Yes. Say it out loud. If you wait for them to ask, most of them never will, and you will have recorded a session they did not know was being listened to.

The Healthwatch England numbers are from a YouGov poll of 4,039 adults, fielded in April, published in the summer, and they keep coming across my desk. Nearly 90 percent of people who had an appointment in the past year did not know whether an AI scribe was used. 81 percent wanted to be told and asked. Comfort was 48 percent for a routine check. It was 28 percent for mental health.

That last number is the one I care about. You work in the 28 percent.

The speech is still short

We use a documentation assistant that listens so I can stay with you instead of typing. It drafts the note. I read and edit it before anything is signed. You can tell me to turn it off for this visit.

Then you wait. If the yes is thin, it is a no for today. I wrote a longer version in Do you need patient consent to use an AI scribe?. This post exists because people read that, put one line in the intake packet, and stopped talking.

The survey is England, NHS, different lawyers. US practices keep sending it to me because patients here also do not look at the phone on the desk. Psychiatry is not a blood-pressure check. The 28 percent is the point.

What belongs in the chart

“Patient informed that an ambient documentation tool would be used; agreed.” If they decline: declined, scribe off, visit continued. If you forget to say it, do not backfill a consent that did not happen.

A general telehealth consent from 2023 does not cover a listener. Neither does a BAA you have with us, or with anyone else. The BAA is necessary. It is not a conversation.

Sensitive visits

Healthwatch also found comfort dropping further for things like domestic abuse. You already know when the room should feel smaller. That is a session to type. Do not negotiate. Do not show them how clever the draft is. Off.

If you only turn it off when they cry, you trained them to cry. Turn it off when they hesitate.

What I would not do with this survey

I would not put “per Healthwatch 2026” in a US progress note. I would not claim 90 percent of your patients are unaware. I would not ignore it because it is foreign.

I would put a poster in the waiting room and still say the sentence in the room. Posters are how NHS practices were told to respond. Posters are not a psychiatrist making eye contact.

Questions I get

Can I disclose once per year? You can remind them in a portal. You still say it on visits that use the tool, especially the first one and any visit that went somewhere unexpected. People forget. You will not remember who you told in February.

What if they ask who hears the audio? Name the vendor. Say whether a human at that company transcribes (for Nextvisit, the product is a draft you review, not a person on a headset). If you cannot answer training-data questions in writing from the vendor, do not improvise.

Does documenting consent slow the visit? It takes twenty seconds. Rebuilding trust after they find a recording they never agreed to takes longer than that.