Ambient AI note-taking has been marketed to physicians on the premise that it gives them more face-to-face time with patients by completing their visit notes in real-time.
For Mikel Daniels, DPM, that promise comes with a catch he believes most physicians using the technology haven’t fully reckoned with.
Dr. Daniels is president and chief medical officer of WeTreatFeet Podiatry, a Maryland-based multispecialty practice he has grown to 10 offices and 10 physicians since going into practice in 2002, along with durable medical equipment, consulting, billing and clinical trials arms that together support roughly 50,000 patient visits a year. He is also a partner in a multiphysician, multispecialty surgical center in Washington, D.C.
AI has reshaped the back office of his practice, he said. Tasks that used to take him a full day, like generating operational reports, now take a fraction of the time.
“I used to spend a whole day just generating reports just to kind of try to figure out what was going on. Now I can just run these massive data dumps and put it into AI and ask the questions and get the answers I want,” Dr. Daniels said.
The practice also uses AI to draft content, from marketing copy to internal materials, freeing him from tasks like correcting grammar and spelling by hand.
“I don’t have to sit here and write, or correct grammar and spelling. I can just dump it in, and it’ll do it for me,” he said.
That convenience comes with a responsibility he said too many physicians skip.
“You do have to be careful because if you let AI write stuff for you, sometimes it writes stuff that’s just blatantly wrong. In this day and age, you can be legally held responsible for everything on your website or everything published under your name,” Dr. Daniels said. “I have never produced a single paragraph with AI that I didn’t correct.”
That discipline matters even more, he said, in the exam room, where the practice uses ambient AI to generate clinical notes in real time.
“That is sold to physicians under a very, very bad theory. The theory being: ‘Oh, I’m done with the note before I walk out of the room,” Dr. Daniels said. “Except [AI] doesn’t understand exaggeration. It doesn’t understand sarcasm. It doesn’t understand jokes.”
He offered a recent example. While a physician the practice was considering hiring sat in on a visit, Dr. Daniels introduced a longtime patient with an offhand exaggeration about how long she’d been coming to the practice — and the ambient AI recorded it as fact.
“That note said the patient had been coming here for 427 years,” Dr. Daniels said.
The error is absurd on its face, he said, but it points to a liability that won’t stay theoretical. In Maryland, where WeTreatFeet is based, the statute of limitations on a malpractice claim is three years — meaning an inaccurate AI-generated note can sit untouched in a chart for years before it ever surfaces in court.
“Five years from now, when a case gets to court, somebody puts you on the stand and says, ‘Doctor, why did you say 427 years?’ ‘Oh, that was AI.’ ‘Well, what else in this note did AI write that’s not true, doctor?’ Now you have no credibility for your documentation,” Dr. Daniels said.
He connected the appeal of ambient AI to a structural problem in how physicians are paid.
“The creators of the systems for third-party payers were geniuses, because they took the one thing that doctors despise, which is documenting, and made their entire income dependent upon it,” Dr. Daniels said. “So now they have the system where it says, ‘OK, you just hit sign here, and your note is done.'”
The case law that would define who bears responsibility for an AI-generated error hasn’t caught up yet, Dr. Daniels said, but he expects that to change.
“You’ll start seeing these things become more and more of a reality, because who is responsible when AI makes a mistake?” he said, pointing to a pending case in Pennsylvania in which a company that used AI to screen patients for a therapy group was sued.
“They’re getting sued for the AI practicing medicine without a license,” Dr. Daniels said.
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