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Towards accurate differential diagnosis with large language models

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Re: Towards accurate differential diagnosis with large language models

#51

Post by dogmatism »

modeless wrote: post #33
dogmatism wrote: post #32

Earlier quoted context omitted.

see my comment above Pt sees Dr in office A, has labs and scans ordered. Labs order is printed out and given to pt, who takes it to lab A. Scan #1 is ordered, and order faxed to facility B, who independently calls, schedules, performs, and interprets scan #1, same for scan #2, but at a different facility. Office A has no electronic link to any of these facilities How does LLM get the data? A human knows the patterns…

In the situation you describe humans fail constantly. My experience with the medical system has decidedly not been that magically competent back office people call every office you've ever visited to assemble your complete medical history from scraps and effectively organize it for the doctor. It's a constant game of telephone where you have to do most of the work yourself, calling around and giving instructions to r…

No, you’re right, it doesn’t work reliably

I just think the y combinator crowd underestimates the human obstacles and ancient tech in the path of getting AI implemented

Re: Towards accurate differential diagnosis with large language models

#52

Post by staunton »

whatshisface wrote: post #41
modeless wrote: post #30

Earlier quoted context omitted.

I mean, have you used GPT-4? Free form text is its bread and butter, and yes, it can absolutely ingest images and read text in them, and combine that with other information from multiple sources in structured or unstructured text or image form, no problem! What you are describing sounded decades away last year. Today it's not something you can rely on quite yet if you need accuracy. But if you still believe it's deca…

This reminds me of what happened in self-driving. It went from "decades away," to "it works but you can't quite rely on it for accuracy" in a year and then it stopped cold for some reason.

Useful Full-Self-driving is arguably harder than "useful automated medicine" in two ways. First, you need insane reliability to match human performance. Much higher reliability than doctors even. Second, it's not "just" information processing somewhere in the cloud. It has to run in real time inside a car. Both are very hard in that the conditions are very context dependent and vary a lot (a.k.a. the real world is messy).

Re: Towards accurate differential diagnosis with large language models

#53

Post by staunton »

dogmatism wrote: post #51
modeless wrote: post #33

Earlier quoted context omitted.

In the situation you describe humans fail constantly. My experience with the medical system has decidedly not been that magically competent back office people call every office you've ever visited to assemble your complete medical history from scraps and effectively organize it for the doctor. It's a constant game of telephone where you have to do most of the work yourself, calling around and giving instructions to r…

No, you’re right, it doesn’t work reliably I just think the y combinator crowd underestimates the human obstacles and ancient tech in the path of getting AI implemented

That only concerns the time needed to implement it though, not capabilities. If an AI is known to be significantly better at diagnosing than your GP, and you know and believe this (this of course has yet to happen and then take time to be noticed by people), then you will use it. You will demand it is used. People actually care about their health.

Re: Towards accurate differential diagnosis with large language models

#54

Post by corethree »

acover wrote: post #42
corethree wrote: post #35

Earlier quoted context omitted.

[flagged]

You can make the right call but still be wrong sometimes. There's a cost to tests of rare diseases.

Then let the person who is wrong foot the cost. The cost isn't just the cost of the test. It's the cost of what occurred because the doctor decided to block a test.

Re: Towards accurate differential diagnosis with large language models

#55

Post by gundmc »

doix wrote: post #26

This doesn't really surprise me given my experience with doctors. If it's a common problem then doctors do fine. As soon as you're not the common case or have something somewhat rare, it becomes a bit of a crap shoot, at least in the UK when you deal primarily with your GP (general practitioner). I have a friend with Crohn's who was feeling low energy. I was a gym bro at the time and convinced him to take a testoster…

Part of this is by design - from medical school, doctors are quite literally taught "when you hear hoof beats think horses, not zebras." The progression and flow the decision trees in diagnosis are built to find the most common ailments in the most efficient way. It sucks for people whose conditions are further down the tree, but generally it does what it was designed to do.

Hopefully technology like this can help us rethink those decision trees, or else crunch more patient-specific information to adjust the diagnosis process on an individual level more efficiently.

Re: Towards accurate differential diagnosis with large language models

#56

Post by corethree »

staunton wrote: post #48
corethree wrote: post #35

Earlier quoted context omitted.

[flagged]

> statements like this literally set me off. The patient being right and the doctor ignoring the patient and treating the patient like an idiot There's a huge number of people who vastly overestimate their medical knowledge, google some symptoms (I'm sure you know the pitfalls of that but many don't), do self-diagnosis as a hobby with friends over coffee, come to absurd conclusions and then bother their doctors about…

Given the amount paid by the patient to the doctor, the doctor is honor bound to listen to the patient, to consider what he said. This is not a trivial amount of money that the patient is forking over to the doctor.

It's understandable from the standpoint of irritation, if the doctor is presented with the same crack pot theories all the time then it's understandable how he would ignore such theories.

It's not understandable from a moral standpoint. If the doctor isn't delivering to the patient what equates to the thousands of dollars the patient forked over to him, then the doctor needs to be paid the amount he deserves.

