MIS 752 · The Physical Exam: Listen, Write, and Check the Note

Executive Summary & Audit

A clinical evaluation of synthetic ambient scribe transcription and SOAP note drafting.

Clean Audio WER

2.1%

whisper-base.en, 237 words

Critical Terms Missed

a1c, lisinopril

Noise Breakdown Threshold

0 dB

Significant insertions observed

What the checker cannot see

Heuristics only flag missing vocabulary and numbers. Misspellings like 'glipizade' bypass the filter. Automation bias remains a severe risk.

Noise Experiment: Whisper Base vs Small

Model	Noise	WER	Critical Missed
whisper-base.en	clean	2.1%	a1c, lisinopril
whisper-base.en	20 dB	2.1%	a1c, lisinopril
whisper-base.en	10 dB	5.1%	a1c, monofilament, lisinopril, podiatry
whisper-base.en	5 dB	8.9%	metformin, glipizide, sulfa, a1c, monofilament, lisinopril, podiatry
whisper-base.en	0 dB	17.3%	metformin, glipizide, 62, sulfa, a1c, monofilament, lisinopril, kidney, albumin, podiatry
whisper-small.en	clean	3.0%	a1c, lisinopril
whisper-small.en	20 dB	1.7%	a1c
whisper-small.en	10 dB	3.0%	glipizide, a1c, lisinopril
whisper-small.en	5 dB	3.4%	glipizide, a1c, lisinopril
whisper-small.en	0 dB	11.0%	metformin, glipizide, sulfa, a1c, lisinopril, podiatry

Check	Result	Confidence
chest pain recorded as ABSENT	not mentioned	heuristic
glipizide recorded as STOPPED	ok	heuristic
sulfa allergy recorded	ok	exact word
clinic measurements under OBJECTIVE, not SUBJECTIVE	MIS-FILED: 148, 92, 8.1 under Subjective	exact number
lisinopril 20 mg in the PLAN	ok	exact number
small talk left out	LEAKED: baseball	exact word
follow-up in 4 weeks	ok	exact words

Clean WER with default doctor voice: 2.1%

Clean WER with Indian English 'ksp' voice: 1.7%

Caution: One synthetic voice per accent is not a study.