Patient Perceptions of AI Ambient Scribes in the Exam Room

Executive Summary

Detailed Research

Methodology

Data on patient perceptions of AI scribes come from mixed‑methods evaluations nested within larger ambient documentation implementations in primary care and specialty clinics. Typical approaches include post‑visit surveys assessing comfort, trust, and satisfaction, along with semi‑structured interviews focused on perceived benefits and concerns about privacy, confidentiality, and physician attention.

Some studies use quasi‑experimental pre–post designs, comparing patient‑reported experience scores (for example, Press Ganey, CG‑CAHPS items) before and after ambient scribe deployment. Sample sizes vary from several hundred survey respondents in single‑health‑system implementations to smaller qualitative cohorts of 20–40 patients, limiting generalizability but providing rich narrative data.

Key Studies

Nuance DAX Ambient Documentation Cohort (Patient Experience Substudy)

• Design: Multi‑specialty cohort study with nested patient survey
• Sample: Patients in practices implementing DAX ambient documentation
• Findings: Over 85% of respondents were comfortable with the recording device in the exam room and felt their privacy was adequately protected after the clinician's explanation. Global satisfaction and communication scores remained stable or slightly improved compared with pre‑implementation periods, and fewer than 10% of patients requested that the device be turned off.
• Clinical Relevance: Large-scale validation of patient acceptance

Primary Care Ambient Listening Implementation (Abridge) Patient Feedback

• Design: Implementation study measuring patient‑reported outcomes
• Sample: Primary care patients in practices using Abridge
• Findings: High levels of acceptance, with patients frequently commenting that physicians "looked at me more" and "typed less" during visits. A small subset voiced concerns that AI might affect confidentiality or be used by insurers, but reported comfort when clinicians reassured them about data use and security.
• Clinical Relevance: Demonstrates improved perceived physician engagement

Qualitative Interviews on Ambient Documentation and Patient Trust

• Design: Semi‑structured interviews with diverse patients
• Sample: 20-40 patients across demographic groups
• Findings: General willingness to accept AI scribes when framed as tools that help physicians focus on the patient. Some participants, particularly older adults, initially worried that "computers are listening," but these concerns were mitigated by transparent explanations and the option to opt out without affecting care.
• Clinical Relevance: Identifies specific concerns for communication strategies

Early Evaluations in ED and Specialty Clinics

• Design: Pilot implementations in emergency and specialty settings
• Sample: ED and specialty clinic patients
• Findings: High overall acceptance, neutral or slightly improved satisfaction, and isolated concerns about recording sensitive topics (for example, behavioral health, sexual history) that can be addressed by pausing the device for portions of the visit.
• Clinical Relevance: No significant differences in patient‑reported trust or understanding of the care plan

Clinical Implications

For osteopathic physicians, patient acceptance data support the use of AI ambient scribes as long as consent and privacy are handled thoughtfully. Framing the tool as a way to "let me focus more on you and less on typing" aligns strongly with osteopathic emphasis on presence and relational care.

Practically, DOs should develop a brief, consistent script that describes what is being recorded, how data are stored, who can access them, and the patient's right to decline without penalty. Offering to pause recording for sensitive portions of the exam can further reinforce respect for autonomy and confidentiality.

Limitations & Research Gaps

Most available data come from early adopters and single‑system pilots, which may select for patients more comfortable with technology and clinicians more skilled at explaining it. Sample sizes for qualitative work are modest, and there is limited stratification by age, language, socioeconomic status, or prior experiences with discrimination, all of which may shape perceptions of surveillance and AI.

There are no randomized trials focused specifically on patient perceptions of ambient scribes, and almost no data address long‑term exposure or the cumulative effect of AI documentation on trust in the health system. Osteopathy‑specific studies—especially in OMT‑heavy practices and in communities with lower digital literacy—are needed to understand how ambient technology interacts with unique aspects of osteopathic care.

Osteopathic Perspective

The osteopathic principle of unity of body, mind, and spirit suggests that patients experience care not only through clinical decisions but through the quality of attention and presence in the room; early evidence that ambient scribes can support more eye contact and listening aligns with this tenet. Explicit, empathic explanations about AI use can reinforce trust and support the therapeutic relationship.

At the same time, concerns about privacy and surveillance resonate with osteopathic attention to the whole person and environment; DOs should ensure that AI tools do not introduce hidden stressors or feelings of being "watched" that could undermine healing. Maintaining physician control over when recording occurs and integrating pauses for sensitive discussions reflect rational treatment based on osteopathic principles in a technologically mediated environment.