7 ms·

Would you trust a LLM giving medical advice in the wild?

esquire_900 3y ago
At some point it becomes a serious tradeoff. It will definitely excel in finding niche solutions, in bringing up that one mechanism that's rarely used but very relevant in some case. It cannot say "I don't know" and will start babbeling instead, but if you know the downsides the upsides can be significant
- tudorw 3y ago
  If I was given the choice of no medical help at all versus take the risk and ask AI, well, I guess I would take the chance?
yieldcrv 3y ago
women and minorites receive notoriously dismissive diagnosis from human physicians which means over 75% of the population would chose this immediately and of the people that are content with their medical attention, a good portion of them would also choose this tl;dr yes
- nologic01 3y ago
  Let me make it more plain. Somebody you love is in an life threatening condition. You need advice what to do or you lose them. You have a one shot option to get advice from a human expert or a LLM. Which one you pick.
  - newswasboring 3y ago
    What exactly are you trying to reason about with this hypothetical? Do you only buy processors which can be sent to space?
  - yieldcrv 3y ago
    LLM on medical forum posts was more empathic and precise than the physicians. Thats the only data we have so far. I’ll pick the LLM. The humans are too random. I’ll take my chances with “hallucination” from something that’s also read every research paper in every language. Its just like Flowers for Algernon but even better.
    - nologic01 3y ago
      Good luck and good night.
    - kmac_ 3y ago
      Why not both. Doctors can sieve hallucinations and random BS and cross check with peers anyway, and correct the diagnosis description. This can save a lot of typical paperwork and increase healthcare availability by decreasing bureaucratic work. It's not about diagnosis but the work around it. To be clear, I just mean the autocomplete for diagnosis description entry, not the diagnosis itself.
  - logicchains 3y ago
    This is a stupid hypothetical; only in an extreme emergency where your loved one only had a few seconds to live would you not have time to consult both a human expert and an LLM.
    - nologic01 3y ago
      You are evading the question because it does not suit your narrative. Countless ink has been spent on discussing the potential risks and dilemmas of automated decision support, e.g., the autopilot situation having to choose whom to save. It is not "stupid" to isolate the essence of the challenges we are facing and discuss them without hidden agendas. Incidentally such discussions also help cast much needed light on tech bro culture and morality.
      - viraptor 3y ago
        This is a trolley type question. It's a fun philosophy game about morality. But nobody ever needs to answer either question with the stated limits. In both cases it's answer C: apply breaks on the trolley and ask both an expert and AI about the issue and discuss AI's response with the expert if you need to.
  - deleted 3y ago
    [deleted]
- Auracle 3y ago
  *Some amount of women and minorities attribute dismissive doctors to their sex or race. I’m a straight white man and I’ve had plenty of dismissive doctors over the years too. It turns out arrogance, laziness, or a lack of time have little to do with the patient themselves.
  - yieldcrv 3y ago
    I think its fine as written because we no longer have to do any empirical analysis anymore just to accommodate your view of the outcome, LLMs are here
  - newswasboring 3y ago
    This is a hilarious example of how you don't get it. People in your position think because they have experienced a mild version of something or experienced something once they now know exactly how any other minority experiences the world. This doesn't make you a bad person btw, just means you are not aware of how small your social context is.
    - Auracle 3y ago
      Mild? When I was 17 I went in to the doctor because of extreme fatigue. He just slapped me on some antidepressants and called it a day. Years later I happened to read about low testosterone symptoms, which matched me very well. He eventually acquiesced to letting me test, and it came back 2 points above the low end of normal - which probably by itself qualified as low for my age. He wouldn't let me do a quick trial of testosterone supplementation nor test again, but I begged him to refer me to an endocrinologist. The endocrinologist (2 hours away) was worse. 100% dismissive, straight up told me I didn't have low testosterone. He did however let me test again, and this time I was 150 below normal. I asked to be put on medications that would maintain my fertility. He told me I didn't need to worry about losing my fertility on straight up testosterone, which is 100% false. I'm going to cut the story off there, but it keeps going. My dad almost died because doctors didn't diagnose his lupus. My sister's friend lost her father when we were young because of an infection after some dental work where they dentist completely dismissed his pain after the fact. Everyone is unaware of how "small their social context is," which is exactly my point. If I were a minority I very well might be blaming my story on that.
- viraptor 3y ago
  LLMs are exposed to exactly the same information that doctors are. If the system starts with llama, it will get all the biases that exist on the internet as well. See the recent examples of chatgpt refusing to accept a judge can be a woman. Or the "come up with punishment given variables race and sex" questions. There's no good reason yet to expect that the 75% would receive better diagnosis from from the AI.
- Prickle 3y ago
