4 ms·

3 and 4 can be highly problematic behaviors in doctors. Patients who have real medical issues are often ignored, scolded, or otherwise denied treatment because

3 and 4 can be highly problematic behaviors in doctors. Patients who have real medical issues are often ignored, scolded, or otherwise denied treatment because of a doctor's perception.

derbOac 1y ago
5 is also something that happens sometimes with physicians and healthcare generally anyway, and could be trained in LLMs is my guess. 1 is often (usually?) not done today by physicians per se anyway. 2 is kind of a strawman about LLMs. 6 is maybe the most challenging critique but is also kind of an empirical one, in the sense that if LLMs routinely outperform physicians in decision making (at least under certain circumstances) it will hard to make the case that it matters. I have my biases but in general I think at least in the US there needs to be a serious rethinking about how medical decisions can be made and how care can be provided. I'm skeptical about this paper — the real test will be something like widespread preregistered replication across a wide variety of care settings — but that would happen anyway before it would be adopted. If it works it works and if it doesn't it won't. My guess is under the best of circumstances it won't get rid of humans, it will just change what they're doing and maybe who is doing that.
spwa4 1y ago
First you misunderstand, I think, point 3 and 4. The point there is that LLMs are incapable of it (because they don't learn on the job, and that's not the only problem, they also aren't human and thus lack perspective, that hallucination would have catastrophic outcomes here, lack of empathy). But without learning on the job, it simply cannot recognize large scale problems. It's not that they sometimes miss it. We DO NOT know everything, and analyzing wth is happening, including radically changing approach on the job is a necessity, not something optional. Empathy, by the way, is something that happens between 2 people. It is not "inside" one person, and it goes in both directions. So that can't be fixed. Empathy towards you only works if you honestly believe that the other person is genuinely worried about you (and, of course, empowered, able and willing to do something about your situation). If you start out with an LLM, you start out 100% convinced (and correct in that, btw) that they aren't worried about you. So it won't work. That even works in reverse. Patients try to deceive doctors ... but within reason, because there's empathy the other way too. When patients have to deceive LLMs instead for a week off from work, there will be zero empathy, zero shame and zero limitations on behavior that from the patient side. This is not solvable. Hell, it'll be a problem of trust. A doctor is trying to help you ... probably ... with maybe 10% helping the company. An LLM is 100% trying to help the company ... do you take the medicine (or accept nothing's wrong?). Is it what's best for you? Let's face it: the whole point of LLM medicine is that it's not what's best for you. Also ... so your critique is that even doctors sometimes cater to interests that are not the patients' best interest? Ok. True. But you do realize that if you apply that as a critique of LLMs, that are corporate controlled, it's going to be 1000x worse? So I don't understand the critique. Yes doctors aren't perfect, flawed in many ways. That is not a good reason to introduce something 1000x worse. The whole point of LLM medicine is that stealing the profit!
- timschmidt 1y ago
  I understand fully, and disagree strongly. > [LLMs] don't learn on the job Funny, the ones I work with get updated with new information all the time. No reason it couldn't happen after every single encounter. > Empathy, by the way, is something that happens between 2 people. People will anthropomorphize anything and that includes empathizing with a rock. A rock cannot empathize back. QED. > If you start out with an LLM, you start out 100% convinced (and correct in that, btw) that they aren't worried about you. So it won't work. See above. Your point is also undermined by the sheer volume of people currently using LLMs as therapists. > Patients try to deceive doctors ... but within reason, because there's empathy the other way too. When patients have to deceive LLMs instead for a week off from work, there will be zero empathy, zero shame and zero limitations on behavior that from the patient side. You seem to think people have limitations on their behavior now. I assure you they do not. Talk to a doctor or social worker about it. It wears them out. LLMs don't get worn out and are much better at calmly and kindly interacting for as long as someone needs. > A doctor is trying to help you ... probably ... with maybe 10% helping the company. An LLM is 100% trying to help the company Some doctors are. Some are more worried about their next golf game or maserati. You are fully pessimistic about LLMs but incredibly naive about people. > Let's face it: the whole point of LLM medicine is that it's not what's best for you. Hard disagree. Last I was in the hospital for a life threatening condition (pancreatitis caused by gall stones) I got to talk to a doctor for 5 minutes. I educated myself about my condition thanks to Wikipedia and medical journals. An LLM would have been incredibly helpful. > do realize that if you apply that as a critique of LLMs, that are corporate controlled, it's going to be 1000x worse? Good thing there are academic, open source, open weight, jailbroken, fine tuned, local LLMs I can run myself and even cross-check between multiple competing models and models from different countries with entirely different economic and political systems for nearly no cost for additional assurance. > So I don't understand the critique. Yes doctors aren't perfect, flawed in many ways. And incredibly expensive, unavailable without appointment sometimes months or years in advance, incredibly limited when it comes to any specialization, sometimes distracted, exhausted, grumpy, dismissive, disagreeable, and subject to all manner of human failings. I'm not sure what Black Mirror episode you're drawing your outlook on life from, but it bears no resemblance to the reality I live in every day. I don't think doctors will be wholesale replaced by LLMs. I am already seeing LLMs lowering barriers to acquiring first-line medical advice and second opinions. Will dystopic things happen? Sure, they're already happening every day without any help from LLMs. That'll continue into the foreseeable future. But having an LLM to ask for second opinions might have saved my Dad's life, and would have allowed me to better educate myself about my own life threatening condition. Good luck prying them out of my hands.

