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I am a proud late adopter of new technology. I had a StarTAC well into the 21st century, fearing the limitless access to digital information and services that smartphones would bring and the way they would rob us of our time and attention and humanity. (I was right! Though this realization offers little solace as I stare into my phone hundreds of hours a day.) I traveled with my books of CDs and my Discman well into the era when Transportation Security Administration agents would look at them with curiosity and suspicion. I tried a Kindle for a while during late-night nursing sessions but found it sapped the joy of reading. I like things that are analog, tangible. This comes partly from a deep tendency toward nostalgia (most of those CDs are James Taylor and Cat Stevens, who were making schmaltzy music 20 years before I was born), partly from a deep-seated resistance to change, and partly, I suspect, from genetics. My father is an avowed Luddite and still sends me newspaper clippings attached to handwritten notes through the mail.
So when the medical director of my clinic announced with enthusiasm and glee that we would be getting A.I. scribes at work, I shrugged and rolled my eyes. Robots in the exam room? It seemed kind of creepy and, moreover, unnecessary. I can type about 80 words a minute, thanks to my mom making me practice Mavis Beacon Teaches Typing for hours on end in the ’90s. My notes were always completed and signed before I left clinic for the day. There was no problem for the A.I. to solve. Or so I thought.
For over a decade, my routine had been the same for every patient: Walk in the room and make a little rapport-building small talk while I swipe in and boot up the computer, then immediately transition to the work of doctoring while I sit and click away (usually with my back to the patient due to terribly designed exam rooms). “Wow, you type fast,” almost every patient would say. I would then make a joke about how fast typing was my No. 1 doctor skill. Which was a sad joke, because it felt sort of true. Among the other doctor skills, like empathy and active listening and clinical thinking and diagnostic acumen and motivational interviewing, typing should not really be considered a skill at all.
Our clinic’s A.I. scribe is named Dax, a strange marketing decision likely intended to encourage thinking of the bot as a pal but resulting in the actual effect of me picturing it as a drunken frat boy trapped inside my computer. Finally, about a month after it had been rolled out at my clinic, I decided to give Dax a whirl—mostly so that when all my colleagues kept annoyingly asking me if I had tried it, I could quip, “Yes! I tried it! It wasn’t for me!”
I stood outside my patient’s room and hit the button on my iPhone to turn on the ambient recorder. I knocked and walked into the room, starting with the usual idle chitchat. Sitting down on the stool, I instinctively turned away from my patient to swipe into the computer before stopping myself, remembering that I didn’t need to chart during this encounter. Instead, seated on the creaky rolling stool, squarely facing her, I asked to hear more about why she had come in, a concern I knew had something to do with not sleeping well. She seemed as surprised as I was by the experience of looking at each other face-to-face—it had probably been many years since she’d experienced that degree of engagement with a doctor.
I got a little carried away. We talked for what felt like an hour about her sleep difficulties, which related to her childhood trauma, her chronically ill son, and her drinking. We talked about motherhood and the excruciating vulnerability of having a part of your body, your heart—really, your most vital organ—living outside your body, running around in the world. We talked about a variety of medications and supplements that could help with sleep onset and nightmares. We came up with a plan to start an alpha-1 adrenergic receptor antagonist, which could help with both, and to try to reduce the drinking as much as possible. We both cried.
When I finally got up to leave the exam room, I had a brief moment of panic. I hadn’t written anything down! I had let the time get away from me! I would pay for it the rest of the clinic session and the rest of the day, running behind both with patients and with notes. Then I looked down at my phone to shut off the recorder and saw that I had been talking to the patient for just 14 minutes. But this had been a focused, connected, meaningful time, rather than the usual clinic visit, which is consumed mostly with typing and clicking, so it had felt like much longer.
OK, I had a nice patient interaction, I thought. But I’ll still have to deal with remembering everything we talked about and writing the note. The clinic note is a vital part of doctoring. It documents the patient’s reported history, the doctor’s physical exam, and the assessment and plan: what’s going on and what we’re going to do about it.
I walked back to the provider room and swiped into my computer, opening up the patient’s chart. And there, highlighted in lime green, were portions of my note, already written for me by the A.I. It broke down our entire conversation into clinical bullet points and didn’t necessarily reflect the humanity of what had occurred in that exam room. But that was OK! It dictated our talk with accuracy and completeness; I hadn’t had to spend time during the appointment simply recording what was happening. And now, post-appointment, I had a head start on the note.
Everyone’s big fear is that the clinic administration will make us see more patients now that A.I. is writing our notes for us. I hope that’s not true, because the math doesn’t add up. I still spend just as much time as I used to working on my note after a clinic visit, editing the A.I.–generated portions, putting in orders, writing out follow-up plans, and coding the billing. Dax doesn’t save me time writing my note or make clinic go any faster. But it does allow me to connect meaningfully with my patients in the way I dreamed of when I applied to medical school in the first place. To accompany them on their journeys, to bear witness to their joy and suffering with my full presence. It creates a sense of time and spaciousness I haven’t experienced in the exam room since I was a medical student, before the pressures of productivity analytics set in. My A.I. scribe has restored the joy to my practice, an experience that is not quantifiable in a metric but which my patients and I can feel in our bones.
I recently saw that same patient again and was pleased to learn that she was doing incredibly well. She was taking the medication and sleeping better. Her ill son had left on a road trip to New York City, and while she worried about how he would do, she was excited that he was taking the adventure. She smiled so broadly that her face transformed into a shape I hadn’t seen it inhabit before. Her eyes twinkled—I swear, they literally twinkled!
Maybe all those things would have happened even if our initial interaction hadn’t occurred with my new best friend Dax in the room. Maybe I would have started the same medication, and perhaps she would have done just as well. But would I have noticed the tears start to form in her eyes if I had been turned away from her, typing on the computer? Would she have been able to access those emotions if I hadn’t been engaged and making eye contact while we spoke? Would I have felt filled up, rejuvenated, reconnected with her and with every other patient in my practice in the same way? I’ve spent a decade participating in the conversation about how primary care doctors can get relief from burnout, but this is the first thing I’ve ever seen that works.
Am I worried about A.I.? Of course. I’m still a late adopter at heart. I worry about its impact on the planet and what it’s doing to our children’s critical thinking and what will happen to all the creatives when people prefer to consume art made for free than by the painstaking work of a human hand. You can take it all away, for all I care. I don’t need ChatGPT or Claude or Gemini—I’d be happy to relinquish it all. Just don’t take away my Dax. He’s reminded me of my love of practicing medicine, and that I have some doctor skills beyond how many words a minute I can type.
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