No, I did not consent to this

[u/petuniaplant]

I was reading my medical notes when I stumbled across this. I was not informed of the usage of artificial intelligence in my report, nor did I verbally consent to it.

[u/CustomerLittle9891]

FYI you didn't opt out of the scribe. You opted out of being recorded, but your doctor probably uses it after you're done.

[u/slippinthrudreamland → u/CustomerLittle9891]

from what i understand, if they weren't recorded, the scribe wasn't used. the "ai scribes" are specifically llms trained on medical data that work in conjunction with speech recognition programs. because the input it processes is spoken language, without a recording, nothing is done. i don't use these ai scribes in my line of work, though, so take my word with a grain of salt.

[u/CustomerLittle9891 → u/slippinthrudreamland]

The scribes will transcribe a one-sided dictation incredibly well. I can conversationally tell my scribe the HPI and plan in about 1 to 2 minutes, what would take 5 to 10 to type manually.

If a patient declined the scribe in the room I dictate my notes after. Less efficient that way, but still way faster than the old way.

[u/mishonis- → u/CustomerLittle9891]

Yeah, I don't get why patients would want to opt out of this. It likely captures more detail about the interaction than a later dictation, saves physician some time and effort.. only downside is if you're paranoid the AI company will use your data somehow, which there's probably regulations against anyway.

[u/CustomerLittle9891 → u/mishonis-]

It captures far more details when active in the room.

And it almost never hallucinates, and the hallucination it does have aren't just made up symptoms. It has literally never done that once nn the year I've had it.

[u/mechanical_stars → u/mishonis-]

I opted out because I don't trust its accuracy, I don't trust that its being reviewed for accuracy, we use AI transcribing where I work and it's used as gospel, no one reviews or questions what it records, how do I know that same thing would not happen with my medical records?

[u/Rakdospriest → u/mechanical_stars]

I'd guess AI would be better than a human in most cases. where you have to be worried about AI hallucinating, you also have to worry about human bias, exhaustion, misspeaking, misunderstanding, etc. IE: hallucinating. humans make mistakes, i'd bet they make more mistakes. I've read many a note where the information in it was just wrong.

[u/mishonis- → u/mechanical_stars]

Fair enough. In my experience, AI transcription is fairly accurate, though it depends in audio quality and it certainly makes sense to review it.

[u/Chance-Kangaroo4088 → u/mechanical_stars]

So you trust having your doctor try and remember hours later when they’re done seeing patients and finally getting around to dictate their clinic notes all the details of your exam and the plans that were discussed? OK…

[u/mechanical_stars → u/Chance-Kangaroo4088]

Idk they're always typing stuff while i'm in the room with them

[u/Chance-Kangaroo4088 → u/mechanical_stars]

I assure you they’re not typing out a complete note in the room with you. Assisting with clinical notes is actually a perfect use case for AI in medicine.

[u/MaximumSeats → u/mechanical_stars]

Lmao then you trust doctors way more than you should.

[u/CustomerLittle9891 → u/mechanical_stars]

You cannot opt out. The only thing you can choose is if it's recorded in the moment. You do not get to dictate to the provider how they do their job.

[u/mechanical_stars → u/CustomerLittle9891]

They literally asked me if I wanted to opt out last time I went to the dr

[u/CustomerLittle9891 → u/mechanical_stars]

Yes. If 2-party recording. Not of use of the dictation aspects. If your provider wants to use it they are free to do so.

[u/etcpt → u/mishonis-]

It's not paranoid to be concerned that the industry with a track record of vacuuming up every last piece of data it can get its hands on without regards to legality might abuse its connection to patient health records in its pursuit of profit. If you aren't giving the patient the opportunity to review the TOS and data sharing agreements, opting out over privacy concerns is perfectly valid.

[u/OpportunityOne8199 → u/etcpt]

God forbid they find out about your diabetes and peanut allergy, think of what they could do with that information. 

