JMIR Publications

ABSTRACT

Background:

The administrative burden of manual documentation has been a primary driver of physician burnout and a barrier to patient-centered care. Ambient AI scribes have emerged as a promising solution that uses ambient sensing to automate clinical note-taking. While their technical accuracy is frequently studied, there is a lack of research on how these tools have impacted interpersonal communication during clinical encounters.

Objective:

This study aims to investigate the communication pathways and interactional shifts that occur when ambient scribes are integrated into primary care, with a focus on how physicians adapt their behavior to accommodate an ambient digital listener.

Methods:

We conducted a qualitative study with 17 licensed family practice physicians in the Greater Toronto Area who use ambient scribes in their daily practice. Data collection included in-person clinical shadowing of five physicians (up to four hours each) followed by 30-minute interviews, and 90-minute semi-structured virtual interviews with the remaining 12 physicians. We analyzed the combined dataset using iterative thematic analysis and open coding to identify emerging communication patterns.

Results:

We identified new affordances and constraints rendered by ambient scribes along three communication pathways. Between patients and physicians, ambient scribes have improved physicians’ ability to observe nonverbal cues and demonstrate active listening, but have also created uncomfortable conversational patterns that have required adjustment. Adding ambient scribes as a third party has benefited patient comprehension because physicians have been more likely to narrate their actions and verbalize their thoughts, but implied or misattributed details have led to documentation errors. Finally, physicians have been able to repurpose their scribes for verbal note manipulation after their encounters, but recalling information from previous encounters for this task has created a new cognitive burden.

Conclusions:

Ambient scribes transform documentation from a private task into a public performance that requires physicians to act as real-time narrators. While these tools successfully reduce screen time, they create a tension where clinicians must balance rapport-building with the technical demands of their ambient scribes. Our findings suggest that this ambient technology is not truly invisible, as it forces physicians to adapt their speech to ensure clinical precision. We suggest that future systems integrate features that take a more proactive role and scaffold recall.