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I used Claude Code to get a second opinion on my MRI

antoine.fi

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Re: I used Claude Code to get a second opinion on my MRI

#601

Post by odiroot »

sxg wrote: post #6

I'm a radiologist but can't really weigh in without seeing the full 3D MRI dataset. Regarding this point: > They performed shockwave therapy on my shoulder even though a recent clinical practice guideline says clinicians should not use or recommend shockwave therapy for rotator-cuff tendinopathy without calcification; I was told during ultrasound that there was no calcification. Ultrasound isn't a great way to assess…

Can vouch for it. Ultrasound hasn't found calcification in my shoulder but MRI did. Exactly as you said, because it was very small.

Re: I used Claude Code to get a second opinion on my MRI

#602

Post by drw85 »

d1sxeyes wrote: post #114
drw85 wrote: post #25

Earlier quoted context omitted.

Nightmare because the AI is just generating a random text that fits the question.

Not quite. An LLM generates text that would likely follow. The sky is… “blue”. A patient in pain with a bone protruding from their shin has a… “broken leg”. The more training data, the more questions it can answer with a reasonable degree of probability of accuracy. Throwing away a potentially useful analysis just because it’s probabilistic seems a bit like throwing the baby out with the bath water.

But for obvious cases like this, you don't need a second or first opinion.

This case is about handing a 3D imaging result to a text predictor and hoping for a valid second opinion.

Re: I used Claude Code to get a second opinion on my MRI

#603

Post by drw85 »

simianwords wrote: post #59
mixologic wrote: post #27

Earlier quoted context omitted.

Its a nightmare because it erodes trust. Doctors are not "always right" which is why "always get a second opinion" is codified in culture. But AI's problem is that its completely full of shit, sometimes, and the people most qualified to evaluate whether its full of shit are the doctors, not the patients, but just like OP's original article, patients are left feeling like their second opinion from AI might be more tru…

The notion that only doctors can verify is false! Doctors are better at verification but normal people can also verify. This is just empirically true. Examples of things normal people can verify - procedural errors that Claude can capture like some blatantly high dosage (grams instead of milligrams) - outdated treatment plan, maybe there’s a credible new treatment plan that’s been used for years but the doctors were…

But those are obvious errors. What if the AI tells you to up your intake of X and it seems plausible? So you up your intake of X by taking some supplement, but upping the intake of X makes your body deplete more of Y and now you have a new or compounding problem.

A doctor might have never recommended upping X, because they would know what it does to your body. Or they might have suggested additional supplementation to avoid this.

The fact that LLMs are trained on all public knowledge is a huge red flag, because there are more wrong infos out there than right ones. Especially about health, diet, etc.

Re: I used Claude Code to get a second opinion on my MRI

#604

Post by base698 »

Aurornis wrote: post #167
AceJohnny2 wrote: post #117

> There's something incredibly peaceful about being in the hands of an expert you trust. [...] AI can absolutely shatter that feeling in an uncomfortable way [...] but I don't know if I can fully trust AI either. This really is key. We know we can't trust the AI, but at the same time we're also more comfortable asking the AI for clarifications or confronting it. Not having a time-bound appointment or paying by the ho…

I have multiple LLM subscriptions at any given time, plus an array of local models. When I ask a question outside of my domain of expertise I like to ask all of the LLMs I have access to. I also create separate sessions and ask the same question multiple ways. It’s revealing to see how many different and contradictory answers I get, most of which are presented confidently. The last time I ran a medical question throu…

My step mom was having debilitating pain. A year of going to doctors and no one was able to find a cause. I scanned her discharge paper work which had her prescriptions on it and gave it to Claude. It identified a prescription that had that exact side effect. They later confronted her primary care that concurred and took her off it.

A friend of mine's wife recently passed. They were chasing a suspected heart defect for over a year. She had been intermittently fainting. At about the year mark they decided to scope her digestive track. They found bleeding ulcers from cancer that was all over her body. I input her fainting symptoms into Claude and gastro impact was number two suspected after heart issues.

I have a few of other cases it's helped with. I'm not sure it could do worse than my own experience with the medical system. This is doubly true in places that lack any sort of medical care.

Re: I used Claude Code to get a second opinion on my MRI

#605

Post by spwa4 »

kgeist wrote: post #364
azan_ wrote: post #354

Earlier quoted context omitted.

How is it possible? You can't diagnose tuberculosis just based on imaging and tuberculosis hospital has to know that!

Yeah, I know! It was strange. They gave me a test, and it came back negative, but they insisted it was negative because I had "latent tuberculosis," which supposedly wasn't detectable by the test yet but was about to become active. I forgot to mention that, besides getting a second opinion from another radiologist, I also took a more modern test at another private clinic. That test has better detection rates than the…

You'll find doctors always believe and treat the worst diagnosis any professional has put on a case. That's a legal thing, not a skill issue.

