AI used by doctors to generate medical notes misses vital information conveyed by patients' gestures and facial expressions, a study warns.Around four in ten GPs now use AI scribes, which convert speech to text and generate summaries of consultations.The 'ambient voice technology' allows doctors to focus more on the patient and is designed to save time by reducing paperwork.But researchers say its use may lead patients to withhold information they do not want AI to hear and may result in the 'deskilling' of doctors who will have fewer opportunities to maintain their clinical reasoning skills.Furthermore, AI summaries tend to prioritise clinical information, which can come at the expense of patients' stories and experiences of their illness, they add.Academics at the University of Edinburgh issued their warning after reviewing 27 articles published in scientific and medical literature exploring the adoption of AI scribes and the implications of their rollout.NHS England has told hospitals that they should 'deploy ambient voice technology (AVT) at pace' but stresses doctors must review the notes it creates and seek permission from patients before using it in appointments.The new review highlights that these programmes capture spoken words only, and can miss gestures, facial expressions and the tone in which patients or doctors are speaking. The 'ambient voice technology' allows doctors to focus more on the patient and is designed to save time by reducing paperwork.Researchers described the tools as having a 'written language bias'.'They convert spoken consultations into text and then process the interaction as a textual record,' they added.'Ambient scribes cannot capture the potentially vital information a clinician can glean from gestures, facial expressions, movement and emotional affect.'The experts say patients may 'adapt their behaviour' in front of AI and a 'lack of trust' may lead to less disclosure of sensitive information such as substance abuse, domestic abuse or mental health struggles.Dr Lucas Seuren, research fellow at the University of Edinburgh's Centre for Biomedicine, Self and Society, said: 'Many clinicians are excited about ambient AI scribes, because they promise to cut down on paperwork.'But the experiences of patients are poorly considered, and there are real risks that the patients' stories are lost.'This can further disadvantage people who already face marginalisation in health and social care services.'The findings, published in BMJ Digital Health and AI, highlight that the technology may 'require careful adaptation to clinical and health system contexts', and 'their implementation may reshape how health and care work is organised and performed'.Researchers said the 'enthusiasm surrounding ambient scribes has driven widespread adoption'.However, most studies have focused on benefits to productivity and technological performance, while 'socio-technical dimensions of adoption have been neglected', researchers said.'Ambient scribes are complex interventions with the potential to reshape clinical work, documentation practices and the organisation of care.'Before pursuing large-scale spread, it is important to develop a robust evidence base of the impacts of early deployment and develop a comprehensive understanding of how care with ambient scribes could and should be designed to support patients, clinicians and care systems,' they added.Some doctors report not recognising their own notes produced by AI and find it harder to remember patients the next time they see them.Dr Sarah Townley, deputy medical director at Medical Protection, which offers medical indemnity to doctors, said: 'Doctors frequently tell us about the burden of excessive administration tasks and their concerns about how this impacts patient care.'We welcome AI scribe tools that are helping to minimise this element of their work but recognise the important risks highlighted by this review.'Gestures, facial expressions and the tone of speech are key features when assessing patients and documentation of these details can also assist doctors with recall when patients return. 'Failure to capture this illustrates the limitations of this technology and the importance of a clear framework for practitioners to utilise AI safely.'Our advice to doctors is that they are responsible for ensuring medical notes produced by transcription software are clear, legible, accurately reflect the consultation and do not omit potentially relevant information.'When using AI scribe tools - particularly those requiring the sharing of personal data with a third party - informed consent should be sought from patients before use, and this should be documented.'Doctors should also receive appropriate training on AI scribes so they understand their limitations and data protection implications and can reassure patients about how their personal information is being used and stored.'