> "Here is a real concern about implementation" → "Therefore you should refuse entirely"
This skips the middle step of "therefore we should implement it well."
I'm not convinced that we should be allowing doctors to record patient visits at this stage yet, but I'm really not convinced by these points, which largely don't hold up under closer examination.
A few that stuck out:
"Privacy" - Labs are routinely sent to third-party companies, and we don't do informed consent for that. The third-party argument isn't unique to recording.
"False promise of efficiency" - This doesn't really have anything to do with patients at all. It's a criticism of medical office management, not of physician-patient interactions. Telling patients to refuse a tool because management might exploit the productivity gains is asking patients to fight a labor battle on the provider's behalf.
"Consent can't be revoked mid-visit" - Consent typically can't be revoked in the middle of an appendectomy, or halfway through administering a vaccine either. Practical irrevocability is a normal feature of informed consent, not a special problem unique to recording. Proper consent processes in medical offices are a broader issue than consent about voice recordings specifically. Had the authors made the point that providers are being asked to obtain consent for tools whose technical implementation and privacy risks fall outside the provider's own domain knowledge — that would be a stronger argument. But that isn't quite the point they made, and their current framing doesn't wholly convince.
I think the "therefore we should implement it well" is not forgotten, it's elided because we don't think it's likely to happen.
Tech-naïve people think that we can build super duper encryption systems.
The more jaded amongst us know that people can get sloppy or complacent, it's rare to see a regulatory system that truly incentivises good practice, data breaches will happen eventually, and no-one will be held accountable.
> Labs are routinely sent to third-party companies
Labs are real businesses that do real things, and would have actual impact for a breach. Meanwhile any idiot can vibe-code a thin shim between a microphone and ChatGPT in a weekend, promise they're HIPAA-compliant, and start selling. Medical professionals have no obligation to do any diligence, and there's no reason for them to not just buy whoever-is-cheapest. They're not even close to the same thing.
Out of curiosity, what's the prioritization of evidence (RTC Metanalysis > RTC > observational ) etc, and what's the end user benefit over a tool like OpenEvidence? You mention that other tools are expensive, slow, or increasingly heavy with pharma ads, but OpenEvidence for now seems to be pretty similiar with offerings, speed, and responses. What's your pitch as to why one should prefer this?
1. Prioritization: I instruct the model to prioritize evidence in this hierarchy: Meta-Analyses & Systematic Reviews > RCTs > Observational Studies > Case Reports. It explicitly deprioritizes non-human studies unless specified.
2. Why not OpenEvidence? OE is excellent! But we made two architectural choices to solve different problems:
'Long Tail' Coverage: OE relies on a pre-indexed vector store, which often creates a blind spot for niche/rare diseases where papers aren't in the 'Top 1% of Journals.' Because Evidex queries live APIs, we catch the obscure case reports that static indexes often prune out.
Workflow: OE is a 'Consultant' (Q&A). Evidex is a 'Resident' (Grunt work). The 'Case Mode' is built to take messy patient histories and draft the actual documentation (SOAP Notes/Appeals) you have to write after finding the answer.
> "Here is a real concern about implementation" → "Therefore you should refuse entirely"
This skips the middle step of "therefore we should implement it well."
I'm not convinced that we should be allowing doctors to record patient visits at this stage yet, but I'm really not convinced by these points, which largely don't hold up under closer examination.
A few that stuck out:
"Privacy" - Labs are routinely sent to third-party companies, and we don't do informed consent for that. The third-party argument isn't unique to recording.
"False promise of efficiency" - This doesn't really have anything to do with patients at all. It's a criticism of medical office management, not of physician-patient interactions. Telling patients to refuse a tool because management might exploit the productivity gains is asking patients to fight a labor battle on the provider's behalf.
"Consent can't be revoked mid-visit" - Consent typically can't be revoked in the middle of an appendectomy, or halfway through administering a vaccine either. Practical irrevocability is a normal feature of informed consent, not a special problem unique to recording. Proper consent processes in medical offices are a broader issue than consent about voice recordings specifically. Had the authors made the point that providers are being asked to obtain consent for tools whose technical implementation and privacy risks fall outside the provider's own domain knowledge — that would be a stronger argument. But that isn't quite the point they made, and their current framing doesn't wholly convince.