Millions of patients now tell their stories to an extra listener in the exam room: an artificial intelligence tool that records the conversation, decides what matters and writes the medical record.
In a new article published in The Lancet, Rice University’s Kirsten Ostherr and her co-authors argue that these tools known as ambient scribes do far more than take notes. The authors describe them as narrative technologies that select, filter and reshape patient stories in ways that influence how patients are understood, treated and remembered, often with little oversight.
Ostherr, the Gladys Louise Fox Professor of English and director of the Medical Humanities Research Institute at Rice, wrote the article with professors Eivind Engebretsen of the University of Oslo and Angela Woods of Durham University.
“Because AI scribes capture and then summarize patient narratives, they are a prime site for humanities researchers to examine and address in public discussion,” Ostherr said. “Scholars in medical humanities have argued for many years that patient narratives are a critically important — but often overlooked — site of meaning-making in health care.”
Adoption is accelerating on both sides of the Atlantic. England’s National Health Service approved 19 suppliers for use across its health service earlier this year, while in the U.S. the tools fall outside the definition of a medical device and face limited Food and Drug Administration review. The authors note the evidence on time savings and accuracy remains mixed and patient experience is rarely measured beyond simple satisfaction scores.
The stakes, they argue, go beyond efficiency. AI-generated notes can strip out a patient’s emotional tone, hesitancy and underlying concerns, and patients who sense their story is being reshaped may begin to hold parts of it back. In addition, the feeling of surveillance that comes from being recorded may inhibit disclosure of sensitive or stigmatized patient concerns. The authors compare the ambient scribe to another clinician in the room, one that exercises judgment and imports assumptions rather than simply transcribing.
The article proposes five priorities for health systems adopting the technology: building critical AI literacy, pushing for tools co-produced with clinicians and patients, centering patient perspectives, making consent meaningful and evaluating how the tools affect meaning-making for patients and clinicians alike.
“With my co-authors, I believe that ambient scribes are an urgent topic for humanists to engage and doing so in The Lancet is ideal, because we see clinicians as key partners in our call to deeper critical engagement with these tools,” Ostherr said.
Ostherr is available to discuss the article, the rapid adoption of ambient scribes and what their spread reveals about how AI is reshaping the patient-clinician relationship. She can speak to the risks these tools pose to patient narratives, the role of the humanities in evaluating health care technology, what meaningful consent and patient involvement should look like and how health systems can adopt AI without losing the patient’s voice.
To schedule an interview, contact media relations specialist Brandi Smith at brandi.smith@rice.edu.