When a drunk driver kills someone on accident he is honor bound by morality to be responsible for the death. Being drunk is not excuse. Same with a doctor. If he claims he's an expert and he's paid thousands of dollars for a check up he is responsible for being right and if being right means listening to every single theory from the patient because that's what he's morally obligated to do. Not wanting to "waste time" because of "pressure" is not an excuse. Ever. Lives are at stake.

Re: Towards accurate differential diagnosis with large language models

#57

Post by corethree »

bradknowles wrote: post #47
doix wrote: post #26

This doesn't really surprise me given my experience with doctors. If it's a common problem then doctors do fine. As soon as you're not the common case or have something somewhat rare, it becomes a bit of a crap shoot, at least in the UK when you deal primarily with your GP (general practitioner). I have a friend with Crohn's who was feeling low energy. I was a gym bro at the time and convinced him to take a testoster…

I have hypertension, as well as diabetes. I wanted my cardiologist to test me for hyperaldosteronism, because I had read it was not uncommon and could be a factor in hypertension that continues to get worse and worse, without an obvious explanation. He refused, saying that it was the job of my endocrinologist to do that test. So, I talked to my endocrinologist and he said it wasn't a normal test they do, but he was h…

You don't know how these doctors view you. They view you as a "non-expert" as one commenter put it. Basically you're stupid to them and your thoughts are pointless.

The only way to convince them is to sue. But there's nothing worth suing here for, you got the test. You can only sue if damage was done, then the doctor would be responsible for blocking the test when you explicitly requested it.

Re: Towards accurate differential diagnosis with large language models

#58

Post by bradknowles »

corethree wrote: post #57
bradknowles wrote: post #47

Earlier quoted context omitted.

I have hypertension, as well as diabetes. I wanted my cardiologist to test me for hyperaldosteronism, because I had read it was not uncommon and could be a factor in hypertension that continues to get worse and worse, without an obvious explanation. He refused, saying that it was the job of my endocrinologist to do that test. So, I talked to my endocrinologist and he said it wasn't a normal test they do, but he was h…

You don't know how these doctors view you. They view you as a "non-expert" as one commenter put it. Basically you're stupid to them and your thoughts are pointless. The only way to convince them is to sue. But there's nothing worth suing here for, you got the test. You can only sue if damage was done, then the doctor would be responsible for blocking the test when you explicitly requested it.

I need to find a doctor who can be a more active partner in helping me diagnose and address my problems.

If you have any suggestions in the Austin area, please let me know.

Re: Towards accurate differential diagnosis with large language models

#59

Post by ProllyInfamous »

gundmc wrote: post #55
doix wrote: post #26

This doesn't really surprise me given my experience with doctors. If it's a common problem then doctors do fine. As soon as you're not the common case or have something somewhat rare, it becomes a bit of a crap shoot, at least in the UK when you deal primarily with your GP (general practitioner). I have a friend with Crohn's who was feeling low energy. I was a gym bro at the time and convinced him to take a testoster…

Part of this is by design - from medical school, doctors are quite literally taught "when you hear hoof beats think horses, not zebras." The progression and flow the decision trees in diagnosis are built to find the most common ailments in the most efficient way. It sucks for people whose conditions are further down the tree, but generally it does what it was designed to do. Hopefully technology like this can help us…

I dropped out of medical school fifteen years ago — entered another [non-tech] profession entirely - and there's one thing I always tell either of the following groups:

Said to physicians: "I dropped out and I TELL EVERYBODY I KNOW you cannot pay a doctor enough for all the unnecessary sacrifices they had to make, just to prescribe you an antibiotic."

...to Non-physicians: "While I believe that you cannot pay physicians enough for their sacrifices, you should definitely investigate your own ailments, and seek multiple opinions whenever your `gut feeling` indicates `abnormal`. Physicians simply DO NOT HAVE TIME to give a fuck about your specifics.

More recently, I have included (to all) "it is probably ALREADY UNETHICAL TO NOT BE CONSULTING WITH LLMs during differential diagnoses."

Just my ¢¢

Re: Towards accurate differential diagnosis with large language models

#60

Post by rscho »

doix wrote: post #26

This doesn't really surprise me given my experience with doctors. If it's a common problem then doctors do fine. As soon as you're not the common case or have something somewhat rare, it becomes a bit of a crap shoot, at least in the UK when you deal primarily with your GP (general practitioner). I have a friend with Crohn's who was feeling low energy. I was a gym bro at the time and convinced him to take a testoster…

As almost every comment of this kind on this site, you are missing the wider socioprofessional context. Yeah sure, you may find papers about plenty of things that may affect you without your doc's knowledge, perhaps even guidelines that are to be followed.

The problem is that respecting every detail of every guideline all the time is pretty much impossible, and even a debatable stance. There are many committees producing guidelines left and right. Because those people's jobs are to produce guidelines, not care for people. The exact same goes for research papers, and validity for patients in practice is a difficult issue.

So, docs all practice mostly from habit and experience. It's a craft supported by science, but clinical medicine itself is science as much as bricklaying is a science. But that doesn't make AI the use-all-do-all, because if everybody starts to test for every little thing, diagnostic probabilities will decrease massively and guidelines would have to adjusted in conséquence. It's a feedback loop. And also, you'd pay 5x the price for healthcare, so not realistic.

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