Why does my AI scribe get my client's pronouns wrong?

Because it guesses. A randomised trial of two AI scribes counted pronoun errors that misgendered patients as one of four named error types, reported eight times. A clinician in a psychiatry forum said their tool used they for every patient, whatever the patient used. In a therapy note, a wrong pronoun is not a typo. It is a statement about the client, written into their record.

What did the research find?

In a randomised trial of two AI scribes at a large California health system, covering 238 physicians in 14 specialties and 72,369 visits, physicians rated clinically significant inaccuracies as occurring occasionally. The error types they reported were omissions (12 reports), formatting problems (11), pronoun errors that misgendered patients (8), and confusion between yes and no (5).

Pronoun errors were not the most frequent problem. They were frequent enough to be counted on their own.

Why does it happen?

The tool works out who is who, and what to call them, from audio. Names can be ambiguous, people refer to each other loosely, and nothing in a conversation announces a client's pronouns unless someone says them. Some tools appear to avoid guessing by using they throughout, which is a different error rather than no error.

Why does it matter more in therapy?

Because the client may read it. Under HIPAA, people have a right to access their own health records, with a narrow exception for psychotherapy notes kept separately. A progress note written by a scribe is part of the record. A client who reads their note and finds themselves misgendered learns something about how carefully they were heard.

What can I do about it?

Record the client's pronouns wherever your tool lets you. Then check them before you sign, every time, the way you would check a medication dose. It takes five seconds and it is the check most likely to be skipped.

The short version

AI scribes infer pronouns, and get them wrong often enough that a large trial counted it as its own error. In a note a client may read, that matters. Check pronouns before you sign, every time. Solanto is being built for therapy practices to write the history and leave the final word to you, in Cloud mode or in Private Mode, where the note never leaves your device.

Solanto has not shipped yet. The price is on the page rather than behind a call, and early access is open: solanto.ai/pricing

Ask a colleague when they last checked the pronouns in a draft before signing it.