Outpatient medicine has a problem: the consultation happens now, but the letter arrives later. You see the patient, make the decisions, dictate after the consultation, and only after transcription and review is the letter finally sent to the GP and the patient. Sometimes weeks have passed. The gap is so familiar that we hardly notice it.

Ambient voice technology (AVT) attacks that gap. In my view, that is its real benefit.

We have been told about productivity and AI liberating us from administration, but the real shift is simpler: a clinic letter that once took five weeks to reach the reader can now be reviewed, printed, and given to the patient in five minutes.

For the past 6 months I have used AVT in my cardiology clinic. The workflow is simple. The patient comes in, verbal consent is obtained, I switch the microphone on, consult as usual, except that I say the medications and examination findings out loud, then review the generated letter, print it, and the patient leaves with it. Consultation, documentation, and communication now sit in the same time frame. That is a meaningful change, and probably the most important one.

The evidence base, at least so far, broadly matches this experience, though with more modest gains than the hype suggests. A 2025 randomised trial of ambient AI scribes in outpatient practice found reductions in time spent on documentation for one platform and possible improvements in burnout and task load. But it also reported occasional inaccuracies and emphasised the need for clinician vigilance. A 2026 multisite JAMA study showed only modest reductions in total EHR time and documentation time, alongside a small increase in visit volume. These are not transformative gains.

So, this is not about saving time. Clinic does not suddenly run faster. You still read the letter, check the medications, and decide whether the generated prose reflects what happened. You still carry the medicolegal responsibility. The work is not abolished. It is relocated.

What used to be delayed dictation and deferred correction becomes immediate review. Time is not removed from the system; it is used differently.

That matters because deferred work is toxic. It occupies mental bandwidth, produces evening admin, invites recall errors, and leaves a persistent sense of incompleteness. The old model asks the clinician to do two jobs separated by time: first the consultation, then the reconstruction of the consultation. Ambient systems collapse those two jobs into one episode. That is why the technology feels better. Not because it removes work, but because it removes delay.

There is another reason it feels better: the patient’s voice is captured more faithfully. Anyone who has run a busy clinic knows the weakness of traditional letters. By the time we dictate, we are no longer simply recording the story - often we are rewriting it. The temporal sequence has been cleaned up and compressed. Once we think we know the diagnosis, confirmation bias tends to emphasise the features that fit and quietly discard those that do not.
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Ambient systems are often better at preserving the patient’s account of breathlessness, chest pain, and palpitations, and more accurate in capturing onset, duration, and triggers. That is not trivial in cardiology, where chronology often drives diagnosis.

But fluency is not fidelity.

These systems can generate confident falsehoods. In my experience, the clearest example is medication allergies. If allergies are not explicitly discussed, the draft may still insert “no known allergies” or an equivalent negative statement. That is not a stylistic error. It is a safety problem.

The danger is not that the text looks wrong, but that it looks so polished as to be credible. A generated letter can be wrong in a far more seductive way than a bad dictation. It is structured, coherent, and confident. It invites approval.
This changes the clinician’s task. You are no longer asking, “How do I say this?” You are asking, “Did this system just say something I never established?” Editing is not the same as writing. It requires a different, and in some ways sharper, form of attention.

What happens when the system fails, if the output is incomplete or if you forget to switch the microphone on. Safe use doesn’t just depend on good drafts. If the AI is unavailable, uncertain, or clearly wrong, the clinician needs an obvious manual fallback rather than a gap or a polished but misleading output. In other words, these systems do not just need accuracy; they need a safe backstop.

One potential downside, rarely discussed amid the enthusiasm for these systems, is what happens to trainees. Writing a clinic letter is not clerical work; it is a cognitive act. It forces you to organise a history, prioritise signal over noise, commit to a diagnosis, and articulate a plan coherently for another clinician. That process - the translation from messy clinical reality into structured narrative - is where much of the learning sits.

If ambient systems assume that role, trainees risk becoming editors rather than authors. Editing is reactive, not generative. Over time, that may erode the ability to independently synthesise complex information, particularly in specialties like cardiology where nuance in symptom chronology, investigation interpretation, and risk framing matters. The analogy is obvious: just as reliance on imaging can atrophy examination skills, reliance on generated documentation may atrophy clinical reasoning as expressed in writing.

Patients, for their part, seem comfortable with the technology. When the purpose is explained clearly, most accept it readily. In practice, verbal consent is straightforward and often reassuring. Some patients like the idea that their account is being captured accurately. Most value leaving clinic with a printed letter in hand.

That last point should not be underestimated. A letter delivered at the point of care is not just faster; it is more transparent. The patient can read it, correct it, and leave with a record of the plan rather than waiting for a delayed and often forgotten communication.

The same immediacy helps with referrals. Ambient systems automatically draft referral letters, reducing the friction of onward referral while the clinical reasoning is still live. The responsibility remains, but the barrier is lower.

