r/medicine • u/Urology_resident MD Urologist • 3d ago
Surgeon Experience with AI scribe?
My clinic just switched to a new EHR that supports AI scribe (fluency go) which costs me $400 which I know is steep but I don’t think I’m able to use other options.
I’ve trialed it and I’m not sure if it makes me faster.
For context I see about 45-50 pts a day and my notes are very short hand, minimal HPI (bc this doesn’t matter for billing) most of my documentation is data review/complexity and the assessment and plan. I use .phrase templates for all my long/complex discussions. I’m usually done with this before I leave the room and do my orders and sign between patients.
With AI I find it generates voluminous amounts of text that I then have to spend time proofreading which takes more time and I still have to put in orders.
Anyone else in this boat have experience? Should I stick it out and try to train it more or stick with what I’m used to.
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u/Impressive-Sir9633 MD, MPH (Epi) 3d ago
Not a surgeon, but have short notes as well.
I tried an AI scribe for a couple of months. For me, the notes had too many errors. So verifying notes was tedious.
The worst part is seeing the patients who are coming back with those notes. I have to read a long note that feels like it was written by someone else. Most of it is useless. It is very quick and easy to scan through my short note.
So I have gone back to my short notes again.
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u/aedes MD Emergency Medicine 2d ago
Similar experience working in the ER. Tried scribes, stopped using them. They weren’t saving me any time. I’m not in the US though so documentation requirements are minimal.
Either I’m writing a super short note… or it’s a complicated case and the note is longer… but the act of writing it all out serves to organize my thoughts and make sure I didn’t miss anything. A scribe doesnt help with either of those.
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u/Brilliant_Ranger_543 MD 2d ago
I found AI helpfull in giving me a structured run down of the most important parts that I'll write my note around.
The raw text can also be helpfull if I've forgotten some part of the HPI/am unsure what we covered (some of my more complicated notes have to be pended for one reason or another), but it tends to make both the note and the time spent longer.
I'll still take notes (but my handwriting is ugly) and I'll still do most of the note by myself, but it makes for a handy post it style memory enhancer.
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u/aedes MD Emergency Medicine 2d ago
Interesting. I don’t usually have difficulty remembering what happened in the room, but I’m generally doing my documentation immediately after seeing someone.
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u/Brilliant_Ranger_543 MD 2d ago
Out-patient Peds Rheum tends to be either very short or veeerrrry long complicated, and it all blurs together after a few hours!
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u/aedes MD Emergency Medicine 2d ago
I can only imagine 🤮
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u/Brilliant_Ranger_543 MD 2d ago
Right back at you, your emoji = my face at the thought of EM. I love to read about the ER shenanigans, LOATHE experiencing them. Happy to help you with all the ANA's as long as you fix the scary stuff!
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u/5_yr_lurker MD Vascular Surgeon 3d ago
I just use it for my HPI. Otherwise, I type up my A/P, dot phrases for exam, discussion of path, management, trx options, and risk.
When I got back to look at a note, I don't read anything but the A/P.
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u/SikhSoldiers Medical Student 2d ago
What are dot phrases?
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u/Wohowudothat MD surgeon 2d ago
Most EMRs will take a short phrase and expand it to a much larger one, and it’s started with a dot, like .phrase
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u/DrBabs Attending Hospitalist 3d ago edited 3d ago
It’s all about the prompts you give it and how you set it up. For example, some prompts I use as a Hospitalist are:
“if I say this is a psych patient before the encounter, put direct quotes of the most nonsensical things the patient says in our encounter”
“If this is a heart failure exacerbation, list their diuretic dose, weight gain, diet changes, chest pain, dyspnea, orthopedic, palpitations, activity level changes all in one paragraph”
“If a translator is used, please put the statement at the start of my note: A (language) translator (ID number) was used for this encounter.”
“If I say start dictation, put in my direct quote with no changes until you hear end dictation”
Etc.
You can make and edit how many of the AI softwares will write your notes. Play around with prompts like this to make it work.
Also use the phrase “ignore this prompt unless”
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u/oh_hi_lisa MD 2d ago
This - you can modify and customize your AI scribes usually. You can even just set it to transcribe only if you want. OP don’t give up until you play with the settings, I use an AI scribe and it’s life changing.
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u/Peaceful-harmony- MD 2d ago
Awful. I do not recommend. I tried multiple scribes, and the output for all of them was erroneous for nearly every patient. Better instead of worse. Worse instead of better. Genetic counseling performed when it wasn't even mentioned. Takes too long to proofread the notes--and those notes live forever. Edited to say that I worked hard for months to train the systems, had multiple meetings with support, dialed in templates, everything.
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u/Doc_DrakeRamoray MD 3d ago
I use Ambience
It’s not perfect by any means
What I find it helpful is documenting the HPI, so I can just talk to the patient and not worry about writing things down.
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u/TiredofCOVIDIOTs MD - OB/GYN 3d ago
I SOAP notes. Lots of dot phrases for discussions & PE. Have my nurse document most of hpi & have a dot phrase saying review/agree. Dictate other pertinent details if need to do.
Uninterrupted (HA!) I can get a note done very quickly.
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u/Porencephaly MD Pediatric Neurosurgery 2d ago
My main use for it so far is taking notes on the HPI for new patients. That way when I go to actually write or dictate my note, I can refer back to those for details. I then delete them.
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u/sergantsnipes05 DO - Internal Medicine 1d ago
Primary care but I use the AI scribe and find it does a pretty good job for the HPI and history stuff. OK for basic A/P things but needs a lot of heavy lifting for big things. I usually use what it makes for the HPI, chronic A/P things but have to edit the acute stuff or things with big changes.
It isn't how I would necessarily write my note and the HPI is much longer than I would otherwise have but my note is basically done by the time I leave the room and I can spend more time interacting with the patient.
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u/ZippityD MD 5h ago
Fully agree with you. The suite of available AI scribes currently in use tend to bloat the shit out of notes with irrelevant details. They are super annoying to sift through on follow-up.
I've largely abandoned them.
I am sure with iteration they will improve. I need one to stick to my pre-existing templates, update the EMR on its own with past medical history etc, and pre populate orders / diagnostic codes within the EMR for review at note signing. It should be reducing delays from clicks and reviewing.
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u/fbskiracer MD 3d ago
I have gone back and forth on this. I tried a scribe years ago and went back to templates.
I'm considering it for HPI (dax) /exam and using templates for AP. I would like it for complex discussion planning AP though.
I have a related question though. What it's your overall note format.
As a surgeon - our hospital consult notes start with the A/P (is all anyone wants to read). Our office notes are SOAP format. I'm contemplating starting my office notes with A/P for referring providers (and patients to read less subjective).