https://benngooch.substack.com/p/i-was-an-enthusiastic-early-adopter

This is not a small thing. The clinical note in general practice is not merely a medicolegal record. It is, as research in the Journal of General Internal Medicine has articulated, a form of narrative medicine — a clinician-authored story that reflects how the physician understood the patient’s situation at that moment in time. The act of writing it is itself a cognitive process: it forces synthesis, prioritisation, and reflection. It is, in a real sense, how we think.

When an AI records everything rather than what we chose to record, this feedback loop breaks. The note stops being a reflection of clinical reasoning and becomes a verbatim archive. And as a PMC piece on note bloat explicitly warns, this risks obscuring the most medically important information under a volume of equally-weighted detail.

The problem is not just that notes become longer. It is that they become less curated, less authored, less ours. And the clinical memory they are supposed to scaffold — the ability to pick up a case six weeks later and immediately reorient — degrades with them.