In the April edition of the British Journal of General Practice, Luke N Allen, Co-Director, Global Primary Care & Future Health Systems, Nuffield Department of Primary Care Health Sciences, University of Oxford, asks, “Why is everybody so transfixed by ambient voice scribes when the potentially transformative impact – for good or ill – lies in GenAI clinical decision support?” (GenAI and clinical decision making in general practice, BJGP Volume 76, Number 765, page 151).
Speaking personally, far from being transfixed, I don’t actually know what ambient voice scribes are. They sound like attendant medieval scriveners, charged with the task of recording the utterances of spirits, hallucinatory or otherwise, heard by people touched by the gentle hand of God, like Joan of Arc or Hildegard of Bingen, or perhaps by the mailed fist of acute paranoid schizophrenia. Is it the voices, or the scribes, that are ambient? Which are hallucinatory, and which are real?
I would guess they are just automated stenographers, not very good at their job, but on a steep learning curve. They just make me very glad that I got out of practice when I did. This stuff was just beginning to take off, and I knew it was going to get worse, but I didn’t realise that HAL, the successor to IBM (or predecessor at least alphabetically), the computer in 2001, was going to take over the consultation room. But apparently these phantom shadowy scribes are unstoppable, as we move from the “dyadic” doctor-patient consultation towards the “triadic” doctor-patient-AI consultation. “The genie,” says Luke Allen, “isn’t getting back into the bottle.” This trope is never missing from any paper on AI. The highlighted quote subheading Luke Allen’s paper states “GenAI isn’t good or bad in itself; it is a tool with known flaws that we need to learn to apply with expertise.” This statement, or something like it, referring to the amorality of automated systems, is, like the “genie” trope, almost universally attached, like a disclaimer, to any discussion of the role of Artificial Intelligence (AI) in almost any walk of life. It always crops up, the way the BBC constantly reminds us that Andrew Mountbatten-Windsor or Peter Mandelson vigorously deny any charges levelled against them.
There are a couple of sentences buried deep within Luke Allen’s paper that I find deeply disturbing.
…it could soon become morally indefensible not to consult GenAI when making clinical decisions.
At the same time, using GenAI as a backdrop for clinical reasoning will probably lead to degradation of cognitive and clinical skills…
The self-contradiction is apparent.
I see that today the doctors in England are about to start another six day strike for the umpteenth time. They say the dispute is about pay, and career opportunities, but I have a notion that no amount of pay, no incentive to get further embroiled in the dystopia that clinical practice has become, could ever compensate for the obligation to share the work space with ambient voice scribes. When talks broke down, the government withdrew the offer of further training places. Surely this was vindictive. Creating a training place for a doctor keen to hone his or her craft is either a worthy pursuit, or it is not, irrespective of any dispute over pay and conditions.
But talking of dystopias, I watched Donald J. Trump give his televised address to the American people a couple of days ago. He is going to bomb the Iranians “back to the Stone Ages (sic) where they belong.” Since then, he has come out with a barrage of expletives deleted (my father would have said to him, “kindly refrain from bringing the language of the gutter into my house”). I was curious to know exactly what he tweeted, or “truth-socialed”, so I looked it up.
Tuesday will be Power Plant Day, and Bridge Day, all wrapped up in one, in Iran. There will be nothing like it!!! Open the F*****’ Strait, you crazy bastards, or you’ll be in living Hell – JUST WATCH! Praise be to Allah
President DONALD J. TRUMP
April 05, 2026, 1.03 pm.
As Miss Elizabeth Bennett enquired of her father re the Reverend Collins in Pride and Prejudice, “Sir, can this man be sensible?” But I should add that I can’t independently verify that this is message was ever posted. I enquired of the net, and this is what I got. But it might have been recorded by an ambient voice scribe for all I know. Come to think of it, I saw the President’s address to the nation on the net as well, and I guess that the soundtrack and image could easily have been cobbled together by the spectral stenographers in the room. But if the post is the real deal, the general consensus among international lawyers seems to be that to carry out such threats would constitute a war crime; indeed the very threat, of itself, may be a war crime. But President Trump doesn’t give a fig for international norms, or the international rules-based order. Indeed, it would appear that the international rules-based order is already scuppered, and a relic of the past.
It occurs to me that it is Donald J. Trump himself who is bombing us all back to the Stone Ages. There was a time, just after the Berlin Wall came down, when it appeared that Humankind might just conceivably be able to turn its back on violence as a means of conducting international affairs, but we seem to have blown it. But it is surely the critical and abiding question of our time. How can we set about abolishing war? It seems to me that we should be encouraging our best minds to tackle and to solve this conundrum. Yet our best minds are preoccupied perfecting the next generation of ambient voice scribes, so that we can hand over all our responsibilities to them.
No wonder there are a plethora of programmes on the radio designed to help one to chill out. It is the nearest we earthbound mortals can get to taking a trip round the far side of the moon. Listening to them is rather like staring at the goldfish in an aquarium while in a state of jet lag. I must retire to my sandbagged bunker, and listen to the latest podcast of Ultimate Calm.
jamescalumcampbell 