Daniel Kahneman, the behavioral psychologist and Nobel laureate in economics, distinguished between two modes of judgment: the quick, intuitive impressions that arise almost automatically and the slower, more effortful reasoning that questions them. A doctor must work in both. Often, I begin to sense a diagnosis as soon as I walk into a patient\u2019s room, before I can fully explain it; when I write my notes, I tend to slow down to do my more deliberate thinking.<\/p>\n
The process of note-writing helps me formulate my medical decision-making and then check whether it really holds up. If I find myself trying too hard to explain away a patient\u2019s symptoms, trying too hard to dismiss a worrisome vital sign, trying too hard to fit an abnormal result into a reassuring narrative, then maybe I need to revise my conclusions. Have I not ruled something out as convincingly as I first thought? Am I tethering myself too quickly to a diagnosis? The patient might need another question, another exam, another test. You have to convince yourself as much as anyone else.<\/p>\n
When that cognitive labor is offloaded to a machine, I\u2019ve come to see, my job shifts. Even when I try to speak my reasoning aloud for the A.I. scribe, I am still doing something different from writing the note myself. I am no longer using the note, sentence by sentence, to think through the case in my own words, to decide what to emphasize, what to soften \u2014 or, as I\u2019m writing, to identify when my reasoning strains. And unlike when I dictate a note, I can\u2019t watch my own phrasing appear on the screen in real time. With the A.I.-generated note, I am instead auditing afterward. I am playing a version of \u201cWhere\u2019s Waldo?\u201d \u2014 What\u2019s missing? Has this note gone astray, and if so, where? \u2014 and it\u2019s a search made all the more difficult because the A.I.\u2019s draft arrives fluent, confident. It sounds so right.<\/p>\n
That cognitive shift does not happen the moment the A.I. scribe delivers a note. It begins in the exam room. Because I know A.I. is recording, I stop listening in the same way. Before A.I. scribes arrived, I would outline a story in my head as a patient talked, fitting the pieces together so I would know what to ask next. In the scribe\u2019s presence, that work is deferred. Let the machine do it! The mind drifts.<\/p>\n
In E.R. settings, patients handed off from one doctor to another when shifts change often feel less known to us; an inherited patient can come already filtered through someone else\u2019s account. With A.I. running in the background, something similar happens: Even when I\u2019m the first doctor to see someone, those patients began to feel, strangely, less my own.<\/p>\n","protected":false},"excerpt":{"rendered":"Daniel Kahneman, the behavioral psychologist and Nobel laureate in economics, distinguished between two modes of judgment: the quick,…\n","protected":false},"author":2,"featured_media":782526,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[276,49,48,1056,84,392,276913],"class_list":["post-782525","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-artificial-intelligence","tag-ca","tag-canada","tag-doctors","tag-health","tag-healthcare","tag-medical-schools"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/782525","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=782525"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/782525\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/782526"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=782525"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=782525"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=782525"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}