Ambient scribes as narrative technologies.

Abstract

Ambient scribes, also known as artificial intelligence-powered voice-to-text technology, are widely cited as time-saving tools that reduce administrative burden for clinicians. Yet, in their current use, these tools pose substantial, often unacknowledged risks that threaten to undermine patient-centred care. We argue that ambient scribes are inherently narrative technologies whose risks-and potential benefits-cannot be fully understood without careful attention to the ways that patients tell their stories and the broader context in which those stories are told. Drawing on medical humanities scholarship, we show that current approaches to ambient scribes take a superficial approach to narrative interpretation that omits the clinically relevant aspects of patient experience. We propose three ways to integrate more robust narrative analysis that can increase the value of ambient scribes: centring patient perspectives, accounting for material and social structures that shape narrative, and reframing the clinical encounter as a node in a broader narrative system. We conclude by outlining five priorities for commissioners, administrators, clinical leaders, and practice managers to ensure that the roll-out of ambient scribes does not deepen existing harms, and could instead contribute to more humane and trustworthy care.