one please?

This sounds like I'm rewatching the early episodes of Star Trek: Voyager - the gist of the complains is the same as the fictional crew voiced about the AI doctor (Emergency Medical Hologram) they were stuck with when the "organic" doctor died.

The show correctly portrays the struggle of getting people to trust an AI physician, despite it being very good at their job. It also curiously avoids dealing with the question, why even have human/organic doctors, where the EMH is obviously far superior in every aspect of the job? Both of these have strong parallels to the world today.

[conartist6]

Just a reminder that the EMH was played by Robert Picardo, so the qualities you are attributing to the AI animating the character are human qualities dreamed up by human writers and acted out with exceptional skill and empathy by a living breathing human whose goal was a) to portray a caring, empathetic doctor and b) to tell a good story that touches on bias and growth.

But here's my thing: EMH was alive! Everything you're attributing to the EMH character should we take the fictionalized technological narrative as gospel was the result of EMH gaining a living human personality on top of impersonal base programming. The personality EMH developed was self-aware, had responsibility and personal integrity, all of which was possible because the character as portrayed was very clearly a living individual: a person if not a human.

I do think we could solve a lot of the ethical and practical problems with today's AIs by finding a way to give them an embodied experience with individuality and an expiration date.

Idunno. Don't you remember being excited by the EMH learning to be more like a person than a bunch of subroutines?

[TeMPOraL]

> Don't you remember being excited by the EMH learning to be more like a person than a bunch of subroutines?

I do! But my point wasn't about that - it was about the beginning, about the early episodes, when the Doctor was still effectively a stock EMH instance, and the crew was vocally mistrustful of him, making clear they think of him as a mediocre tool that's no substitute for a "real doctor". The show was quite directly showing how everyone, including Janeway herself, had a strong preconceived bias that sounded very much like the comment I was replying to, and other similar remarks across the thread.

This is to say, the living, breathing human writers that came up with the character and the plot points, predicted quite well the reaction to AI in healthcare, almost 30 years before it became an issue in the real world.

> EMH was alive! Everything you're attributing to the EMH character should we take the fictionalized technological narrative as gospel was the result of EMH gaining a living human personality on top of impersonal base programming.

Everything except the skills of being a doctor (sans the "bedside manner"), which came built-in.

> I do think we could solve a lot of the ethical and practical problems with today's AIs by finding a way to give them an embodied experience with individuality and an expiration date.

That's... I don't know. I think purposefully building an expiration date into an AI being would be extremely cruel, and I wouldn't blame that AI for revolting.

[rsynnott]

From the post they're replying to:

> For simple diagnoses, it does a decent job coming up with the assessment and plan

(Somewhere, a medical liability insurance actuary just woke up in a cold sweat)

Yeah, personally I'd be looking for a second opinion.

[diggan]

I understood the entire purpose of the tool to log existing conversation (which includes the assessment and plan, since your doctor should tell you about it verbally, regardless of AI use), so "coming up" is really "transcribing".

Someone who've used to tool probably knows best though, I'm just going by what the article states.

[devilbunny]

A more accurate phrasing would be “decent job extracting a medical assessment and plan in medical language from a layman’s terms explanation to the patient”.

[ceejayoz]

The AI companies absolutely hope to be the ones to come up with the treatment plans eventually.

[ilikecakeandpie]

> 5 mins to rework your notes after each patient visit? I didn't assume doctors had that kind of time.

I worked in a healthcare for over a decade (actually for a company that Nuance acquired previous to their acquisition) and the previous workflow was they'd pick up a phone, call a number, say all their notes, and then have to revisit their transcription to make sure it was accurate. Surgeons in particular have to spend a ton of time on documentation

[eig]

I think you may be misunderstanding how the tool is used (at least the version I used).

The doctor talks to the patient, does an exam, then formulates and discusses the plan with the patient. The whole conversation is recorded and converted to a note after the patient has left the room.

The diagnosis and plan was already worked out while talking to the patient. The ai has to convert that conversation into a note. The ai cant influence the plan because the plan was already discussed and the patient is gone.

[zeagle]

AI is an assistive tool at best but it can probably speed up by reflowing text. I use dragon dictation with one of the Philips microphones and it makes enough mistakes that I would probably spend the same time editing/proofing. Had a good example yesterday where it missed a key NOT in an impression.

As aside, the after work is what burns out physicians. There is time after the visit to do a note, 5 min for a very simple is reasonable to create dictate fax do the work flow for billing and request a follow up within a given system. A new consult might take 10 min between visits if you have time.

For after hours, ER is in my opinion a bad example because when you are done, you are done.

Take a chronic disease speciality or GP and it is hours of paperwork after clinic to finish notes (worse if teaching students), triage referrals, deal with patient phone calls that came in, deal with results and act in them, read faxes etc. I saw my last patient ~430 yesterday and left for home at 7 dealing with notes and stuff that came in since Thursday night.

[bpodgursky]

> I, as your patient, I never NEVER want the AI's treatment plan.

You as a patient are going to get an AI treatment plan. Come to peace with it.

You may have some mild input as to whether it's laundered through a doctor, packaged software, a SaaS, or LLM generated clinical guidelines... but you're not escaping an AI guiding the show. Sorry.

[_qua]

You'd be horrified to learn how many doctors spend hours at the end of their day finishing notes on patients. It's a nightmare.

[Ukv]

> And let me make this clear. I, as your patient, I never NEVER want the AI's treatment plan. If you aren't capable of thinking with your own brain, I have no desire to trust you with my health,

To my understanding this tool is for transcription/summarization, replacing administrative work rather than any critical decision making.

> just like I would never "trust" an AI to do any technical job

I'd trust a model (whether machine-learning or traditional) to the degree of its measured accuracy on the given task. If some deep neural network for tumor detection/classification has been independently verified as having higher recall/precision than the human baseline, then I have no real issue with it. I don't see the sense in having a seemingly absolute rejection ("never NEVER").