The question is whether this early experience generalises in a robust way. Here the evidence is still thin. Most studies are multispecialty outpatient evaluations or primary care implementations. There is little cardiology-specific data. That matters. Cardiology is not generic outpatient medicine. It is a field of valve gradients, ECG intervals, medication doses, and risk-laden omissions. It is one thing for an ambient system to produce a competent note for a straightforward follow-up. It is another for it to reliably handle the patient with mixed angina and dyspnoea, prior PCI, LV impairment, complex medication decisions, and multiple referral pathways.

We should stop asking whether ambient voice technology is “good” and start asking more precise questions. Where does it work well? Where does it fail? Which errors matter clinically? How often does it introduce false negatives or misplaced certainty? These are the questions that will determine whether this becomes routine practice or remains a promising but imperfect tool.

Regulators have already recognised that this is not a trivial addition. NHS England has issued guidance on the use of AI-enabled ambient scribing systems, including requirements around consent, transparency, and information governance. That is appropriate. These are clinical documentation tools, not convenience software.
So where do I stand after using it for half a year?

Positive, but not evangelical.

It works. It handles a range of patient voices better than expected. It captures symptoms well. It produces usable letters. It removes the need for traditional dictation and creates a clearer real-time record of the consultation. Most importantly, it collapses the interval between consultation and communication from weeks to minutes.

But it is not magic. It does not abolish work. It does not remove the need for review. And it does not earn trust simply by sounding competent.

It may not shorten clinic, but it shortens the distance between decision and documentation.

That is enough to matter.

There’s a question that keeps coming up in conversations with trainees and trainers alike: Why, in the final year of interventional cardiology training, are we sending people back to the Acute Medical Unit? 

Let’s be clear at the outset: this is not an argument against general medicine. Cardiologists absolutely should be physicians. We deal with older, frailer, multimorbid patients. If anything, cardiology is becoming more generalist, not less. But this isn’t really about whether generalism matters. It’s about when it should be taught and at what opportunity cost.

The Wrong Skill at the Wrong Time
Training isn’t just about content - timing matters. Early in training, broad medical exposure makes perfect sense. You build diagnostic breadth, learn how to manage complexity and develop clinical judgement. But interventional cardiology is different.

By the final year, trainees should be doing one thing above all else which is to become safe, independent operators. In practice, that means exacty that: practice. Practice at handling complex PCI, practice at making real-time procedural decisions, practice managing complications, practice using imaging properly (IVUS/OCT) and the most important skill, understanding when not to intervene. These are not theoretical skills. They are built through repetition, continuity, and exposure to real cases. You cannot learn bailout strategies dealing with frailty on AMU. 

Training time is finite
Every week on AMU is a week not spent in the cath lab, seeing complications, following cases through and building procedural fluency. The uncomfortable truth is you can catch up on general medicine. but you cannot easily catch up on lost procedural experience. Recent UK survey data suggest that many interventional trainees plan fellowship training after CCT, often because they do not feel ready for independent consultant practice. That should worry us all.

In 2026 a CCT in cardiology for an interventional trainee isn't perceived by the trainees as a credible qualification to practice independently in the cath lab. This means the training programme isn't doing what it should be.

Let’s be honest: the push for more generalism comes from a real place which is an ageing population, pressure on acute medicine and workforce shortages but that doesn’t automatically make it good training design. There’s a difference between what the system needs and what the trainee needs and right now in 2026, final-year AMU rotations feel less like education and more like gap filling and service provision.

Even more important is that interventional cardiologists don’t spend their time on AMU practising general medicine when they are a consultant. They work in the cath lab, managing ACS pathways, running cardiology services, dealing with complications and complex decision-making. Training should prepare them for that reality yet instead, we’re taking them away from it just at the point of peak specialisation.

Patient safety matters
​This isn't just an educational issue - it’s a patient safety issue. Interventional cardiology is high-risk. Outcomes depend on experience, judgement and exposure to complications. These things are learned in the cath lab not taught in a classroom. If we reduce exposure at the exact point trainees should be consolidating independence, we shouldn’t be surprised if confidence is lower, fellowship training becomes the norm and early consultant years are more fragile.

If we want interventional cardiologists who are strong physicians we should teach general medicine early, reinforce it throughout training and embed it within cardiology contexts (heart failure, ACS, multimorbidity) not bolt it into the final year, when something much more specific should be happening. That’s not balance, its poor sequencing.

Interventional cardiologists don't think the current model incorporating general medicine is a good idea. I've been involved in training and education in cardiology for more than 20 years and a more sensible model would front-load general medicine, sign it off earlier, protect the final years for advanced cardiology and accept that procedural competence needs dedicated time.

If the programme can’t deliver both within the current structure, then we need to be honest about that. This isn’t about resisting change or clinging to subspecialisation, it’s about getting the basics of training right. 

Final-year interventional trainees should be in the cath lab, not on AMU, not because general medicine doesn’t matter but because timing matters more than we’re currently willing to admit.

General Medical Council. Cardiology Curriculum 2022
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McGrath S, Morgan H, Muir D, Hildick-Smith D. Evaluation of the UK Intervention Subspecialty Programme: The Trainees' Experience. Interv Cardiol. 2025 Jun 10;20:e20.