When not to use
an AI scribe

Most of these decisions can be made before the patient sits down: the reason for the visit, who walked in with them, who booked the appointment, whether the last entry carries a safety flag, and whether this is a phone consultation.

Keep capture off where a partner or family member is present and answering for the patient. Create a moment alone: the other person waits outside during the examination, or the patient comes to the treatment room for a specimen. The RACGP's White Book, its guideline on abuse and violence in general practice, sets that out.

Do not raise recording in front of a suspected perpetrator.

Health records are read by patients, released under signed authority, and produced under subpoena in family law and criminal proceedings. Restricting the visibility of an entry in your clinical software does not keep it out of one.

Phone and video consultations remove the check the rest of this rests on, seeing who else is in the room.

• If capture has started and the picture changes, stop at the first natural break.

Doctors and nurses are mandated reporters in every state and territory. Past that the lists diverge: some jurisdictions name psychologists, dentists or pharmacists, and in the Northern Territory the duty sits on every person. Several jurisdictions carry a separate criminal offence for an adult who fails to report a known child sexual offence. Check the obligation where you practise.

Write the notification yourself. It carries what you observed, what was said and by whom, and why you formed the belief. A drafted summary strips the specificity a notification is judged on.

The triggers are visible before the consultation: an appointment booked by a school, a caseworker or under a court order; an injury whose history does not fit it; an adult who wants to stay for the examination; an adolescent asking to be seen without a parent.

Hesitation counts as a decline. Tell the patient it is off, switch it off, and carry on.

A consultation booked for a repeat prescription can turn into a disclosure of sexual assault with capture running. Stop it, then discard the session so no partial recording sits in a review queue.

The record may be tendered in evidence, so it needs the patient's own words, in the order they were said, alongside the questions you asked. A forensic medical examination is specialist work with its own chain of custody rules.

Leave capture off whenever the patient's willingness to speak is the clinical value of the encounter: disclosure of assault, sexual and reproductive health, drug and alcohol use, gambling, immigration status, and anything the patient has not said out loud before.

For a patient with persecutory delusions carrying a surveillance theme, a device in the room listening confirms the belief you are there to assess. The same applies to a patient who is acutely agitated, intoxicated or delirious. Capacity is decision specific, and agreeing to be recorded cannot be decided in that state.

A suicide risk assessment is a clinical formulation. The note has to show what you asked, how you weighed static and dynamic factors, what you concluded and what you did about it. Write it yourself.

Assessments and orders made under a state or territory Mental Health Act are statutory instruments completed by the examining practitioner and signed as a personal attestation. Fill them in yourself, every time.

Stable reviews, medication discussions and most therapy sessions where the client has agreed behave like ordinary consultations.

The Medical Board's code of conduct tells doctors to avoid providing care to anyone they have a close personal relationship with. A scribe adds two more places the material sits: an unsigned draft in a review queue, and audio held for whatever retention period applies.

Settle two questions before the consultation: who can open an unsigned draft, and who can access or replay audio. Permissions on the clinical record and permissions inside the scribe's own workspace are separate systems. Until you have that in writing, document staff and colleague consultations the ordinary way.

Capture takes in whoever speaks: a support person, an interpreter, a parent who mentions their own diagnosis while their child is the patient. That material sits inside somebody else's health record.

Know where the stop control is before you need it, and reach it without looking away for more than a second. There is usually a natural break: you stand to examine, or the patient steps behind the curtain.

Stopping and deleting are two actions. A stopped session may still hold everything captured up to that point. End the session and discard it, and confirm in advance what your tool does with a discarded session. The transcript is a separate artefact from the audio and the note.

The record has to show history, examination, reasoning, plan, and that it was written contemporaneously by the clinician who provided the care.

• If the patient declined or hesitated, record the outcome where your practice keeps consent information, in neutral words such as declined ambient documentation. Do not record the reason the patient gave.
• If you stopped because of a safety concern, document it through your practice's usual family violence or child protection process. A note saying you switched the recording off because the patient seemed frightened of their partner is itself a disclosure.
• Name these categories in your practice's AI use policy, so a locum knows them on their first morning.