  We need a source for that "75% would choose this immediately". Our group, sure! Our generation, and people in our shoes, and with our level of knowledge about LLMs. But maybe not others. tl;dr Not yet Consider three things: 1. What people prefer when it comes to intimate/private issues that a physician diagnoses. 2. Tainted source datasets, resulting in the same "dismissive diagnosis" from the LLM 3. Lack of Trust held within a new system 1. For starters, there are certainly a large subset of people that simply "don't trust machines". Alternatively, they "don't trust major corporations". They would likely pick local doctors over machines, due to a perceived lack of connection/humanity in the LLM. Combine that with the recent increased use of LLM / AI models used to make scam calls, and you have a potentially deep seated (and at times illogical) distrust of any LLM diagnosis. Some would say the machine doesn't and cannot understand their unique situation. And refuses to give them what they need. So they would go to a doctor. Some would have difficulty being honest with a machine. Would you trust a human or a machine to keep your medical records safe? (I honestly don't know which I would trust. Both at the same time preferably?) 2. Others would say the dataset is made up of biased diagnoses specifically tailored towards the majority, and fail to diagnose the minority correctly. You are assuming that the LLM cannot be tainted by biased or dismissive diagnosis made by doctors against the very same women and minorities. The datasets have to come from somewhere, and some of that data will without a doubt be biased. 3. There is a lack of trust. Automated systems are making great strides yes. But absolutely no one trusts them fully. Whether it be planes, cars, logistics, data, etc Absolutely no one trusts them fully. Especially with GPT like systems that simply cannot say "No" and start making stuff up. Remember the fiasco with Bard gaslighting someone about the current year? Imagine if that happens during an LLM diagnosis. Come full circle, those same people who don't trust a human physician due to discrimination? "Why the hell would I trust an AI machine made specifically to make money!". What is there that actually makes a corporate AI more trust worthy than the local physician? What is there that actually prevents the LLM from discriminating? This is really my main concern: Nothing stops the LLM from discriminating. All it takes, is a dataset with built in biases. It isn't nearly as clear cut as you make it out to be.
mlajtos 3y ago
In software development sphere, there is a review process for all code that is written. No code gets into production without an explicit approval of some peer or supervisor. When you get diagnosed by a doctor, usually no one checks the diagnosis. I would love if my health was checked by medical professional committee. Human and/or AI.
- viraptor 3y ago
  That's just not correct on both sides. Code reviews happen sometimes in some environments - it's not a given. On the other side, doctors do run their questions by other doctors if they're not sure about the results. (Again, not enforced) Similar for pathology tests results, but with the added layer of the tests themselves being reviewed too. You'd have to join the social network groups for doctors to see that, but there's a lot of double checking happening both with local peers and wider groups. For the more interesting cases anyway... you're not getting a second review if you come in with runny nose and test positive for RSV. (Edit: and even in more complex cases you may not get it for a lot of reasons)
  - borski 3y ago
    Genuine question: how do they not violate HIPAA? Are they just crazy careful to abstract and anonymize any identifiable details?
    - viraptor 3y ago
      I'm not based in the US so maybe someone else knows the details there. But HIPAA qualifies the privacy requirements with "and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual." - normally the questions I see are extremely generic, with the sex/age being mentioned at most.
  - vidarh 3y ago
    My last two ENTs did not run their answers by anyone. The first failed to correctly record the details of my issue, to the point of writing a summary that said exactly the opposite. The second failed at applying high-school level logic and came to a conclusion that is logically impossible (I tried to walk him through the failure in his reasoning several times before giving up and seeking another opinion). So there may well be a lot of double checking, but there are also a lot of cases of doctors being confidently wrong and not having their reasoning tested. (But, yeah, we have plenty of software developers confidently checking in untested, unreviewed code too)
irjustin 3y ago
I would if it's shown to be better than doctors at their own game. Wouldn't you? If you asked me in 1995 would I bet my money on World Chess Champion or a computer? ask that again 4 years later. At some point I will trust cars to drive us more than us to drive cars. These "gotcha" statements aren't helpful.
- rscho 3y ago
  Chess is a game of perfect information. Healthcare outsiders really don't understand that information retrieval is _the_ big issue in medical automation, and that reasoning on said data is the smaller problem. See, docs have one major advantage: they walk around the corridors. Doing so, they acquire a lot of info that is as of now out of reach for computers. Until that's changed, we won't see chatGPT for medicine.
  - irjustin 3y ago
    Sure, but that wasn't the question. The question was an "ever" one with no restrictions. So... I answered it.
vidarh 3y ago
Given my last encounter with an ENT specialist that failed to apply basic logic, I'd be tempted to ask in response why you would trust a doctor giving medical advice in the wild. And the answer is the same: Thorough testing and vetting and auditing out any adverse outcomes is what makes or would make either safe enough. Once an LLM is thoroughly tested and shown to perform at least as well as a real doctor, without any worse worst-case outcomes, then sure. So, not yet.
cfn 3y ago
It is a nice second opinion source, for sure.

