Finally, AI makes itself useful
The blog I didn’t want to write. But don’t worry, AI still mostly sucks…
There is a rule that every blog worthy of the name is required to have at least one entry per year about AI, and I’ve avoided writing mine as long as I could. I’ve been proudly and purposefully oblivious to the phenomenon of AI, I felt I’d already missed the boat and could just move on without that tech, like old men do (I’m getting on fine without a backup camera or nosehair trimmer, right? Right?!) And while it seems like everyone else is using AI to make essays, music and art, I keep my head down, doing those things the old fashioned way, or paying other humans to do it for me (at least I think they’re humans…)
But then I met Heidi. Sweet, sweet Heidi.
I’m afraid to admit I may never be the same.
Trigger warning: the following paragraph includes frank discussion of how this emergency doctor gets paid. If you, like me, would rather not know about such vulgary, feel free to skip!
For 20 years my doctoring process has involved saying everything out loud at least twice: once to the patient and once dictated into a microphone. It’s a lot of talking and by the end of a shift I just cannot stand my own voice anymore. I tend to spend more time with patients than many ED docs—I talk a lot, I like to take them through my thought process so they know I’m not just whipping out of the room to order random tests. But all that talking takes time, so I see fewer patients per shift, so I get paid less, because many (not all, it depends on the department) emergency doctors get paid only for the specific patients we see, without a guaranteed salary. It’s a potentially perverse arrangement where the more cursory you are, the more money you can make. But, I’ve long since accepted there is no perfect way for doctors to get paid, all methods have drawbacks, and each of us has to find a balance we can live with while being comfortable with the care we’re giving. But it’s a constant struggle, every day feeling you should have seen more patients and taken better care of them and finished the notes faster and gotten home sooner. The iron triangle of Time-Money-Quality is unforgiving, you can’t lengthen one side without shortening the others. Or can you?
Trigger warning: the following paragraph includes detailed description of writing a medical note, and should be of little interest to anyone.
This year my department started offering an AI scribe phone app, Heidi, that listens to our patient interactions (with patient permission) and, using our personalized instructions, arranges the interview into a readable record. We drop in prior medical records to give the scribe more patient context, we update it with results, and it keeps up the documentation throughout the patient’s ED course. I take pride in the my old fashioned notes, so it’s taken me time to relent and give Heidi a try, but all the cool kids in the department were doing it, so I broke down. It was a bit creepy at first, knowing this robot was listening to every word between me and the patient. But it took just a couple hours to realize that I could spend more time talking to the patients, knowing Heidi would summarize it into a pretty good note without my having to repeat it all in a dictation. After some fine tuning, I feel pretty good about the note it generates without nearly so much mic time. I don’t feel totally positive about this; some of the humanity of the note is lost, and the output definitely requires review. But Heidi also picks up details I might have missed or forgotten, and it makes helpful suggestions I hadn’t considered (Dacryoadenitis? Good pick up, Heidi!) I’ve even got it set to give me relevant clinical studies and interesting factoids for each case (so far they don’t seem be hallucinations, but one must be mindful.) Most important, Heidi drives home the forgotten point that spending most of our day writing notes isn’t the actual purpose of being a doctor! Much of that note isn’t needed for patient care, but rather to meet billing and medical-legal requirements. It’s okay to let someone or something else do that work. This particular bit of AI is actually letting me be more human, spending more time with patients and less time talking to a computer. I’m not sure I’m leaving work that much quicker than I used to, but I am leaving with more notes complete and feeling less wrung out at the end of a shift.
Dacryoadenitis? Good pick up, Heidi!
So in a month I’ve gone from shunning AI to relying on it all day, every day in the most important thing I do, taking care of sick people. It’s left me feeling a little guilty, a little creeped out, but also reenergized for my job in a way that may just extend my career by a few years. I’ve even had weirdly pleasant dreams in which I’m making little changes to my algorithm, honing better notes with less work (sort of like Tetris dreams, remember those?). I can safely say this is the biggest change I’ve seen in medical practice since we replaced paper charts and orders (yes, I am that old). Am I teaching a computer to replace me? Probably, but I’m getting long the tooth for this job anyway, and when the droids drag me out I doubt I’ll complain. Go ahead and plug me into the Matrix, but make me someone important, like an actor.
