AI can’t be all that bad. The problem I’m always seeing with AI is a double-edged sword. You have corporations shoving AI in just about everything, treating it like its a cure for cancer and that really rubs people the wrong way. Then, on a more of a society level, you’ve got people who use AI for an assortment of things like making art with AI and still accredit themselves as an artist to people who treat AI like a therapist when it is not advised to.
However, I’ve found some benefits with AI. For example, I’m chatting with ChatGPT on credit cards, because it is something I may lean towards getting into. It’s helping me better understand than most people have tried explaining to me. Simply because it is giving me a more stream-lined response than people just beating the bush.
I’m a therapist. I use HIPAA compliant AI to generate my (editable) case notes for my sessions now. Not only is it a huge time saver to simply edit a generated note as opposed to making one from scratch, but in many cases it takes more detailed notes, including quotes from clients.
I have heard of other therapists and medical doctors also using AI to help with diagnosing.
The danger is when therapistsdon’t review the content to check for accuracy. Because occasionally it will generate something not really reflective of what the therapist might have been doing, or it might lack detail that the therapist might have otherwise inclused. But more often the stuff it comes up with is surprisingly accurate.And editing is even easier when you can just tell the AI something like, “include more details about how the client noticed their pattern of putting their own feelings last,” and it just does what you asked. You don’t necessarily have to edit manually, though you can.
I dislike this immensely and actively seek health care providers that don’t use these tools.
My core problem is that I want a professional who engages with me as a human and knows me.
I’m a professional (not in health care) but I “know” all of my clients, and I don’t think that’s an unreasonable expectation for a client or patient. When I pay $100 to talk to a GP for 10 minutes, I don’t think it’s too much to ask for them to have a conversation with me, really truly listen to me, and spend a few minutes writing some notes.
In the case of a mental health professional the time spent after an appointment with a patient is much greater. I don’t really want what I’ve said to be automatically converted to notes for a human to review. I want a human to consider the human to human conversation we have had, in the context of other conversations we have had and the relationship I have with them, and use those insights to produce appropriate documentation.
Finally, I have a strongly held belief that relying on the assistance of gen AI reduces one’s skills and abilities. For example, consider two therapists who have just completed their education and accreditation and start seeing patients. One uses gen AI to produce notes for every patient, the other eschews this practice. Ten years later, which therapist would you really trust to listen to patients and be able to distill the key elements of the conversation both spoken and unspoken?
That said, I’m aware that these services are becoming an industry standard. I suppose they may help therapists see more patients, and in the context of public health that might be a good thing. Whether or not I would use a service like this if I were a therapist is a difficult question to answer. If I were just starting out I think I probably would. That is to say my beef isn’t with you personally using a service like this, more that it’s becoming an industry standard.
I understand those concerns and I think there’s validity. But there’s also enormous potential for benefit.
I know of several therapists who are very good at being present with a client but terrible at documentation. And if one of these has a busy day or two it is easy to get behind. By the time they get around to writing the note the details are very fuzzy. Human memory is notoriously unreliable. A therapist I respect has said that if you’re writing a note 24 hours or more after the session, you’re probably writing fiction. A tool like this has the potential to greatly help the documentation process. But I agree that it should never become a replacement. I thoroughly read all my notes and often make edits to make them more relevant to me.
An attorney I know who specializes in representing therapists and regularly conducts legal and ethics trainings has also said that from a legal standpoint, when comparing human to AI generated notes, the AI notes are usually superior. They contain details like quotes and they automatically include all the stuff that matters for legal or insurance requirements. This attorney is VERY risk averse and honestly I thought she would have been against this, expecting horror stories like artifacts. Her opinion was a factor in me trying it out.
Again, I stress that this is a tool and not a replacement. When I read through a note, I am considering the things my clients said and my interventions to see if it matches up. It’s not perfect but it is very good and I’ve regularly been surprised with how helpful it can be.
Thanks for a considered response. As in all things, there’s nuance and I acknowledge there are benefits.
I’m genuinely curious as to whether you think reliance on this service will diminish someone’s opportunity to build the related skills?
I think that given human nature, there will certainly be some providers who overly rely on it. There are already therapists and other professionals who cut corners where they shouldn’t in a variety of ways. Probably the most common example of this is when therapists write bare-bones notes with practically no useful information to bridge one session to the next. That’s been happening since documentation was a legal requirement.
However, as always, any serious professional is going to take the time to do it right. They will understand how to use a tool effectively while keeping their skills sharp. In my field, with this tool, that would mean every note is read and edited so that it is truly useful. For example, editing the content of the note so that it can be interpreted through the therapist’s theoretical orientation.
I would hope that training programs and continuing education providers emphasize that any note they sign, including one generated by AI, is one that they are still legally responsible for. So it behooves them to always read it thoroughly and check it for accuracy.
With any new tool, certain skills will diminish but new skills will be developed. So writing skills may suffer, but good therapists will be good at editing and using effective prompts to get a good note.
Also, for what it’s worth, documentation skills and intervention skills are very different. I have known a few excellent therapists who were absolute shit at documenting. These therapists tend to be so naturally gifted and intuitive that they don’t need to document very well to be effective. And many therapists write very good notes but are mediocre at the actual therapy. So, at least for now, I tend to see the potential pros as outweighing the potential cons. That could change though!
So how does that work? Do you just have an AI listening throughout the session like a note-taker?
Yes basically, but since it is HIPAA compliant the recording is automatically destroyed when the note is saved. Also no protected recordings are used to teach the AI. The therapist can also choose from a number of different case note formats that might focus on different things
How do you know for certain?
People conflate security with risk mitigation. It’s not secure in the way that you can confirm the data has been deleted. The risk however is mitigated due to vendor attestations reinforced by contracts.
Yep, so you can’t actually know if the recording is destroyed, it’s just contractually required to be destroyed. Big difference in my book.
Wished these sensitive audios would be processed locally and never leave the therapist’s network instead.
I can’t know for certain, as I’m not on the product side of things. But I do know that HIPAA standards are very rigorous and if it were discovered that they were intentionally misleading therapists and clients then it would invite a class action lawsuit that would be insanely large.
I do ask for and document my clients’ consent, though, so if anyone is not comfortable with it that’s fine. I just write the note the old fashioned way. Most are fine but a few have said they don’t want to and it’s not a big deal.
A HIPAA violation is a death sentence to a company, along with massive fines.
There’s no incentive for them to fuck around