“To paraphrase health policy expert Timothy Hoff, there is a fight going on for the soul of health care, and primary care is at the center of the struggle. In the United States, we face an unresolved tension between two conflicting visions: Does our society want an empathetic, highly relational care delivery system built around primary care and trusting relationships, or, as Hoff puts it, “a more efficient, convenient, and highly transactional care delivery system, impersonal and built on algorithms, health care corporations, and technology”?
[..] Increasingly, health care organizations and information technology vendors, recognizing the need to better support clinicians, boast that they can ease the pain and save physicians’ time by offering AI [artificial intelligence] solutions to note writing. But I worry that unless additional protections are put in place, our institutions will use AI-generated documentation the way they’ve used other labor-saving technologies — as justification for increasing the numbers of patients we are expected to see, a tactic deployed by health care organizations in the past when human medical scribes were introduced to facilitate documentation. [..]
I recall being horrified when, several decades ago, I began seeing residents’ notes stating “social history negative ×3” (presumably referring to cigarettes, alcohol, and nonprescribed street drugs). At first, I thought it was just a matter of a few insensitive trainees, but such dehumanizing shorthand soon became standard for all resident notes about inpatients. I asked my residents whether patients had no other social existence — nothing to note about where and with whom they lived, what they did for work or fun, what they liked? AI’s sharp ears can effectively hear and transcribe my entire conversation, but like my residents, it decides what is or is not important, and currently there’s no way I can tell it that I am a primary care doctor who would like to include more humanizing “chitchat.”
[..] in addition to missing often meaningful social history, I worry about the loss of the cognitive space for crafting diagnostic assessments and plans in my own words, especially since I know that patients are now reading them. The assessment and plan are the most important part of the note, but this opportunity to reflect is lost when we automate the process.
Given the time pressures on clinicians, AI documentation is an unstoppable tsunami, a wave that will wash over our work lives, with no way of turning it back. Perhaps there will be technical “fixes” to help the virtual AI creature in my exam room better sort the wheat from the chaff, or learn my charting preferences. What is less likely is that primary care physicians will be able to regain control over our relationships and the means of production of our notes without a fundamental shift in the balance of power — a concerted move away from a corporate-controlled, transactional, assembly-line model toward a more patient- and clinician-centered redesign of primary care.”
Full article, GD Schiff, New England Journal of Medicine, 2025.5.10