AI medical scribes

Thanks to AI, doctors no longer need to write summaries—clinical notes—of patient exams. Now, scribe applications, installed on their phones, will do the job. The apps eavesdrop on their conversations with patients, synthesize the information, and produce a polished document with the details, structure, and tone of a proper clinical note—notes with no typos, proper grammar, and written in complete sentences.  After the apps produce the notes, the doctors read, correct—if necessary—and sign them.

AI scribes not only relieve doctors of a tedious chore, they also make it possible for doctors to focus their attention on the patient instead of a computer screen. (Doctors also find that the AI scribes increase productivity and revenue.) What’s not to like?

Companies, many of them start-ups, create and sell the apps to medical facilities. They’ve raised nearly $5 billion since 2019. So far, the rate of adoption has reached as high as 80 percent in some clinics and departments. It’s been the fastest-adopted medical technology of all time.

One doctor, while initially thrilled, found that, by letting the AI scribe write the note, she was “no longer thinking through the interaction with a patient and the meaning of the information” she had gathered—that the writing process itself helped her formulate her medical decision-making. Her cognitive labor was being “offloaded to a machine.”

Three years ago, I wrote a blog post about the rise in medical scribes: humans who accompany the physician during an exam and enter the relevant information into the computer. At that time, it was the fastest growing healthcare profession in the nation. I suppose most of those people are now looking for work.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

The rise in urgent care clinics

A few months ago, I lacerated my lower leg by smashing it into the corner of my car door. I considered just bandaging it but then thought the better of it. My husband drove me the 40 minutes to our nearest urgent care place and they stitched up the laceration. That visit was among those deemed appropriate for urgent care.

According to a recent article in The New York Times, urgent care is one of the fastest-growing sectors of the U.S. health care system. The number of urgent care clinics has risen from 7,000 in 2014 to over 15,000 in 2024.

Apparently, this rise has been partly driven by the decline of primary care, that is, increasing numbers of people finding it difficult to find a regular provider or to be seen quickly. Urgent care is also usually cheaper and faster than the ER.

Urgent care clinics are designed to handle illnesses and injuries that come on suddenly but aren’t life-threatening— “episodic” conditions such as colds, sprains, cuts, and urinary tract infections. Clinicians can order X-rays and basic blood work. They’re not equipped to handle longstanding symptoms or conditions. Only about 15 percent of urgent care providers are doctors. Most are nurse practitioners and physician assistants.

Where I live, we used to have an old-fashioned clinic that took care of urgent cases. The Dignity Health corporation bought it, closed it, and moved their staff to a mall a half hour’s drive from our house. When I went to that office recently to get a tick head removed from my arm, the receptionist said, “We don’t take walk-ins.” That’s why the number of urgent care clinics has doubled.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Elder care

A recent article in The Atlantic tells us that the Netherlands offers “the world’s most generous long-term care insurance, covering professional nursing or home care for all residents who can demonstrate need.” That country spends 4.1 percent of its GDP on formal elder-care services. In the U.S., the percentage is 1.3.

The point of the article is to expose the false belief that, with sufficient savings and adequate public services, care of the elderly can be handled by professionals. In fact, most elder care is still done informally—that is, by relatives or friends. This is true even for the elderly Dutch. Plus, even if the elderly are in residential care, family members tend to be highly involved.

One woman, in commenting on this article, wrote the following: 

“My mother had to go into a senior living facility after several falls and had become increasingly confused. I lived a 5 hour drive away and my brother lived 3,000 miles away. She kept asking when she could go home (we had to sell her house). She had long-term care insurance but it did finally run out because even though she made over $300,000 for her house her monthly fees at the facility were inching up to $10,000/month. Eventually she needed to be moved to a nursing home in my home town ($4,000 for the ambulance) and now the monthly cost was $15,000. Outrageous is the only word for it. We can pay $16,000,000 for the reflecting pool fiasco but not health care. The whole thing is devastating and depressing.”

Agreed.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Veering left

It’s not political. Rather, researchers have discovered that almost all of us have a natural tendency to wander in a counterclockwise direction. An applied physicist discovered this phenomenon when he was studying whether people maintain a certain distance between one another while walking. In reviewing the data from his 40 experiments, he noticed that most of his participants spontaneously veered to the left. This piqued his interest. He looked for additional data in the scientific literature and found a study showing that people who are lost usually wander in circles, but the study didn’t specify the direction.

As he continued his research, he found that veering left was unrelated to hand dominance, the layout of the room, or anything else that he could discern. He did find that the phenomenon holds true across demographics, cultures, and conditions. A study of 52 Japanese kindergarten children, who were moving about while music played, showed that most of the children moved counterclockwise.

To continue collecting data, scientists conducted further experiments. For example, they instructed study participants to wander about in an open schoolyard while a drone recorded their movements. Within seconds, they found that 80 percent of people were moving in a counterclockwise direction. As one researcher noted, “It’s not a gradual drift but rather a bias that emerges almost immediately.”

The scientists are baffled. As one physicist noted, "In principle, there is no reason for the fact that people prefer rotating counterclockwise."

I’ve never paid much attention to my own wanderings, although I’m aware that I usually tend to go left when exiting a hotel room, regardless of where I’m heading.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.