At some point it becomes a serious tradeoff. It will definitely excel in finding niche solutions, in bringing up that one mechanism that's rarely used but very relevant in some case. It cannot say "I don't know" and will start babbeling instead, but if you know the downsides the upsides can be significant

tudorw 3y ago
If I was given the choice of no medical help at all versus take the risk and ask AI, well, I guess I would take the chance?

yieldcrv 3y ago

women and minorites receive notoriously dismissive diagnosis from human physicians which means over 75% of the population would chose this immediately and of the people that are content with their medical attention, a good portion of them would also choose this tl;dr yes

nologic01 3y ago
Let me make it more plain. Somebody you love is in an life threatening condition. You need advice what to do or you lose them. You have a one shot option to get advice from a human expert or a LLM. Which one you pick.
- newswasboring 3y ago
  What exactly are you trying to reason about with this hypothetical? Do you only buy processors which can be sent to space?
- yieldcrv 3y ago
  LLM on medical forum posts was more empathic and precise than the physicians. Thats the only data we have so far. I’ll pick the LLM. The humans are too random. I’ll take my chances with “hallucination” from something that’s also read every research paper in every language. Its just like Flowers for Algernon but even better.
  - nologic01 3y ago
    Good luck and good night.
  - kmac_ 3y ago
    Why not both. Doctors can sieve hallucinations and random BS and cross check with peers anyway, and correct the diagnosis description. This can save a lot of typical paperwork and increase healthcare availability by decreasing bureaucratic work. It's not about diagnosis but the work around it. To be clear, I just mean the autocomplete for diagnosis description entry, not the diagnosis itself.
- logicchains 3y ago
  This is a stupid hypothetical; only in an extreme emergency where your loved one only had a few seconds to live would you not have time to consult both a human expert and an LLM.
  - nologic01 3y ago
    You are evading the question because it does not suit your narrative. Countless ink has been spent on discussing the potential risks and dilemmas of automated decision support, e.g., the autopilot situation having to choose whom to save. It is not "stupid" to isolate the essence of the challenges we are facing and discuss them without hidden agendas. Incidentally such discussions also help cast much needed light on tech bro culture and morality.
    - viraptor 3y ago
      This is a trolley type question. It's a fun philosophy game about morality. But nobody ever needs to answer either question with the stated limits. In both cases it's answer C: apply breaks on the trolley and ask both an expert and AI about the issue and discuss AI's response with the expert if you need to.
- deleted 3y ago
  [deleted]
Auracle 3y ago
*Some amount of women and minorities attribute dismissive doctors to their sex or race. I’m a straight white man and I’ve had plenty of dismissive doctors over the years too. It turns out arrogance, laziness, or a lack of time have little to do with the patient themselves.
- yieldcrv 3y ago
  I think its fine as written because we no longer have to do any empirical analysis anymore just to accommodate your view of the outcome, LLMs are here
- newswasboring 3y ago
  This is a hilarious example of how you don't get it. People in your position think because they have experienced a mild version of something or experienced something once they now know exactly how any other minority experiences the world. This doesn't make you a bad person btw, just means you are not aware of how small your social context is.
  - Auracle 3y ago
    Mild? When I was 17 I went in to the doctor because of extreme fatigue. He just slapped me on some antidepressants and called it a day. Years later I happened to read about low testosterone symptoms, which matched me very well. He eventually acquiesced to letting me test, and it came back 2 points above the low end of normal - which probably by itself qualified as low for my age. He wouldn't let me do a quick trial of testosterone supplementation nor test again, but I begged him to refer me to an endocrinologist. The endocrinologist (2 hours away) was worse. 100% dismissive, straight up told me I didn't have low testosterone. He did however let me test again, and this time I was 150 below normal. I asked to be put on medications that would maintain my fertility. He told me I didn't need to worry about losing my fertility on straight up testosterone, which is 100% false. I'm going to cut the story off there, but it keeps going. My dad almost died because doctors didn't diagnose his lupus. My sister's friend lost her father when we were young because of an infection after some dental work where they dentist completely dismissed his pain after the fact. Everyone is unaware of how "small their social context is," which is exactly my point. If I were a minority I very well might be blaming my story on that.
viraptor 3y ago
LLMs are exposed to exactly the same information that doctors are. If the system starts with llama, it will get all the biases that exist on the internet as well. See the recent examples of chatgpt refusing to accept a judge can be a woman. Or the "come up with punishment given variables race and sex" questions. There's no good reason yet to expect that the 75% would receive better diagnosis from from the AI.
Prickle 3y ago
We need a source for that "75% would choose this immediately". Our group, sure! Our generation, and people in our shoes, and with our level of knowledge about LLMs. But maybe not others. tl;dr Not yet Consider three things: 1. What people prefer when it comes to intimate/private issues that a physician diagnoses. 2. Tainted source datasets, resulting in the same "dismissive diagnosis" from the LLM 3. Lack of Trust held within a new system 1. For starters, there are certainly a large subset of people that simply "don't trust machines". Alternatively, they "don't trust major corporations". They would likely pick local doctors over machines, due to a perceived lack of connection/humanity in the LLM. Combine that with the recent increased use of LLM / AI models used to make scam calls, and you have a potentially deep seated (and at times illogical) distrust of any LLM diagnosis. Some would say the machine doesn't and cannot understand their unique situation. And refuses to give them what they need. So they would go to a doctor. Some would have difficulty being honest with a machine. Would you trust a human or a machine to keep your medical records safe? (I honestly don't know which I would trust. Both at the same time preferably?) 2. Others would say the dataset is made up of biased diagnoses specifically tailored towards the majority, and fail to diagnose the minority correctly. You are assuming that the LLM cannot be tainted by biased or dismissive diagnosis made by doctors against the very same women and minorities. The datasets have to come from somewhere, and some of that data will without a doubt be biased. 3. There is a lack of trust. Automated systems are making great strides yes. But absolutely no one trusts them fully. Whether it be planes, cars, logistics, data, etc Absolutely no one trusts them fully. Especially with GPT like systems that simply cannot say "No" and start making stuff up. Remember the fiasco with Bard gaslighting someone about the current year? Imagine if that happens during an LLM diagnosis. Come full circle, those same people who don't trust a human physician due to discrimination? "Why the hell would I trust an AI machine made specifically to make money!". What is there that actually makes a corporate AI more trust worthy than the local physician? What is there that actually prevents the LLM from discriminating? This is really my main concern: Nothing stops the LLM from discriminating. All it takes, is a dataset with built in biases. It isn't nearly as clear cut as you make it out to be.