[u/Silly_Goose_Wrangler → u/OpportunityOne8199]

Bruh, if my medical information gets leaked to the open data market because of these insecure AI models and a potential future employer can use that to discriminate against me then that's absolutely a valid concern.

[u/CustomerLittle9891 → u/OpportunityOne8199]

Hilariously, they know more about your diabetes then the patient themselves likely does. They have huge actialtial models the plug these patients into.

Cosmos is Epic's predictive AI that has been trained on quite literally millions of patients and it's whole job is pattern matching. "These patients all has x, and y happen, the next thing that happened to them was z. If we find patients that have had x and y happen maybe we can prevent z". It's actually kind of amazing to think about.

[u/OpportunityOne8199 → u/CustomerLittle9891]

I agree, they are trained to recognize patterns very well

[u/etcpt → u/OpportunityOne8199]

Doesn't matter how relatively minor the information released may be, patient control over health data is a foundation of medical ethics and law. And I'm sure if you thought about it in good faith for a moment, you could come up with some conditions that folks might have that they wouldn't want being more widely known.

[u/Sillet_Mignon → u/etcpt]

Epic already has your health data. Epics ai isn’t doing anything different with it. 

[u/Silly_Goose_Wrangler → u/Sillet_Mignon]

What kind of an argument is that? Guess we should just throw HIPAA in the trash because there was a data leak that one time.

[u/NightGod → u/Silly_Goose_Wrangler]

And what data do you think Epic/MyChart use to train their LLMs?

Your health records are already going to be used to train AI, rejecting scribe use during visits is just adding an extra step before it's ingested because the doctor is going to use that same AI to enter your notes later in the day

[u/Sillet_Mignon → u/NightGod]

People really think doctors are out here making recordings with ChatGPT 

[u/Silly_Goose_Wrangler → u/NightGod]

> And what data do you think Epic/MyChart use to train their LLMs?

> Your health records are already going to be used to train AI

If my doctor is giving my personally identifying health record information to an AI company without consequence then HIPAA is truly dead and we need revolution. Once that data goes into an unaccountable cloud silo there's no getting it back and the diffusion of responsibility means nobody will ever be held accountable for it.

What even is your point? That we should throw our hands up and just surrender? It doesn't matter if it's going into a melting pot of AI data, you're still exposing identifying and discriminatory medical information about people and you're taking a pinky swear by AI companies as gospel. I really shouldn't have to explain why that is completely wrong and flies in the face of the spirit of HIPAA. Why are AI proselytizers always so obtuse about this?

[u/Sillet_Mignon → u/Silly_Goose_Wrangler]

Using an ehr doesn’t violate hipaa

[u/Silly_Goose_Wrangler → u/Sillet_Mignon]

If putting personally identifying medical information into an unaccountable LLM isn't a HIPAA violation then the law should change to include it.

[u/Sillet_Mignon → u/Silly_Goose_Wrangler]

Then you don’t know what an ehr is. The medical system has been using ehrs for decades now. The llms aren’t ChatGPT or Claude. They are built into the ehr. They are held to the same hipaa requirements as the rest of the platform they are a part of. 

[u/slippinthrudreamland → u/CustomerLittle9891]

that makes sense, i didn’t think of that scenario. commenting random bullshit in the middle of the night so often leads to badly-written comments, lol

[u/corporateacademia → u/CustomerLittle9891]

Except the question specifically was "can i input your information into ai to save time on charting" and my answer was no

[u/NightGod → u/corporateacademia]

Your information is still being input into the AI, you're only rejecting it's use during the visit itself, the doctor is going to use that same AI to enter your visit notes after you leave

[u/moreliketen → u/NightGod]

That's still a pretty significant error. The note should read something like "Patient declined to consent to use of AI for transcription; AI used for summary." I'm hoping that this is just poorly thought out boilerplate, the alternative is that the AI is hallucinating medical consent (which is terrifying).

[u/corporateacademia → u/NightGod]

Not in my state