by Ambient AI now records the conversation at the hospital bed and the exam table. The microphone is optional, for the moment. The receptionist slid a tablet across the counter and asked, in the bright tone reserved for upgrades, whether I would consent to let the clinic “AI Listen” to the appointment. Percy and Lotty, The Boles Brits, were already complaining inside their carrier, due for the rabies shots the state requires. The pitch was efficiency. The software would listen to my conversation with the veterinarian, transcribe it, and “ambient scribe” the care notes so the doctor could spend less time typing and more time with the animals. I declined. There was a checkbox for that, which I noted with the small relief of a man who has read the next paragraph before signing the first.
Let me be honest about my own position, since the easy posture here is that of the technophobe, and it is not mine. I build with these tools every day and admire what they can do. My unease is a question of placement. A tool that helps me draft a website sits at my desk, under my hand, working for me. A microphone that records the entire appointment sits in the rooms where people undress, weep, and hear bad news, working for someone else. The exam table and the hospital bed are among the last rooms where most of us still expect a closed door. Someone has wired those rooms for sound and called it a feature.
This reaches far beyond a single clinic. Mayo Clinic has expanded its use of the Abridge platform across its enterprise to more than two thousand physicians, building on earlier work that used the same technology for nursing documentation. Reports describe ambient listening tools recording patient interactions with nurses in Mayo’s emergency rooms, and the institution has committed over a billion dollars to artificial intelligence across more than two hundred projects. Ambient scribing has become the breakout commercial category in clinical software, generating roughly six hundred million dollars in 2025, with Microsoft’s Nuance, Abridge, and Ambience dividing the market between them. The veterinary world followed within a season. ScribbleVet, HappyDoc, VetSkribe, and VetGeni all sell the same arrangement to animal hospitals, and one of them advertises that it was trained on more than a million and a half real appointments. The microphone has moved past the experimental stage. Animal hospitals and major medical centers now treat it as standard equipment in the examination room, on both sides of the species line.
Here is where my work on Carceral Nation comes back to find me. Jeremy Bentham designed the Panopticon in 1791 and called it the inspection-house: a ring of cells around a central tower, lit so that a single watchman could see every prisoner while no prisoner could tell whether the watchman was present. Michel Foucault, in Discipline and Punish, read that design as the blueprint of modern power. Its cleverness lay in the fact that the watching did not need to be constant to work. A prisoner who could not confirm whether anyone was looking behaved as though someone always was, and so policed himself. Power, in Foucault’s phrase, became visible and unverifiable. The comparison has limits, and I want to mark them before a critic does. No one is jailed at the vet, and the technicians holding Percy and Lotty mean them no harm. What survives the disanalogy is the structure. The clinical microphone reproduces the panoptic principle and inverts its optics. Bentham built his inspection-house around the eye. The version arriving at the bedside is built around the ear, and unlike the watchman in the tower, it makes no pretense of looking away.
The defenders of ambient scribing have a reasonable reply, and it deserves an answer rather than a sneer. They point out that the conversation was always going into the medical record, that the clinician always took notes, and that the software simply automates a chore. Three differences undo the comparison. A written note is a lossy summary, filtered through a clinician’s judgment about what matters. An ambient transcript is total capture. The vendors give the game away when they advertise that their software automatically strips out the small talk and the off-topic chatter, because stripping it out means the system first heard and processed all of it, including the parts you assumed were private. Persistence is the second difference. A clinician’s memory of your visit fades; a recording does not, and Mayo Clinic has not said publicly how long these recordings live or whether they help train the underlying models. Aggregation is the third. Your veterinarian’s note stayed in your animal’s chart. The transcript travels to an outside company pooling millions of encounters to sharpen a product. Your veterinarian knows you and your cat. The company gathering the transcripts knows the population.
The opt-out I clicked is real, and my gratitude for it is the reason I distrust its future. Optional surveillance follows a familiar arc. It arrives as a courtesy you may decline, hardens into the default you must remember to refuse, and ends as the invisible condition of using the service at all. Browser cookies walked that path. So did the location setting on the phone in your pocket and the automated cameras that now read license plates on roads that once had none. A right to opt out also assumes a person free to use it. Researchers writing in npj Digital Medicine observed that patients may hold back what they disclose, or feel too intimidated to ask the provider to pause the device, once they know the room is recording. Consent from a frightened patient, or from an owner whose cat is crying on a steel table while a stranger raises a needle, is consent in name. The arrangement counts on your reluctance to make a scene.
Then there is the bill, where the marketing turns honest by accident. The clinic sells ambient scribing as a way to save time, and save time it does. The question is whose. Minutes reclaimed from typing become more appointments on the schedule or an earlier drive home for the doctor, and neither result shows up as a smaller number on your invoice. The software itself is a new monthly cost; one popular veterinary product starts at a hundred and nineteen dollars a month. Competition can push such savings toward lower prices, yet veterinary medicine is consolidating at speed. Mars Veterinary Health alone owns Banfield, VCA, and BluePearl and runs close to two thousand practices, and private equity has poured tens of billions of dollars into the sector in recent years. As local competition thins, the gains from automation flow to owners and investors, not to the family paying for a rabies shot. There is a further asymmetry worth naming. Your own medical conversation falls under HIPAA, the federal health-privacy statute; your pet’s conversation falls under nothing comparable, because that law was written for human patients and never extended to animals. The legal floor under Percy and Lotty’s transcript sits lower than the one under yours. You pay twice either way. The fee will not fall on account of the microphone, and your conversation becomes an asset on a balance sheet you will never see.
So, how far is too far, and can we ever escape the listener? Banning the technology is not the cure, and trusting the people who sell it is worse. What needs governing is the architecture around the microphone: the defaults, the disclosures, the retention, and the question of who profits. A defensible version of this tool would ask you to opt in rather than out, would erase the audio once the note is written, would forbid the use of patient and client recordings to train commercial models, and would tell you in plain language where your words go and who keeps them. None of that is technically difficult. All of it is commercially inconvenient, which is why none of it will arrive unless we demand it.
I declined the microphone for Percy and Lotty, and I will keep declining for as long as the checkbox exists. The harder task is to keep the checkbox there at all, and to resist the quiet redefinition of “ambient” that would carry it from a thing in the background to a thing we are no longer allowed to question. Bentham’s tower worked because the prisoner forgot that being watched was ever a choice. The exam room is a small place to plant a flag. It is also the room where we are most alone, most anxious, and most easily overheard, which is the reason the flag belongs there.
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