Charleston, SC — February 22, 2026
For over a decade, the “Charleston Medical Experience” has had a specific, frustrating geometry. You’d sit on the crinkly paper of the exam table at MUSC or a clinic in Mt. Pleasant, and the doctor would enter. But they didn’t really enter.
They walked to the workstation, pulled the rolling stool up to the monitor, and offered you their shoulder. You spent fifteen minutes talking to the Back of the Lab Coat. You’d describe your chest pain or your child’s fever, and the response was the rhythmic clack-clack-clack of a mechanical keyboard.
The doctor wasn’t being rude. They were trapped by the high price of documentation. In 2023, every word you said cost them three minutes of “Pajama Time” later that night—unless they typed it right now. The “Price of the Note” was so high it outranked your face.
The $1,000\%$ Shift: From Scribes to Air
To see the invisible AI in the room today, you have to follow the collapse of that price.
In 2023, a high-volume specialist at MUSC had two choices to stay “human-centered”: spend two hours charting at midnight, or hire a Human Scribe (usually a pre-med student) to follow them around.
- The 2023 Price: ~$35,000/year (Salary + Benefits) per human scribe.
- The 2026 Price: ~$3,000/year (Enterprise Ambient AI License).
That isn’t a 10% efficiency gain. It is a 1,000% (Order of Magnitude) collapse in the cost of capturing a medical thought. When the cost of a medical note drops from $30.00 in human labor to $3.00 in ambient compute, the “back-to-the-patient” behavior becomes economically absurd.
The “Eye Contact” Era
Walk into an MUSC exam room today, and the geometry has shifted.
The rolling stool is pushed into the corner. The monitor is dark. The doctor walks in, sits in a chair directly across from you, and looks you in the eye. Their hands are empty. There is no scribe in the corner. There is just a small, unobtrusive smartphone or a wall-mounted mic—the “Ambient Layer.”
This is the “OOM” (Order of Magnitude) signal in the wild:
- The Absence of the Keyboard: The clack-clack-clack is gone. The air is doing the work.
- The Return of Presence: The doctor is listening because the “Price of the Note” is no longer high enough to justify the “Cost of Ignoring the Patient.”
- The “Instant Draft”: By the time you walk to the checkout desk, a perfectly formatted SOAP note—summarizing your history, exam, and plan—is already sitting in your MyChart portal.
Why It’s Invisible
You don’t see the AI because it has no interface. It doesn’t ask for a prompt. It just “breathes” in the conversation, filters out the small talk about the Bridge Run, and distills the clinical truth.
MUSC didn’t just approve their new AI Center for Health Innovation (Feb 2026) to build robots; they did it because the administrative friction of healthcare has finally been turned into a cheap, background utility.
If your doctor is still looking at their screen, they aren’t “using tech”—they are stuck in a high-price legacy loop. But if they are looking at you? You’ve detected the ambient layer. The air in the room is different now.
Next in the Series: The Broad Street Retainer: How the 10x Drop in Legal Discovery Saved the Small Business Owner.