Write on Paper, Wrong in Practice: Why LLMs Still Struggle with Writing Clinical Notes
Bibliographic record
Abstract
Large Language Models (LLMs) are often proposed as tools to streamline clinical documentation, a task viewed as both high-volume and low-risk. However, even seemingly straightforward applications of LLMs raise complex sociotechnical considerations to translate into practice. This case study, conducted at a pediatric rehabilitation facility in Ontario, Canada examined the use of LLMs to support occupational therapists in reducing documentation burden.We conducted a qualitative study involving 20 clinicians who participated in pilot programs using two AI technologies: a general-purpose proprietary LLM and a bespoke model fine-tuned on proprietary historical documentation. Our findings reveal that documentation challenges are sociotechnical in nature, shaped by clinical workflows, organizational policies, and system constraints. Four key themes emerged: (1) the heterogeneity of workflows, (2) the documentation burden is systemic and not directly linked to the creation of any single type of documentation, (3) the need for flexible tools and clinician autonomy, and (4) effective implementation requires mutual learning between clinicians and AI systems. While LLMs show promise in easing documentation tasks, their success will depend on flexible, adaptive integration that supports clinician autonomy. Beyond technical performance, sustained adoption will require training programs and implementation strategies that reflect the complexity of clinical environments. Our findings reveal that documentation challenges are sociotechnical in nature, shaped by clinical workflows, organizational policies, and system constraints. Four key themes emerged: (1) the heterogeneity of workflows, (2) the documentation burden is systemic and not directly linked to the creation of any single type of documentation, (3) the need for flexible tools and clinician autonomy, and (4) effective implementation requires mutual learning between clinicians and AI systems. While LLMs show promise in easing documentation tasks, their success will depend on flexible, adaptive integration that supports clinician autonomy. Beyond technical performance, sustained adoption will require training programs and implementation strategies that reflect the complexity of clinical environments.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.033 | 0.207 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.014 | 0.015 |
| Scholarly communication | 0.013 | 0.011 |
| Open science | 0.003 | 0.010 |
| Research integrity | 0.005 | 0.006 |
| Insufficient payload (model declined to judge) | 0.006 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".