In this installment of Med Op-Ed: Prescription renewal systems raise liability and safety concerns, when clots may signal a catastrophic prognosis, and how writing clinical notes shapes doctors.

Concerns About AI Prescription Experiment

Automated prescription renewal systems promise efficiency but raise concerns about transparency, clinical monitoring, and liability when algorithms operate without meaningful physician oversight, according to Nikhil Jaiswal and colleagues writing in JAMA Internal Medicine.

The Context

• A pilot program in Utah allows AI to autonomously renew approximately 190 medications. Patients seeking refills complete an online form, enter the medication they want refilled, and select a pharmacy.
• Typically, prescription renewals are an opportunity for clinicians to assess adherence, toxicity, and organ function. Some drugs in the program, such as sacubitril‑valsartan and levothyroxine, require laboratory monitoring.
• Key questions about liability and alignment with federal regulations remain unresolved, the authors note.

In Their Own Words

“The Utah patient who selected lisinopril from a dropdown menu deserves to know who made the decision to renew it, what that decision-maker could see, and where she can turn if the decision was wrong.”

Read it: When an Algorithm Renews a Prescription

Venous Thromboembolism (VTE) Recurrence in Cancer: A Grim Prognosis

For patients with cancer on extended anticoagulation, recurrent VTE should be viewed as a sentinel marker of high-risk malignancy — not necessarily as a failure of anticoagulant therapy, according to Philippe Gabriel Steg, MD, writing in Circulation.

The Context

• A recent analysis of data from the API-CAT trial indicates that after 6 months of anticoagulation in patients with cancer, the rate of recurrent VTE over a year is about 2.5%, irrespective of whether the initial clot caused symptoms or was discovered incidentally during imaging for other reasons such as cancer staging.
• Recurrences tend to mirror the presentation of the index event, with pulmonary embolism recurring as pulmonary embolism and deep vein thrombosis recurring as deep vein thrombosis.
• The prognosis of recurrent VTE in this population is dire, with a mortality rate of 50% within 1 month, predominantly attributed to cancer progression rather than the clot itself.

In Their Own Words

“The practical implications are clear: regardless of whether cancer-associated VTE is symptomatic or incidental, or if it is deep vein thrombosis or pulmonary embolism, recurrent VTE is rare but extremely ominous.”

Read it: Recurrent Venous Thromboembolism in Cancer: A Foreboding Event

What’s Lost When Doctors Stop Writing Notes?

Note-writing is not just for clinical documentation. The process can cultivate essential habits of mind, reasoning, and professional judgment in physicians — a dimension threatened by the rapid adoption of AI scribes, Joshua Briscoe, MD, and colleagues argue in the Journal of General Internal Medicine.

The Context

• Historically, note-writing — from pre-Hippocratic times through the “SOAP” era — has been used to educate trainees as well as summarize and justify assessments and treatment plans.
• But the advent of electronic medical records shifted the focus toward bureaucracy, billing, and liability.
• As AI extends beyond documentation to interpretation and recommendation, physicians may gradually offload formative practices that help give medicine its core.

In Their Own Words

“Whether through total displacement or subtle diminishment, AI scribes may invite clinicians to off-load habits of mind to automation, encouraging passivity in clinical reasoning and weakening important processes of moral and cognitive habituation.”

Read it: In Defense of Note Writing: Moral Formation and the Use of AI Scribes

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.