Key points
- A voice assistant turns what the clinician says to it into text or actions. An ambient scribe listens to the whole consultation and drafts the note from the conversation itself.
- In a randomised trial of 238 US outpatient physicians, one ambient scribe cut time in notes by 9.5% against usual care, while a second showed no significant change.2
- Dictation fits notes composed alone, such as an operation note, and an ambient scribe fits consultations that are mostly conversation.
- Review before signing either way. In one study, 42.4% of signed dictated notes still held at least one error.1
- wai is an ambient scribe that drafts the note during the consultation, in the room or on video, for the clinician to review and sign.4
Summary
Choose an ambient scribe to keep your eyes on the patient for the whole visit and have the conversation drafted into a note and letters. Choose a voice assistant or dictation to compose every sentence yourself in short structured encounters. Review and sign either way.
You spend the visit looking at the patient, and the note is drafted by the time the door closes. The choice between dictation and an ambient scribe comes down to where you want your attention during the consultation.
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| Question | Voice assistant or dictation | Ambient scribe |
|---|---|---|
| Who composes the note | The clinician, word by word | The scribe drafts, the clinician edits |
| Where attention goes | To the dictation, during or after the visit | To the patient, for the whole visit |
| Who is recorded | The clinician | Clinician and patient, with consent |
| Best fit | Short structured encounters, reports, operation notes | Conversation-led consultations and history taking |
| Typical error to look for | Misheard words, deletions and insertions | Omissions, misattributed statements, unsupported detail |
| Randomised evidence on time | Not tested in the trials cited here | Two trials published in 2025, with mixed results by product |
| Review before signing | Always | Always |
Two ways to speak a record
A voice assistant listens to the clinician alone. You dictate the note or speak commands that insert a template or phrase, speech recognition turns it into text, and you compose every sentence.
An ambient scribe listens to the whole consultation, with the patient's consent, and drafts a structured note in your format from the conversation. You review, edit and sign, and your attention stays with the patient during the visit.
What dictation taught medicine about review
Researchers led from Brigham and Women's Hospital in Boston checked 217 notes dictated by 144 physicians at two US health care organisations in 2016 against the original audio.1
Unreviewed speech recognition drafts carried 7.4 errors per 100 words, transcriptionist review cut that to 0.4, and signed notes held 0.3.1 42.4% of signed notes still contained at least one error, and 6.4% of errors in signed notes were clinically significant.1
The authors concluded that catching most errors before signing shows the importance of manual review, quality assurance and auditing.1 Ambient drafts get the same review.
What the ambient trials show
At UCLA, 238 outpatient physicians across 14 specialties were randomised to one of two ambient scribes or usual care between November 2024 and January 2025.2 One scribe cut time in notes by 9.5% against control and the other showed no significant change.2 Users of both reported clinically significant inaccuracies occasionally, and one mild adverse event was recorded.2
In Wisconsin, a 24-week stepped-wedge trial randomised 66 practitioners across ambulatory clinics in two states.3 Of 71,487 notes, 38% were drafted with ambient AI. Time on notes fell by 0.36 hours a day, documentation quality scored 3.97 to 4.99 out of 5 across domains, and billing diagnostic codes improved.3
Trial the specific scribe on your own consultations. The guide to AI scribe accuracy sets out what to check in each draft.
Which one fits which work
Dictation fits work composed alone after the patient has gone, such as a radiology report or an operation note.
An ambient scribe fits consultations that are mostly conversation, where history and shared decisions make up the record, which covers most general practice and outpatient specialty work. Many clinicians combine the two, letting the scribe draft the note and speaking a correction at signing.
Consent and the room
An ambient scribe records the patient, so tell them and ask before it runs. Rules differ by country and, in the US, by state, and the scripts are in patient consent for AI scribes.
Dictation records only the clinician, and the dictated note holds the same personal health data as any record.
Where wai sits
wai is an ambient scribe within a clinician workspace. It briefs you on the patient's history before the visit, drafts the note during the consultation in the room or on video, and prepares letters and suggested coding afterwards.4 Every document is a draft for you to check and sign, and only you can sign it.4
Where to start
Time a normal week of documentation, including notes and letters finished after the last patient. Then run an ambient scribe on a full clinic day with consent from every patient, and review each draft against your memory of the consultation.
Score minutes saved per session and edits per note, and log any clinically significant error caught. Where drafts need heavy editing, tune the template and run another day. The aim is the evening you leave clinic with every note already written.
Bring a consultation type you see every week, watch the ambient draft run live, and judge the edits yourself.
Frequently asked questions
Is an ambient scribe more accurate than dictation?
Does an ambient scribe save time?
Do patients need to consent to an ambient scribe?
They should be told and asked, because the scribe records them. Requirements differ by country and, in the US, by state.
Can a clinician still dictate with an ambient scribe?
Yes. Many clinicians let the scribe draft the note and then add or correct a line at signing.
Does an ambient scribe work for video consultations?
Some do. wai drafts the note during the consultation, in the room or on video.4
Who signs the note?
The clinician, after review. wai drafts notes, letters and suggested coding for the clinician to check, and the signature is always the clinician's own.4
Sources
- 1JAMA Network Open, Zhou and colleagues, 2018Analysis of Errors in Dictated Clinical Documents Assisted by Speech Recognition Software and Professional TranscriptionistsRead 14 October 2026Read source
- 2NEJM AI, Lukac and colleagues, 2025Ambient AI Scribes in Clinical Practice, A Randomized TrialRead 14 October 2026Read source
- 3NEJM AI, Afshar and colleagues, 2025A Pragmatic Randomized Controlled Trial of Ambient Artificial Intelligence to Improve Health Practitioner Well-BeingRead 14 October 2026Read source
- 4wai, 2026AI medical scribe for cliniciansRead 14 October 2026Read source
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