Think about the consequences of mistakes in both directions ...

Re: I used Claude Code to get a second opinion on my MRI

#606

Post by wizzwizz4 »

prmph wrote: post #587
dirkt wrote: post #520

Earlier quoted context omitted.

What happened to VERIFYING an answer? Does nobody do that anymore? When I ask an LLM, I trace the sources, and see if they make sense. More often than not the sources don't actually say anything about the topic in particular... > It’s also scary how easily you can lead each LLM to the answer you have in mind. Exactly. Which is why "treat an LLM like a human expert who can answer your question" doesn't work. It's more…

I've also noticed the opposite problem: Sometimes the LLM, when asked a detailed question (probably with some lead-in), pushes back in a way that betrays that they fell back to general tropes without really considering the nuances of your specific context. This happens many times, and I usually have to lead the LLM through a chain of reasoning to prove to it that its objection, through generally sound, do not apply t…

> I usually have to lead the LLM through a chain of reasoning to prove to it

What's the point of doing this?

Re: I used Claude Code to get a second opinion on my MRI

#607

Post by wizzwizz4 »

dumb1224 wrote: post #582
marcta wrote: post #523

Earlier quoted context omitted.

Why should a radiologist have to debunk AI slop? They have enough to do already. That's the same mentality that is frustrating open-source repositories with sloppy pull requests, and saying "here, sort this out for me".

Depending on the disease, even in cancer there's myeloma which may cause bone metastasis in many parts of the body with very focal lesions. Radiologists can't assess each and an every one of them, or even to find them all. So AI can definitely help in these scenarios.

And that AI will not be fancy autocomplete: it will be some kind of image classifier that is not trained on Reddit.

Re: I used Claude Code to get a second opinion on my MRI

#608

Post by petercooper »

I'm pro-AI, but when I can't even give Claude a photo of my fingers clearly on four different piano keys and get an accurate result of which keys I'm pressing, I'm bearish on its visual analyses. (With that said, I imagine it's been trained on more photos of MRI scans than people playing piano, so I could see how it might provide interesting ideas for a radiologist to consider.)

Re: I used Claude Code to get a second opinion on my MRI

#609

Post by Delk »

mettamage wrote: post #558
Delk wrote: post #468

Earlier quoted context omitted.

AFAIK mirtazapine shouldn't cause habituation the way actual "sleeping pills" or benzodiazepines do. That's one of the reasons it may be preferable as a sleeping aid, especially in the longer term. Anecdotally, when I took mirtazapine for sleeping problems, it did sometimes seem to have a stronger effect the first time I took it after not using it for a while. After that the effect stayed stable. Overall it shouldn't…

> After that the effect stayed stable. Overall it shouldn't cause habituation, and my doctor said as much. Yea so this is where it gets murky for me. I experience some habituation actually. But my actual doctor went like "wtf is this?" and she didn't really mentioned what she knows about it. So on this particular pill my friend is my doctor. Not an ideal situation. I mean, he is an actual doctor but for him to be my…

> I experience some habituation actually.

I suppose it can be quite different for different people. I stopped using it because it often (not always) made me still feel tired and unfocused in the morning, something that apparently also doesn't happen to everyone.

> But my actual doctor went like "wtf is this?"

Different country, but where I live, prescribing low-dose mirtazapine for insomnia appears to be fairly common practice even though it's off-label. I've had it suggested or mentioned by three or four different doctors, including GPs. I also know several other people who have been prescribed it.

The doctors here seem to prefer low-dose mirtazapine as safer over typical CNS depressants such as benzodiazepines for insomnia nowadays, at least if the problem may be longer-term.

So it's not really something particularly weird. Of course different countries also have different medical cultures so I guess it's not surprising if it's not that common in other places.

Re: I used Claude Code to get a second opinion on my MRI

#610

Post by simianwords »

drw85 wrote: post #603
simianwords wrote: post #59

Earlier quoted context omitted.

The notion that only doctors can verify is false! Doctors are better at verification but normal people can also verify. This is just empirically true. Examples of things normal people can verify - procedural errors that Claude can capture like some blatantly high dosage (grams instead of milligrams) - outdated treatment plan, maybe there’s a credible new treatment plan that’s been used for years but the doctors were…

But those are obvious errors. What if the AI tells you to up your intake of X and it seems plausible? So you up your intake of X by taking some supplement, but upping the intake of X makes your body deplete more of Y and now you have a new or compounding problem. A doctor might have never recommended upping X, because they would know what it does to your body. Or they might have suggested additional supplementation t…

I was about to respond but your last statement implies fundamental misunderstanding of how LLMs work. I don’t think you even know about RLHF and you think good and bad ideas are spread in proportion to how much they are seen on the internet.
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