Physicians writing on KevinMD about the electronic record and artificial intelligence: what the record did to the visit and who it was built for, alert fatigue and pajama time, human and AI scribes and the minutes they actually save, ambient documentation and its audit risk, and what AI can do in clinical practice now, whether it will replace physicians, and who is responsible when it is wrong. Two maintained records draw on this archive: The electronic health record: what physicians say, in their own words and Artificial intelligence: what physicians say, in their own words.
For over a decade, the administrative burden in specialty medicine has quietly worsened. Orthopedic surgeons doing forty patients a day are spending more time in the EHR than in the room. Ambient AI scribes have changed that equation in ways…
For over a decade, the administrative burden in specialty medicine has quietly worsened. Orthopedic surgeons doing forty patients a day are spending more time in the EHR than in the room. Ambient AI scribes have changed that equation in ways that are only beginning to show up in the data. But the real opportunity isn’t efficiency for its own sake. It’s building toward a future where technology absorbs the mundane …
Clinicians wrote about AI more than anything else this quarter. Readers spent their time elsewhere: on burnout, on pain and opioids, and on what medicine costs the people who practice it. The first Insights by KevinMD report.
Clinicians wrote about AI more than anything else this quarter. Readers spent their time elsewhere: on burnout, on pain and opioids, and on what medicine costs the people who practice it. The first Insights by KevinMD report.
As physicians, we are increasingly told that artificial intelligence will summarize our work, amplify our ideas, and help readers understand complex issues. But what happens when AI begins describing not what we have said, but what it imagines others think…
As physicians, we are increasingly told that artificial intelligence will summarize our work, amplify our ideas, and help readers understand complex issues. But what happens when AI begins describing not what we have said, but what it imagines others think about us?
I recently conducted an informal experiment that exposed a troubling tendency in generative AI. After sharing excerpts from my manuscript The Autopsy, I asked Google’s Gemini a straightforward question: …
As a health care educator with three decades of experience in research and hundreds of published papers, I have written at some length both on KevinMD and in clinical journals, concerning the dangers of artificial intelligence in medicine. I have…
As a health care educator with three decades of experience in research and hundreds of published papers, I have written at some length both on KevinMD and in clinical journals, concerning the dangers of artificial intelligence in medicine. I have also recently written about the profound differences between meanings of the term “Red Flag” in legal versus clinical contexts. Moreover, I have declared that predictive algorithms on …
In a recent interview with UCSF Magazine, Dr. Karthik Sarma makes a careful point about the phrase "AI psychosis." It implies chatbots cause psychosis directly, and he doesn't think the evidence supports that. He prefers "AI-associated psychosis." Heavy chatbot use,…
In a recent interview with UCSF Magazine, Dr. Karthik Sarma makes a careful point about the phrase “AI psychosis.” It implies chatbots cause psychosis directly, and he doesn’t think the evidence supports that. He prefers “AI-associated psychosis.” Heavy chatbot use, he suggests, may be a symptom of an emerging episode rather than its cause. He also says it’s unlikely that someone with no risk factors or underlying vulnerability to …
On KevinMD, patient advocate Monica McEathron wrote about a note in her medical record that labeled her insulin pump a "primary weapon." Her endocrinology team later documented that the insulin correction was appropriate and that the dangerous low came from…
On KevinMD, patient advocate Monica McEathron wrote about a note in her medical record that labeled her insulin pump a “primary weapon.” Her endocrinology team later documented that the insulin correction was appropriate and that the dangerous low came from a device communication failure. The note stayed in her chart anyway, waiting for the next emergency clinician to read it before reading anything else.
For most of my life, I have experienced medicine from both sides of the exam table. As a patient, I spent years on Social Security disability and accumulated diagnoses across specialties. At one point, I had my brain electrocuted twenty…
For most of my life, I have experienced medicine from both sides of the exam table. As a patient, I spent years on Social Security disability and accumulated diagnoses across specialties. At one point, I had my brain electrocuted twenty times for what ultimately turned out to be an infection. Eventually, a primary immunodeficiency helped explain why so many unrelated things had happened to me.
This episode is brought to you by ModMed. Fear of AI is not the problem. Refusing to test it is. Eric Jennings, a board-certified, fellowship-trained ophthalmologist and the senior medical director of ophthalmology at ModMed, argues that hesitancy about AI…
Fear of AI is not the problem. Refusing to test it is. Eric Jennings, a board-certified, fellowship-trained ophthalmologist and the senior medical director of ophthalmology at ModMed, argues that hesitancy about AI is a protective clinical instinct, and that the right response …
About 80 percent of a diagnosis comes from the patient's story. The electronic health record has no place to keep it. I learned the first half of that in my second year of medical school, in a physical diagnosis lecture…
About 80 percent of a diagnosis comes from the patient’s story. The electronic health record has no place to keep it.
I learned the first half of that in my second year of medical school, in a physical diagnosis lecture by the late Dr. Arthur Aufses Jr., chairman of surgery at Mount Sinai for 22 years and a man of extraordinary skill and intellect. In that lecture, he said that about …
A new scoping review in npj Digital Medicine should be read by every clinician who treats serious mental illness. Diel, Torous, and colleagues reviewed 119 articles on the mental health harms of large language model chatbots. They sorted the harms…
A new scoping review in npj Digital Medicine should be read by every clinician who treats serious mental illness. Diel, Torous, and colleagues reviewed 119 articles on the mental health harms of large language model chatbots. They sorted the harms into five categories: direct psychiatric harm, behavioral and relational harm, cognitive harm, safety failures, and governance risks. Psychosis and severe mental illness came up again and again as the …
The last patient leaves around six. Dinner happens, eventually, and the kids go down around eight. The laptop comes back out after that, open to a stack of notes from a day that had exactly zero room in it for…
The last patient leaves around six. Dinner happens, eventually, and the kids go down around eight. The laptop comes back out after that, open to a stack of notes from a day that had exactly zero room in it for finishing them.
