AI scribe consent: what I’ve learned after three years of use in practice

I have used an AI scribe in my family practice for about three years. By now, most of my patients are familiar with it. Some even ask why I continue to raise the issue of consent when they have already agreed to it several times.The answer is simple: expectations around AI scribes continue to evolve. Regulators and professional organizations are emphasizing privacy, transparency, patient autonomy and physician accountability. In Ontario, privacy guidance continues to emphasize meaningful patient consent before an AI scribe is used in a clinical encounter.Consent is not a one-time administrative taskIn my practice, I have tried to make consent as automated as possible while still giving patients meaningful information and a real choice. Most patients have now signed an AI scribe consent form, and their decision is indicated in the chart with a flag.Initially, the consent form was sent automatically by secure email before appointments. More recently, I adjusted the process so patients who have already signed or declined the form do not need to review it before every visit. Instead, they receive a reminder that we have recorded their decision and that they can change their mind.The reminder says: According to our records, the AI scribe consent form has already been completed for Dr. XX and does not need to be completed again. If you believe this is not correct, or if you have changed your mind about your consent decision and wish to complete the form again, please tap or click the Complete form again button below.Otherwise, please tap or click the Finish or Next button.AI scribe consent information is also included in the intake package sent by secure email to all new patients. If a patient books a virtual encounter, the medical office assistant securely emails a note that includes consent information for the virtual visit and for use of the AI scribe.We also use visible reminders in the clinic. There is signage in the waiting room and in each examination room.Even with these consents, reminders and notices, I still ask patients verbally at the start of each encounter.Build consent and review into the documentation workflowMy AI scribe templates for both in-person and virtual appointments include notes that the patient verbally consented to use of the scribe and that the record was reviewed and corrected if needed by the clinician. That second point is essential; AI tools can misinterpret clinical conversations, omit important details or introduce errors. The scribe may reduce documentation burden, but it does not remove the physician’s responsibility for the accuracy of the medical record.Patients need an easy way to say noIn practice, very few patients object. Occasionally, however, a patient will ask me not to use the scribe for that visit, or to stop using it partway through the encounter because they have something sensitive to disclose. When that happens, I stop the scribe.That is an important part of consent. Patients should not feel that the use of an AI scribe is mandatory or that declining it will affect their care. Practical tips from my workflowSend AI scribe consent information before the appointment; automate this step if possible.Use a flag to indicate whether the patient has signed or declined the consent.Include AI scribe consent information in new-patient intake packages.Use signage in waiting areas and examination rooms.Ask for verbal confirmation at the start of each encounter.Automatically document verbal consent in the clinical note.Make it easy for patients to decline or pause use of the scribe.Review and edit every AI-generated note before it is finalized, and automatically document that this review occurred.The bigger issue: administrative burdenAfter several years of using an AI scribe, I still find it unclear exactly how much consent documentation is enough. Physicians are trying to adopt tools that reduce paperwork, but the consent process can become another repetitive administrative task, and one that risks losing meaning through constant repetition. For example, a physician who sees 100 patients a week needs to request more than 400 verbal consents in a month. Our exam rooms are already crowded with notices about vaccinations, diabetes care, block fees, community resources, privacy and more. Adding another sign can contribute to visual clutter and reduce attention for each individual message.The best approach for now is to automate the process as much as possible while keeping patients informed and in control. A clear, province-wide process for AI scribe education and consent, similar in spirit to organized cancer screening programs, would help. With more than 10,000 family physicians registered for the Canada Health Infoway AI scribe program, this is no longer a niche issue. A standard provincial process could improve understanding for patients and, ideally, spare clinicians from repeating the same consent script at the start of hundreds of thousands (if not millions) of encounters.Dr. Michelle Greiver is a family physician with North York Family Health Team in Toronto and professor in the department of family and community medicine at the University of Toronto.

AI scribe consent: what I’ve learned after three years of use in practice

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