3 and 4 can be highly problematic behaviors in doctors. Patients who have real medical issues are often ignored, scolded, or otherwise denied treatment because of a doctor's perception.

derbOac 1y ago

5 is also something that happens sometimes with physicians and healthcare generally anyway, and could be trained in LLMs is my guess. 1 is often (usually?) not done today by physicians per se anyway. 2 is kind of a strawman about LLMs. 6 is maybe the most challenging critique but is also kind of an empirical one, in the sense that if LLMs routinely outperform physicians in decision making (at least under certain circumstances) it will hard to make the case that it matters. I have my biases but in general I think at least in the US there needs to be a serious rethinking about how medical decisions can be made and how care can be provided. I'm skeptical about this paper — the real test will be something like widespread preregistered replication across a wide variety of care settings — but that would happen anyway before it would be adopted. If it works it works and if it doesn't it won't. My guess is under the best of circumstances it won't get rid of humans, it will just change what they're doing and maybe who is doing that.

spwa4 1y ago

First you misunderstand, I think, point 3 and 4. The point there is that LLMs are incapable of it (because they don't learn on the job, and that's not the only problem, they also aren't human and thus lack perspective, that hallucination would have catastrophic outcomes here, lack of empathy). But without learning on the job, it simply cannot recognize large scale problems. It's not that they sometimes miss it. We DO NOT know everything, and analyzing wth is happening, including radically changing approach on the job is a necessity, not something optional. Empathy, by the way, is something that happens between 2 people. It is not "inside" one person, and it goes in both directions. So that can't be fixed. Empathy towards you only works if you honestly believe that the other person is genuinely worried about you (and, of course, empowered, able and willing to do something about your situation). If you start out with an LLM, you start out 100% convinced (and correct in that, btw) that they aren't worried about you. So it won't work. That even works in reverse. Patients try to deceive doctors ... but within reason, because there's empathy the other way too. When patients have to deceive LLMs instead for a week off from work, there will be zero empathy, zero shame and zero limitations on behavior that from the patient side. This is not solvable. Hell, it'll be a problem of trust. A doctor is trying to help you ... probably ... with maybe 10% helping the company. An LLM is 100% trying to help the company ... do you take the medicine (or accept nothing's wrong?). Is it what's best for you? Let's face it: the whole point of LLM medicine is that it's not what's best for you. Also ... so your critique is that even doctors sometimes cater to interests that are not the patients' best interest? Ok. True. But you do realize that if you apply that as a critique of LLMs, that are corporate controlled, it's going to be 1000x worse? So I don't understand the critique. Yes doctors aren't perfect, flawed in many ways. That is not a good reason to introduce something 1000x worse. The whole point of LLM medicine is that stealing the profit!

timschmidt 1y ago
I understand fully, and disagree strongly. > [LLMs] don't learn on the job Funny, the ones I work with get updated with new information all the time. No reason it couldn't happen after every single encounter. > Empathy, by the way, is something that happens between 2 people. People will anthropomorphize anything and that includes empathizing with a rock. A rock cannot empathize back. QED. > If you start out with an LLM, you start out 100% convinced (and correct in that, btw) that they aren't worried about you. So it won't work. See above. Your point is also undermined by the sheer volume of people currently using LLMs as therapists. > Patients try to deceive doctors ... but within reason, because there's empathy the other way too. When patients have to deceive LLMs instead for a week off from work, there will be zero empathy, zero shame and zero limitations on behavior that from the patient side. You seem to think people have limitations on their behavior now. I assure you they do not. Talk to a doctor or social worker about it. It wears them out. LLMs don't get worn out and are much better at calmly and kindly interacting for as long as someone needs. > A doctor is trying to help you ... probably ... with maybe 10% helping the company. An LLM is 100% trying to help the company Some doctors are. Some are more worried about their next golf game or maserati. You are fully pessimistic about LLMs but incredibly naive about people. > Let's face it: the whole point of LLM medicine is that it's not what's best for you. Hard disagree. Last I was in the hospital for a life threatening condition (pancreatitis caused by gall stones) I got to talk to a doctor for 5 minutes. I educated myself about my condition thanks to Wikipedia and medical journals. An LLM would have been incredibly helpful. > do realize that if you apply that as a critique of LLMs, that are corporate controlled, it's going to be 1000x worse? Good thing there are academic, open source, open weight, jailbroken, fine tuned, local LLMs I can run myself and even cross-check between multiple competing models and models from different countries with entirely different economic and political systems for nearly no cost for additional assurance. > So I don't understand the critique. Yes doctors aren't perfect, flawed in many ways. And incredibly expensive, unavailable without appointment sometimes months or years in advance, incredibly limited when it comes to any specialization, sometimes distracted, exhausted, grumpy, dismissive, disagreeable, and subject to all manner of human failings. I'm not sure what Black Mirror episode you're drawing your outlook on life from, but it bears no resemblance to the reality I live in every day. I don't think doctors will be wholesale replaced by LLMs. I am already seeing LLMs lowering barriers to acquiring first-line medical advice and second opinions. Will dystopic things happen? Sure, they're already happening every day without any help from LLMs. That'll continue into the foreseeable future. But having an LLM to ask for second opinions might have saved my Dad's life, and would have allowed me to better educate myself about my own life threatening condition. Good luck prying them out of my hands.