Bill Gates: Ambient scribes should be in every patient-provider interaction

Microsoft founder-turned-philanthropist Bill Gates has always been keen on leveraging technology to improve healthcare, both in the United States and in underserved communities abroad. 

While his company’s attempts to improve the digital ecosystem haven’t always been as successful as desired (RIP HealthVault), recent years have seen Microsoft become a notable player in the healthtech space – especially since the 2023 announcement that Epic Systems would be integrating the DAX Express ambient listening platform (created by Nuance, a Microsoft acquisition) more deeply into its workflow. 

The partnership marked the beginning of the ambient listening revolution in healthcare, which has since taken off in a major way. In 2024, more than 40% of healthcare executive respondents to an MGMA poll said their organizations were already using ambient listening tools to capture patient data and improve documentation. Eighty percent of participants said they were somewhat likely (27%) or very likely (53%) to consider adding or updating an ambient listening platform in the near future. 

To Gates, the rapid adoption rate is a no-brainer.  

“I don’t think there should be a patient doctor meeting where the AI is not sitting in and both transcribing offering to help with the paperwork and even making suggestions, although the doctor will be the one who makes the final decision about the diagnosis and whatever prescription gets done,” he said in a recent podcast hosted by Peter Lee, President of Microsoft Research. 

“[If] you can improve that experience and streamline things and involve the people advising you, I don’t understand why that’s not more adopted. Even for follow-up calls to make sure the patient did things to understand that they have concerns, and knowing when to escalate back to the doctor…the benefit is incredible. That paradigm is ready for prime time in my view.” 

While Gates is enthusiastic about the technological component, he also repeatedly stressed that humans must remain in the loop to ensure that these AI-driven tools, including emerging clinical decision support systems and patient-facing generative AI capabilities, are applied safely and ethically to the very sensitive task of delivering care.  

“I’d say for the next few years, we’ll also need to do reinforcement learning about the context of being a doctor and how important certain behaviors are [when taking on that role],” he commented. “These machines don’t have that broad social experience. And so, if you know it’s going to be used for health things, a lot of reinforcement learning would still be valuable.” 

“Eventually, having read all the literature of the world about good doctors and bad doctors, the model will understand as soon as you say, ‘I want you to be a doctor diagnosing somebody.’ I hope that three years from now, we don’t have to do that reinforcement learning. But today for any medical context, you would want a lot of data to reinforce tone and the willingness to say things when there might be something significant at stake.” 

Even with better bedside manner, however, Gates still doesn’t think that AI models will fully replace humans and their ability to deliver care with empathy, compassion, and the benefit of cumulative clinical experience.   

“[Human clinicians] have a lifetime of reinforcement of that, particularly when you get into areas like mental health,” he said. “We’ll always have doctors, but I’d say healthcare will be massively transformed in its quality and efficiency by AI.”  

And it won’t take very long to achieve these results, Gates predicted, especially given the extraordinarily speedy uptake of ambient listening and the white-hot interest in other AI-powered tools, such as AI agents, that is already helping to transform the way the healthcare industry operates. 

“I think the next two years will see massive experimentation with AI in a co-pilot role,” he said, “both in general medicine and in the mental health side, as well. And I think that’s going to build up the data and confidence to give the AI some additional autonomy.” 

In the next five years, appropriate deployment of AI could “stun” the world with improved quality of care, significant reduction of clinical burnout, and improvement in the economics of healthcare, he forecasted.  

“My personal role is going to be to make sure that in the poor countries, there isn’t some lag [in adoption],” he concluded. “In fact, in many cases, we’ll be more aggressive because we’re comparing [the future state] to [the current state of] having no access to doctors at all. And so, I think whether it’s India or Africa, there’ll be lessons that are globally valuable because we need medical intelligence in those areas. And AI is going to provide a lot of that.” 

The full podcast, including commentary from Sébastien Bubeck, Research Lead at OpenAI, is available here. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].