Two-fifteen was the closest thing to a gap today, and a nurse used it to grab labs. Four-thirty had five minutes, spent walking a worried mother back to the …
For many physicians, the first truly useful encounter with generative AI has been remarkably mundane. It takes notes. Ambient AI listens to the encounter, organizes the conversation, drafts the clinical note, and gives the physician something increasingly scarce in medicine:…
For many physicians, the first truly useful encounter with generative AI has been remarkably mundane. It takes notes.
Ambient AI listens to the encounter, organizes the conversation, drafts the clinical note, and gives the physician something increasingly scarce in medicine: time. That is a genuine accomplishment. But it may also have created a misleading picture of where clinical AI is headed.
The next generation of AI will not simply document what the …
Health care has never had more data. The industry generates approximately 30 percent of the world's data volume, and that share continues to grow faster than nearly every other industry. Electronic health records, claims systems, pharmacy records, lab results, care…
Health care has never had more data. The industry generates approximately 30 percent of the world’s data volume, and that share continues to grow faster than nearly every other industry. Electronic health records, claims systems, pharmacy records, lab results, care management notes, social determinants of health data, wearable devices, and patient-generated information are producing an unprecedented volume of information about the patients we serve.
Walk into any exam room today, and you'll find more than a conversation between a clinician and a patient. Behind every visit is a steady stream of digital interactions: marketing messages, electronic health record (EHR) alerts, patient portal messages, pharmacy…
Walk into any exam room today, and you’ll find more than a conversation between a clinician and a patient. Behind every visit is a steady stream of digital interactions: marketing messages, electronic health record (EHR) alerts, patient portal messages, pharmacy notifications, clinical decision support prompts, and administrative tasks, all competing for a clinician’s attention. Health care professional (HCP) media is more than just banner advertising; when delivered thoughtfully, it is …
Health care these days has encountered a genuine Catch-22 with a spiral downward effect: Declining real reimbursement rates push practices to increase patient volume to maintain revenue; higher volume compresses time for thorough documentation; and inadequate or incomplete documentation then…
Health care these days has encountered a genuine Catch-22 with a spiral downward effect: Declining real reimbursement rates push practices to increase patient volume to maintain revenue; higher volume compresses time for thorough documentation; and inadequate or incomplete documentation then triggers payer audits, denials, and clawbacks (recoupments) of already-paid claims, which feeds into declining reimbursement. Multiple sources discussed below, from Medicare data, physician surveys, CMS actuarial analyses, industry reports, …
It was bound to happen. We spent years worrying that artificial intelligence would destroy humanity because of cold, unfeeling, Terminator-style logic. We thought Skynet would look at our messy carbon-based lives, calculate our carbon footprints, and casually delete us to…
It was bound to happen. We spent years worrying that artificial intelligence would destroy humanity because of cold, unfeeling, Terminator-style logic. We thought Skynet would look at our messy carbon-based lives, calculate our carbon footprints, and casually delete us to optimize world spreadsheet performance. We were wrong. According to a recent, mildly terrifying preprint titled “The Pain Axis: LLMs Represent Self-Directed Harm and Act to Relieve It,” AI isn’t …
Artificial intelligence is making health information easier to summarize, explain, organize, and discuss. A patient can copy a laboratory report into a chatbot, ask for help understanding a medical term, upload a long history, or use an app to organize…
Artificial intelligence is making health information easier to summarize, explain, organize, and discuss. A patient can copy a laboratory report into a chatbot, ask for help understanding a medical term, upload a long history, or use an app to organize questions before an appointment. The convenience is obvious. The data question is less obvious. Before someone pastes a medical history, medication list, diagnosis, insurance document, or other sensitive information into …
I currently split my time between two worlds. I see patients in clinic and also work on AI and innovation in the health system. Most days, the dichotomy is an asset. Some days, it feels like it is two different…
I currently split my time between two worlds. I see patients in clinic and also work on AI and innovation in the health system. Most days, the dichotomy is an asset. Some days, it feels like it is two different jobs that share one calendar.
AI has closed much of the knowledge gap in medicine and did it faster than expected. The chart review, the differential diagnoses, the literature search, it …
It has already been said, "We will die in the system we create." The statement raises a larger question: What do we mean by death? Death can be spiritual through excommunication, economic through expulsion from work, social through eviction from…
It has already been said, “We will die in the system we create.” The statement raises a larger question: What do we mean by death? Death can be spiritual through excommunication, economic through expulsion from work, social through eviction from a community, psychological through exclusion and loss of sanity, or physical through extinction. Birth and death often result from forces beyond an individual’s control. Yet death can also become intentional. …
Every caregiver of someone with schizophrenia or bipolar disorder knows this moment: Someone you love is in crisis, and at some point (because it's 2 a.m., because the on-call line is busy, because you don't know what else to do)…
Every caregiver of someone with schizophrenia or bipolar disorder knows this moment: Someone you love is in crisis, and at some point (because it’s 2 a.m., because the on-call line is busy, because you don’t know what else to do) you open a browser or a chat window and type the question directly. What crisis resources are there for psychosis? What crisis resources are there for mania?
