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> they can't do mathematical calculations Tell me you never taught service courses for pre-meds without telling me you never taught service courses for pre-med

by ke88y 3y ago

> they can't do mathematical calculations Tell me you never taught service courses for pre-meds without telling me you never taught service courses for pre-meds ;) > They hallucinate, They're incredibly good at being convincing, no matter what junk they are outputting Describes about a third of the doctors I've interacted with, tbh. > And the advice I got seemed useful, and helped kick off additional research and useful conversations with veterinary staff. It's similar to "Dr. Google". Possible to misuse. But also, there's nothing magical about the medical guild initiation process. Lots of people are smart enough to learn and understand the bits of knowledge they need to accurately self-diagnose and understand tradeoffs of treatment options, then use a medical professional as a consultant to fill in the gaps and validate mental models. Unfortunately, most medical professionals aren't willing to engage with patients in that mode and would rather misdiagnose than work with an educated patient. (My bil -- a medical doctor, and a fairly accomplished one at that -- has been chided for using "Dr Google" at an urgent care before.) > Do the benefits outweight the risks? As with pretty much every ethical question involving LLMs, there are no obviously correct answers here. At the end of the day, it doesn't matter. At least in the US, you won't have access to any meaningful treatment without going through the guild anyways. I don't think that using LLMs for medical diagnosis is a good idea, but it's important to admit when the status quo is so thoroughly hollowed out of any moral or practical justification that even terrible ideas are better than the alternative of leaving things as they are.

haldujai 3y ago
> Lots of people are smart enough to learn and understand the bits of knowledge they need to accurately self-diagnose and understand tradeoffs of treatment options, then use a medical professional as a consultant to fill in the gaps and validate mental models. This is incredibly dangerous, lots of people are smart enough that they can research questions about their condition/care to discuss with their medical professional but should absolutely not be self-diagnosing. It is very reasonable to ask "I read about X what do you think" but you (and even physicians cannot do this for themselves by the way) should not be self-diagnosing anything. This is like saying lots of doctors are smart enough to learn and understand the bits of knowledge they need to accurately train LLMs and put them in charge of [life threatening system]. > But also, there's nothing magical about the medical guild initiation process. You're right, it's not magical. It's just 10+ years of medical training.
- zarzavat 3y ago
  Doctors may have 10 years of medical training but they have very little time to apply that knowledge to any particular patient. If you come to a doctor’s appointment with zero research then you will not be able to push back if your doctor attempts to misdiagnose you. It will be a unidirectional conversation. If you have prepared for your appointment then the following conversation is more likely to happen: Patient: I have symptoms X and Y Doctor: You probably have condition A Patient: But I don’t have Z, is it really likely that I have A? Doctor: It’s also possible that you have condition B In a perfect world, patients would get hour long appointments and doctors would explore the entire fault tree. For rich people this may actually be reality. But for us proles, every minute we get with a doctor is precious so we’d better study up so we can use them as medical oracles.
  - haldujai 3y ago
    As stated, being informed is encouraged. Self-diagnosis is not for anyone to do. I think another issue here is your expectations out of a medical visit may be unrealistic. Physicians aren’t supposed to arrive at the correct diagnosis from the initial visit (for most things). We start with a suspected diagnosis and differential and refine it with investigations and multiple visits for temporality/evolution. Note that in your hypothetical that probably and possible are not mutually exclusive. It’s entirely possible patient A’s right upper quadrant pain is a gallbladder cancer but it is also probably gallstones even if you tell me the pain isn’t triggered by fatty meals. Just because a preliminary diagnosis is stated as probable it doesn’t mean other potential causes aren’t being simultaneously investigated with that ultrasound. I also don’t need to be telling the patient about all of the potential possibilities from the get go as it may cause anxiety, this is a patient-specific judgement call. > In a perfect world, patients would get hour long appointments and doctors would explore the entire fault tree. Honestly, outside of counseling type visits or complex oncology I’m not sure what I would spend an hour talking about. Why do feel we need to explore the entire fault tree in a single visit with missing investigations? As a hypothetical: 50 y/o male patient comes in with first time rectal bleeding, I’ll ask a few questions and perform a physical exam but regardless of the fault tree or why this happened, this patient is getting a colonoscopy. Until we’ve excluded cancer and inflammatory bowel disease further discussion is moot.

by ke88y 3y ago

haldujai 3y ago

> Lots of people are smart enough to learn and understand the bits of knowledge they need to accurately self-diagnose and understand tradeoffs of treatment options, then use a medical professional as a consultant to fill in the gaps and validate mental models. This is incredibly dangerous, lots of people are smart enough that they can research questions about their condition/care to discuss with their medical professional but should absolutely not be self-diagnosing. It is very reasonable to ask "I read about X what do you think" but you (and even physicians cannot do this for themselves by the way) should not be self-diagnosing anything. This is like saying lots of doctors are smart enough to learn and understand the bits of knowledge they need to accurately train LLMs and put them in charge of [life threatening system]. > But also, there's nothing magical about the medical guild initiation process. You're right, it's not magical. It's just 10+ years of medical training.

zarzavat 3y ago
Doctors may have 10 years of medical training but they have very little time to apply that knowledge to any particular patient. If you come to a doctor’s appointment with zero research then you will not be able to push back if your doctor attempts to misdiagnose you. It will be a unidirectional conversation. If you have prepared for your appointment then the following conversation is more likely to happen: Patient: I have symptoms X and Y Doctor: You probably have condition A Patient: But I don’t have Z, is it really likely that I have A? Doctor: It’s also possible that you have condition B In a perfect world, patients would get hour long appointments and doctors would explore the entire fault tree. For rich people this may actually be reality. But for us proles, every minute we get with a doctor is precious so we’d better study up so we can use them as medical oracles.
- haldujai 3y ago
  As stated, being informed is encouraged. Self-diagnosis is not for anyone to do. I think another issue here is your expectations out of a medical visit may be unrealistic. Physicians aren’t supposed to arrive at the correct diagnosis from the initial visit (for most things). We start with a suspected diagnosis and differential and refine it with investigations and multiple visits for temporality/evolution. Note that in your hypothetical that probably and possible are not mutually exclusive. It’s entirely possible patient A’s right upper quadrant pain is a gallbladder cancer but it is also probably gallstones even if you tell me the pain isn’t triggered by fatty meals. Just because a preliminary diagnosis is stated as probable it doesn’t mean other potential causes aren’t being simultaneously investigated with that ultrasound. I also don’t need to be telling the patient about all of the potential possibilities from the get go as it may cause anxiety, this is a patient-specific judgement call. > In a perfect world, patients would get hour long appointments and doctors would explore the entire fault tree. Honestly, outside of counseling type visits or complex oncology I’m not sure what I would spend an hour talking about. Why do feel we need to explore the entire fault tree in a single visit with missing investigations? As a hypothetical: 50 y/o male patient comes in with first time rectal bleeding, I’ll ask a few questions and perform a physical exam but regardless of the fault tree or why this happened, this patient is getting a colonoscopy. Until we’ve excluded cancer and inflammatory bowel disease further discussion is moot.