Every doctor is a writer, or that’s what I used to believe. From the first days of medical school, my classmates and I learned how to write, albeit for a particular purpose and according to strict rules — a type of writing that wasn’t necessarily beautiful, or even particularly interesting. But it was writing.
I still have some of those earnest attempts from my first year:
Ms. T was once a regular attendee at her church, but she now limits her time outside of the home because she can’t be away from her oxygen tank for more than a few hours. (She has portable O2, but doesn’t know how to use it.)
Over time my notes evolved (or devolved) from carefully wrought narratives to a template of fillable fields and checkboxes. (Location of lump: right breast. Duration: 1 week. Tenderness: none.) There’s simply no time for anything but the bare facts required by the billers, payers, and lawyers. No matter what our attendings taught us, the patient’s story is — alas — beside the point.
Nevertheless, the process of note-writing (what many more accurately call “charting” or “documentation”) still has a point. I would even argue that the process is the point — because it forces me to slow down, reflect, and make meaning of the events and conversations that take place in the exam room, and the relationships I build there. Until very recently, every doctor, like it or not, had to do this work: the work of a writer.
But now, suddenly, we find ourselves at a crossroads: For the first time, many of us have the option to outsource note-writing to artificial intelligence. A process that once required dedicated time and attention (often divided and rushed attention) can now happen in real time, without us being involved at all. For me, the erasure of this particular, ritualized process of meaning-making represents a profound blow to the humanity of my work and my relationships with my patients.
Like most doctors, I work at a fast pace — not necessarily by choice — and my patient encounters are highly physical and intimate. Even during a routine pap smear or a birth control consult, it’s not unusual for my patients to share deeply personal information about their lives, sometimes to cry. (Weight gain since menopause. Sex painful. Husband unfaithful more than once.) These aren’t the kind of encounters where I can talk and type at the same time.
I might, therefore, have become an early and enthusiastic adopter of the AI scribe, a technology whose alleged purpose is to allow me to devote my undivided attention to patients. Indeed, in one managed care setting where I practice, my colleagues are constantly praising their new AI scribes (which the leadership and administration have made extraordinary efforts to roll out over the past year), primarily because the scribes “save so much time.” Across the media and in conversation with other doctors, most of the responses I hear are enthusiastic (albeit cautiously so).
But as a doctor who is very much a writer, I feel a sense of dread and even grief at this new option (or pressure) to outsource my note-writing to AI. The note-writing process — even clicking through those checkbox- and template-driven forms — is still how I make meaning of events, conversations, and relationships. When I sit down to write a note, I am more than merely a technician who knows how to perform a procedure, interpret a lab result, or prescribe a medication; I’m a human being who can integrate my patient’s story into what I know about the human body and the human experience, and who can distill that understanding into words. (Sometimes when the baby cries, she wants to run out of the house and not come back.)
This process doesn’t just benefit me; it also benefits my patients. Part of the work of nurturing any relationship — including the doctor-patient relationship — occurs outside of the face-to-face interaction, when each party goes our separate ways. This solitary, intentional work can take different forms for different people. As a doctor, an important way I sustain and deepen my relationships with my patients is by writing about them. This is the very process that the AI scribe asks me — or forces me — to give up.
But what exactly would I be giving up? To be clear: I haven’t yet tried using an AI scribe, nor a human scribe, in my decade or so of practice, although I suspect I may soon have no choice. At the managed care setting where I work, the eight-hour clinic day is divided into back-to-back 15-minute appointment slots — with four 15-minute “patient management” slots dispersed throughout the day to allow clinicians to catch up on documentation. Once AI scribes have been fully integrated into standard clinic workflows, it seems all too obvious what we can expect to happen to those “protected” chunks of time: They will disappear, only to be replaced by four (or more) additional patient appointments. Why should administrators protect doctors’ time for note-writing when we have AI scribes to write notes for us? Why, indeed, should we be paid to do anything other than those tasks for which we can code and bill: performing exams and procedures, prescribing medications, ordering and interpreting tests? What value is being placed on my capacity for reflection and meaning-making, and on my relationships with my patients? The answer is obvious: The value of that time, and of that very human work, is being rapidly reduced to zero.
Maybe not every doctor is a writer. Certainly not all will mourn, as I will, the day they relinquish their note-writing to AI scribes. Some will continue to make meaning of their work in other rich and valuable ways: teaching on morning rounds, leading tumor board meetings, taking a walk around the hospital parking lot at the end of a long day. They may even find they have more time for these things now that they can rely on AI to write their notes for them.
But for me, note-writing is still where the meaning-making happens—at least in the finite hours of my clinic day. It saddens me that the health care system in which I work expects me, and may soon force me, to outsource this profound, deeply human process. I don’t believe for a second that this change is about “protecting” my time or sanity. I believe it is about squeezing a few more billable units from what remains of my precious, solitary time in which to think, to reflect, to be human.
Christine Henneberg is a practicing physician and a writer whose debut novel, “I Trust Her Completely,” is forthcoming in May 2025.