'Excuse me. I need to check something at the desk.'

Patients say they don’t like it when their doctors spend more time hunched over a computer keyboard than they do talking to them during a visit. How do you think patients will respond when their doctor pulls out an iPhone in front of them, calls Siri or Cortana and says, “What’s wrong with this patient?”

Suppose you are a pediatrician in Colorado taking care of an infant with bronchiolitis (inflammation of the smaller airways)? Did you remember to ask whether the child could have been exposed to marijuana passive smoke?

Given that doctors don’t want to look stupid or unknowing in front of patients, it is more likely they will excuse themselves by politely stating they have to check something at the front desk, and, while they are there, surreptitiously look up a bunch of things using point-of-care decision support apps, since their electronic medical record does not provide it now.

But, in case you haven’t heard, things are changing about the doctor-patient sick-care model. It is no longer about the doctor making the diagnosis and recommending treatment. Instead, doctors and patients are collaborating, together arriving at shared recommendations. Most patients have already done their Internet homework before they come for a visit, so why shouldn’t the doctor do the same when patients arrive for their appointment?

Let’s face it. The examining room is no longer the same place. The relationship has shifted. While the music might be the same, the choreography has changed. Patients are taking videos of office visits, sometimes unbeknownst to their doctor. Each has enough computing horsepower in their pockets to put a man on the moon, let alone improve the approximately 6-10% diagnostic error rate or include information derived from history scripts suggested by “whomever” is inside.

There will come a time shortly when patients and doctors will get used to having a third person in the room—a voice-activated physician assistant, getting smarter by the day using AI and deep intelligence, embedded in EMR 3.0.

Of course, that will introduce a whole new set of issues. I mean, how do you subpoena Siri and make sure she’ll appear at the deposition?