So for work, I’m sold. But art? Fuck that!
Trigger warning: the following paragraphs including me gushing about how great my family is, but they probably aren’t reading this so it’s okay.
In the last few weeks it’s been gratifying to see my whole family fighting the good fight, making all kinds of old-fashioned art for art’s sake. A few weeks ago my band, Twice-a-Day Ray, made up of analog emergency medicine professionals, played a blazing four-hour show at the Cantab Lounge in Cambridge, as we do every other month. In the morning I’m sore as hell and I wish I’d had some sort of robot to help me through it, but so far it’s still 100% human effort (digital delay pedals don’t count). My lovely and talented wife Ethel joined the band for several songs and sang lead on one of my all-time favorites, Hit Me with Your Best Shot. Pat Benatar is Ethel’s go-to karaoke muse, and I’ve been air guitaring Neil Giraldo riffs since third grade. Getting to inhabit our heroes together on stage for 150 seconds was life affirming, and I can’t think of a better way to spend a Friday night.
A couple days later, our son Ezra shared a recording of his high school jazz quartet playing Lady Bird and Señor Blues. Ezra is an excellent drummer but never shares his stuff, so we knew it must be particularly good. Just a few bars in and I was fighting tears, I could hear the musicianship right way as he led the band with confidence, and they all did more than follow along, they made the songs their own. Then we got to visit our daughter Virginia at college for parents weekend, including two nights of her dance performance. Watching our beautiful, graceful dancer letting it all out for an overflow crowd, dancing to Bowie’s Life on Mars, I again had to cry a little. Ethel and I have tried to raise our kids to value artistic expression, not for a scholarship or career but for its own sake. But still, seeing how far they have come was hard to believe—we want to take credit, but all the hard analog work, with sore muscles and battered spirits, has been theirs.
And finally, the comic books! All natural there as well. The comic world has been upended by the intrusion of AI generated comic art (comic writing probably isn’t far behind), but me and my human team are cruising. Pencils for By the Time I Get to Dallas #5 are in the can, with inks and colors under way. Meanwhile Trinity Project is not far behind, half done with line art on Book 5. Mark it, Dude: this story will be complete and in your hands in 2026!
Do not go gentle into that AI prompt.
So, what have we learned today? I’m not sure, but I’d say do not go gentle into that AI prompt. Make your own art. Make it sweaty, spill ink, leave skin on the stage, play a bad note and play it twice, break a stick, play an extra chorus if you aren’t ready for the song to end. These things are still ours. But if AI can help you like your job more, and get you home sooner, well, it’s worth a shot.
Human editor update: This essay is a bit long but used to be longer. I asked ChatGPT to suggest some cuts. It did a pretty good job.
Great update Colin. I've retired from active practice due to a disability (HSP) that, as part of the diagnosis, affected my speech adversely. Clinic days were awful because I had to type my notes using a lousy template. Even with my NP who assisted me with patient discussions we were still spending the entire lunch hour doing notes and another hour after the last patient left doing the same. A few of my fellow docs used Google glasses with an assistant in India (!) listening to the interaction and typing their notes during the visit which was state of the art at the time. Having an AI assistant do the note task sounds awesome although you are right to be wary of it. Hopefully our younger colleagues maintain the same level of wariness.
AI in art is inevitable I'm afraid. I'm opposed to it myself but given its inevitability I suppose a compromise would be to require a small watermark in whatever piece is produced to alert the humans that there was a robot involved. Difficult with music though. Assigning a human name to an AI assistant like "Heidi" versus "Dictation Robot 3.0" hastens acceptance and diverts the user from what's going on behind the scenes. The only thing that is constant is change.
Finally, you are justifiably proud of your children's accomplishments. You have raised them right!