When AI Writes the Record: What Happens to Clinical Reasoning?
Writing and composing patient notes by hand versus proofreading an AI-generated record represent two very different cognitive processes, each with its own impact on clinical reasoning and case management.
Does Writing Patient Notes Inspire Thought?
Writing patient notes from scratch requires active engagement with the case. It forces the clinician to:
Synthesize Information: When writing, the clinician must mentally organize the patient's history, exam findings, differential diagnoses, and treatment plans. This process reinforces understanding and helps uncover gaps in reasoning.
Prioritize Key Details: The act of writing could force decisions about what is most relevant, ensuring critical thinking about symptoms, disease progression, and response to treatment.
Make Connections: Handwriting or dictating notes might encourage clinicians to make associations between different aspects of the case, potentially leading to better diagnostic accuracy.
Engage in Reflective Practice: The process of composing notes may allow for deeper reflection on the patient’s condition, response to treatment, and possible alternative diagnoses.
What Do We Lose When AI Takes Over?
When AI generates the initial patient record and the clinician simply proofreads it, several key aspects of case management may be diminished:
Reduced Deep Processing: Proofreading AI-generated text is a passive activity compared to active writing. The clinician may miss opportunities to critically analyze subtle details or inconsistencies.
Loss of Narrative Control: AI-generated notes may not fully capture the clinician’s thought process, reasoning, or clinical intuition. Over time, this could lead to more rigid, "templated" thinking rather than flexible, case-by-case problem-solving.
Over-Reliance on AI Defaults: If AI prioritizes certain details over others based on algorithms rather than clinical reasoning, important nuances might be lost, especially in complex or atypical cases.
Less Personalized Care: AI-generated records may sound formulaic and lack the personalized insights that come from a clinician’s direct interaction with the patient.
Missed Learning Opportunities: Writing reinforces learning. A clinician who regularly writes notes sharpens their diagnostic skills. When AI takes over, younger or less experienced clinicians may lose opportunities to develop their own clinical reasoning.
Finding a Balance
AI scribing tools can be incredibly useful for reducing administrative burden and improving efficiency.
However, they should not replace active clinical thinking. A balanced approach might involve:
Letting AI generate a bare-bones draft, but requiring the clinician to expand on key details, revise wording, and add their own insights.
Using AI for routine documentation but manually writing notes for complex cases where deeper thought is required.
Encouraging reflective note-writing in teaching settings so younger clinicians continue to hone their diagnostic skills.
Rick’s Commentary
In the end, while AI can streamline documentation, it should never replace the cognitive engagement that comes with composing patient notes.
The act of writing is an essential part of thinking, learning, and
making better clinical decisions.
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