The problems isnt LLMs per se, it is the shift to trusting the output of the machine coupled with a decline in verifying that the output is reasonable. It's basically what your teachers warned you about with wikipedia in eight grade except applied to all areas of life, including medicine. Dictation is already high-stakes and LLMs do not automatically reduce that risk.

Here is an example. My provider sent me this note. I'm quoting verbatim here from my MyChart record:

"Your liver enzymes are high, I would like to order acetaminophen containing medication like Tylenol, I would like to order liver ultrasound I placed ultrasound order in the system, make an appointment for radiology, I would like you to get hepatitis panel lab work done, obtain blood work order, please schedule a well visit to get it done"

When I queried it, this is what I got back. It was a dictation error. You could almost hear the panic in the message:

"Sorry for wrong message earlier, I was dictated message- so could not realize that it was written to take Tylenol type of medicines- I DO NOT RECOMMEND ACETAMINOPHEN CONTAINING MEDICINE - LIKE TYLENOL AND ALCOHOL DUE TO ELEVATED LIVER ENZYMES."

Again the problem is not dictation, or LLMs. The problem is humans ignoring their responsibility to check the output of a machine.

Which is itself a problem as (in my partners evaluations as an optometrist), LLMs used for clinical notes has a bad habit of dropping clinically important information, and the biggest providers don’t give you a copy of the raw transcript or a recording

Which means she ends up spending just as much time as if she’d done it herself as it needs to be verified for accuracy every time…

OpenEvidence is specifically meant to help clinicians make evidence-based decisions in the diagnosis and treatment of patients, not note transcription.