“In ENT, we tend to have very quick visits with our patients, where ultimately documentation ends up being a substantial percentage of the time spent on each visit. So these tools really have the potential to make us more efficient and allow us to take care of more patients and focus more on caring for patients rather than on clinical documentation,” he said, adding that it takes a little time to get used to the systems and learn how to customize your preferences.
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July 2025“I think the tools are getting there in terms of what they’re capable of,” he said.
Dr. Jiam, who uses the Ambience Healthcare platform, said that knowing the ambient scribe is recording the visit is reassuring.
“Because I know that note-taking—whether it’s right after that visit or long-term at the end of the day—is not going to be as burdensome, I can be more in the moment and present with the patient and have that sort of detail,” she said. “The HPIs, and even some of those longer histories, don’t feel as burdensome or daunting because I don’t feel like I have to capture all of that on the spot to do right by the patient.”
She said her training involved a one-hour group training session with a vendor representative.
The HPIs, and even some of those longer histories, don’t feel as burdensome or daunting because I don’t feel like I have to capture all of that on the spot to do right by the patient. —Nicole Jiam, MD
Tulio Valdez, MD, MS, professor of otolaryngology-head and neck surgery at Stanford Medicine, in Stanford, Calif., where he is a pediatric otolaryngologist, said his center tried platforms for about half a year and recently rolled out the DAX platform across the system.
“I’ve been using it for the last month, and to be honest, it’s great,” he said. “It does provide much better feedback to patients because you’re really spending more time paying attention to them rather than typing or documenting or doing all the other things.”
He said the platform is not so good with Spanish language interactions, so if he wants to use the ambient scribe, he has to repeat what was said in English to have the notes recorded correctly.
Still, the ways it has saved time and improved the dynamics of visits have been a big plus, he said.
Challenges of the Tech
A language gap is not the only limitation that doctors are discovering with this technology.
Dr. Jiam said that sometimes the scribe will not use the correct medical terminology, typically when terms might be similar in meaning but have important differences in a medical sense.
“They may lump colloquial terms like ‘vertigo’ and ‘dizziness’ and ‘disequilibrium’ together when there is more sort of a medical precision behind how I use those words and how I’m defining them,” she said.
Also, she said, the timing aspects that have been discussed during the visit might not be accurately described in a summary.
“It may say, ‘This patient has had vertigo for like four months,’” when the reality is very different, she said. The AI might have rendered the discussion that way because the patient had believed it was vertigo, but it was actually disequilibrium, “with brief bouts, like less than a minute, of vertigo.”
But if the AI version were to be simply cut and pasted into the official note, “expert to another expert, it’s not really correct,” she said. This has led her to write her own assessment and plan, rather than use the ambient scribe for that.
“The accuracy behind it is not 100%, for sure,” but a healthy realization that it’s just “an adjunctive tool” will go a long way, she said.
Dr. Bur had a similar perspective, pointing to the risk of the potential for “automation bias,” or relying too much on an automated system, Dr. Bur said.
“When we have tools that take care of documentation for us, initially you’re going to be very careful to make sure that the scribe is behaving appropriately, that it’s documenting what you say,” he said. “But as you see good results, as you start to become more reliant on the tool, then you may be less likely to check.”
At Cleveland Clinic, Dr. Boose said there is an awareness of the need for careful use of the technology.
“We are committed to the safe and responsible use of AI in the healthcare setting,” he said. “This AI feature is not intended to diagnose, treat, cure, prevent, or mitigate any disease or other medical condition. Providers are required to read the note in its entirety to confirm its accuracy and completeness and edit as needed prior to signing the note.”
Dr. Rameau pointed to challenges seen with speech recognition technology for those with communication disabilities affecting voice, speech, or language. In a study on which she worked, published early in 2025, automatic speech recognition systems had a word error rate that was 10 times worse for those who were deaf and hard of hearing, with the worst results seen for those in the low speech intelligibility classification—an 85.9% word error rate for those encounters, compared to 5% for the normal hearing group. This raises the possibility of high error rates for those with laryngological challenges, such as those who use an electrolarynx (Laryngoscope. doi:10.1002/lary.31713).
“If we tend to rely more and more on this technology and it’s not documenting well for some of our patients with communication disabilities, then we could potentially have downstream harm to those patients because we’re just not collecting the right information and just not providing the same level of clinical decision support,” she said.
What’s Next
Otolaryngologists who follow technology closely say the increasing use of artificial intelligence in documentation is a clear step toward a more ingrained use of AI for actual diagnosis.
Dr. Bur said it is “absolutely a step in that direction.”
“The advantage of using tools like virtual scribes is that they can create structured data,” he said. “So they can actually extract specific variables that then can be used for predictive models in order to make predictions that ultimately help diagnose patients more accurately.”
“Absolutely, I think it’s going to assist in diagnosis,” Dr. Valdez said. “It’s still not giving those prompts—‘You should do this, you should do that’—but it’s a step away from being able to.”
Dr. Rameau said that if these platforms capture patient encounters more thoroughly, especially as they improve, that will only make AI better at making diagnoses. And she said research already suggests that artificial intelligence might be better than clinicians at diagnostics and clinical reasoning.
“As ambient AI becomes more widespread, probably some of this clinical decision support is going to be integrated into these tools,” she said. “And as that happens, it is possible that at some point there could be more of an assessment of AI versus humans, AI versus humans plus AI. And if AI is superior, then we really need to have a thoughtful conversation with our patients and figure out, you know, who decides. If AI is better, what would be the role of humans, and where would clinicians find themselves?”
She said otolaryngology, a surgical specialty, is a bit more protected. And the human touch and empathy are likely going to continue to be important to the healing process, she said. But, whatever happens, the medical community has to remember what AI is—not human, but technology produced by companies.
“We as clinicians have an oath … that you shall not do harm,” she said. “AI is not trained in that way. And AI is also created by Silicon Valley big tech companies, and their goal is to create profit. Our goal as clinicians is to heal our patients, so we have to be thoughtful about these things.”
Thomas R. Collins is a freelance medical writer based in Florida.
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