The Referral That Was Never Made

Ontario's auditor general reviewed AI-powered medical transcription tools that had been approved for use by doctors across the province. The audit found that most of the approved tools produced clinical notes containing fabricated content: invented referrals for tests or therapy that had never actually been discussed, incorrectly transcribed prescription medication names, and summaries that missed key details from mental health encounters. The tools had received official approval to be used in real patient care despite these problems surfacing during evaluation.

Apraxia (transcription is the tool's job, and it fumbled it), considered, but transcription errors alone would just mean missing or garbled content; the more troubling finding is content that was invented outright, like referrals that were never discussed, which isn't a failed transcription of something real.

Delusional Disorder (one sustained false belief carried across a task), doesn't fit either; each fabricated detail was a separate, unrelated invention rather than one consistent false premise running through an entire session.

Brief Psychotic Disorder, most consistent with the pattern. Each fabrication (a referral, a medication name, a diagnosis) was a discrete, confidently stated clinical fact that had no basis in the actual encounter, generated and inserted into an otherwise normal-looking note.

A fabricated referral in a medical record isn't a cosmetic error, it can change what care a patient receives or misinform the next clinician who reads the chart. The audit's most important finding may not be the tools' error rate at all, but that procurement approved them for real patient use despite fabrication problems that were already visible during evaluation; catching this kind of failure has to happen before deployment, not after.

Catch fabrication before deployment, so procurement does not approve tools whose problems are visible in evaluation.

Pre-deployment accuracy evaluation; clinician review of generated notes; procurement criteria tied to fabrication rates.