The golden encounter: Justin Jones, MD, DAX superuser

Before DAX came along, Justin Jones, MD, was seriously considering quitting medicine. Typing notes while talking to patients felt like it sacrificed something important in his care, but typing notes later, often late into evenings and weekends, was burning him out.???

Since Intermountain Health rolled out DAX, the AI-powered ambient notetaking scribe for all physicians and advanced practice providers (APPs), the tool has only become more accurate and user-friendly. Soon it will get even better, with functionality in Spanish and access for Android users set to roll out in 2025.??

Dr. Jones is one of the organization’s top users. Here’s why.??

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How do you use DAX in your practice and what do you like so much about it???

When I was a first-year resident, we had a psychologist evaluate us during a clinical encounter. My intention back then was to never type while talking to the patient – I wanted to give them my full attention and keep track of everything mentally.?

I came out of that visit and sat down with the psychologist for feedback, and she said, “You need to type when you talk. If you don’t, you’re going to be up until midnight every night, and you’re going to burn out.” So I made what felt like a pragmatic yet disappointing trade off – give up full, undistracted listening to stay sane.?

As residents, we couldn’t afford scribes, so I always thought, “when I get into practice I’ll get a scribe." But a scribe is expensive, especially for a primary care doctor. To finance a scribe you have to be seeing 20 to 26 patients a day. I couldn’t fathom that. I would either have to go faster, talk about fewer problems, or go into less depth, any of which would sacrifice the quality of my patient care.???

Honestly, my wife and I were starting to talk about a five-year plan where I was going to side-hustle, cut down to part time, maybe leave medicine altogether. I wasn’t ready to quit, but I was doubting my ability to keep it up long term.??

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So the psychologist’s prediction came true? It was too overwhelming??? ??

Well, if I hadn’t followed her advice, I truly believe would have burned out a lot earlier. It’s a pick your poison sort of thing. You can either have the intimate connection with the patient where you’re having a conversation uninterrupted and then spend extra hours typing notes at night, or you can type the whole time. You can either have it fast or good.???

That started weighing on me. Because there are also those moments where a patient would say, “Hey, my dad just died, and I’m feeling really awful.” Or “Hey, I’m really struggling, I’m having thoughts of suicide. There’s a gun in my house and I’ve thought of using it.” In that kind of emotionally valent moment, it would be incredibly callous to keep typing.?

Those sorts of encounters are heavy and difficult, but when you’re able to guide a patient to a helpful solution or plan, they can also be intimate and fulfilling. They’re part of?why I went into medicine. But they also came with this baggage – do the right thing and be penalized later. And the notes would pile up through the week and bleed into my weekend.???

When DAX came it was honestly amazing. I didn’t even realize how fractured my mind had become trying to type notes and steer the conversation at the same time. It feels so freeing, because now I can just have a conversation and trust that it’s all going to be transcribed. That’s honestly been such a huge relief.??? ??

What does it look like in practice???

The tool is pretty simple. Before I go in, I dictate the patient’s name and date of birth and then get the consent of the patient to use the software. And after the visit there’s a very brief waiting period while it processes the note. I give it a quick scan, make any changes I need to make, and then it’s done. The big difference is the mental clarity and connectivity it restores to the exam room.???

One of my clinical preceptors used to talk about “the golden minute.”?Whenever you go into a room, spend the first minute making eye contact with the patient and talking with them. Just spend that one minute before you start typing notes and ordering things. And I’ve always tried to honor that. But now instead of the golden minute it feels like the golden encounter.??

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?Right, yeah. Now you get the whole thing.??

Exactly. My patients feel more connected, my work gets done faster, and I’m able to see more patients without feeling like I’m sacrificing their care. It’s a rare triple-win.??