mlajtos 3y ago

In software development sphere, there is a review process for all code that is written. No code gets into production without an explicit approval of some peer or supervisor. When you get diagnosed by a doctor, usually no one checks the diagnosis. I would love if my health was checked by medical professional committee. Human and/or AI.

viraptor 3y ago
That's just not correct on both sides. Code reviews happen sometimes in some environments - it's not a given. On the other side, doctors do run their questions by other doctors if they're not sure about the results. (Again, not enforced) Similar for pathology tests results, but with the added layer of the tests themselves being reviewed too. You'd have to join the social network groups for doctors to see that, but there's a lot of double checking happening both with local peers and wider groups. For the more interesting cases anyway... you're not getting a second review if you come in with runny nose and test positive for RSV. (Edit: and even in more complex cases you may not get it for a lot of reasons)
- borski 3y ago
  Genuine question: how do they not violate HIPAA? Are they just crazy careful to abstract and anonymize any identifiable details?
  - viraptor 3y ago
    I'm not based in the US so maybe someone else knows the details there. But HIPAA qualifies the privacy requirements with "and that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual." - normally the questions I see are extremely generic, with the sex/age being mentioned at most.
- vidarh 3y ago
  My last two ENTs did not run their answers by anyone. The first failed to correctly record the details of my issue, to the point of writing a summary that said exactly the opposite. The second failed at applying high-school level logic and came to a conclusion that is logically impossible (I tried to walk him through the failure in his reasoning several times before giving up and seeking another opinion). So there may well be a lot of double checking, but there are also a lot of cases of doctors being confidently wrong and not having their reasoning tested. (But, yeah, we have plenty of software developers confidently checking in untested, unreviewed code too)

irjustin 3y ago

I would if it's shown to be better than doctors at their own game. Wouldn't you? If you asked me in 1995 would I bet my money on World Chess Champion or a computer? ask that again 4 years later. At some point I will trust cars to drive us more than us to drive cars. These "gotcha" statements aren't helpful.

rscho 3y ago
Chess is a game of perfect information. Healthcare outsiders really don't understand that information retrieval is _the_ big issue in medical automation, and that reasoning on said data is the smaller problem. See, docs have one major advantage: they walk around the corridors. Doing so, they acquire a lot of info that is as of now out of reach for computers. Until that's changed, we won't see chatGPT for medicine.
- irjustin 3y ago
  Sure, but that wasn't the question. The question was an "ever" one with no restrictions. So... I answered it.

vidarh 3y ago

Given my last encounter with an ENT specialist that failed to apply basic logic, I'd be tempted to ask in response why you would trust a doctor giving medical advice in the wild. And the answer is the same: Thorough testing and vetting and auditing out any adverse outcomes is what makes or would make either safe enough. Once an LLM is thoroughly tested and shown to perform at least as well as a real doctor, without any worse worst-case outcomes, then sure. So, not yet.

cfn 3y ago

It is a nice second opinion source, for sure.