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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

#81
post #5

If it's not already obvious, LLMs are going to be doing most of the mental work currently performed by doctors, lawyers, accountants, etc. I have already nearly stopped using Google search for anything, in favor of GPT-4. GPT-4 has helped me very quickly prototype things that I normally would have had to spend hours researching. GPT-4 has also created custom curriculum for me to help me learn various things for which…

I’m very glad you set the argument this way, since it very neatly sets the stage for the core disagreement to be argued. > Simply very good information synthesizers > Simple very good syntactic synthesizers I argue that theorists tend to adhere to the former, and practitioners the latter. Consider prototyping: For an expert, it costs nothing (or near nothing) to check the output. You even start better, because you kn…

Interesting comment.

I think it is clear that GPT-4 contains a LOT of information. You can ask it explicit factual questions and it often gets the right answer. When it gets the answer wrong, its wording is typically syntactically correct English, or syntactically correct code.

I'd argue that just because some of the errors it commits are "semantic errors" such as calling a method by an incorrect (but often similar) name in a segment of code or printing false statement in well-crafted prose, it nonetheless gets a lot of the semantics right.

What is reasoning besides a set of language patterns that we define as valid reasoning? Imagine evaluating statements in various formal logics. Nonsense in one can be valid in another based on semantic rules alone.

One could derive the model (model as in model-theoretic semantics) of a formal logical system by sampling a list of valid and invalid statements.

LLMs are doing that kind of thing, it seems. There are gaps, but they are not necessarily gaps that the LLM itself cannot notice.

For example, I will often ask GPT-4 to formulate a plan for something or to create a list of priorities/considerations for an undertaking. I will then ask it to draft an initial plan. After that I will ask it to review/critique its draft based on the initial goals. It typically points out exactly the kinds of gaps that a human would point to as deficiencies that indicate the LLM is not reasoning.

In my view, this indicates that the "knowledge" of how to do the task was always aviailable to the LLM, but the interface (or some aspect of the internal implementation) did not allow the knowledge to be applied all at once. This is not necessarily dissimilar from human intellectual work, in which drafts and self-critiquing is not an unreasonable series of steps.

I have done some work with parallel promopts and various "roles" for different LLM interlocutors toward the same task. While it does sometimes go off the rails, it seems clear that multiple prompts with role-based instructions do achieve a greater level of analytical rigor than a single prompt.

Re: Towards accurate differential diagnosis with large language models

#82
post #70

Earlier quoted context omitted.

I’m very glad you set the argument this way, since it very neatly sets the stage for the core disagreement to be argued. > Simply very good information synthesizers > Simple very good syntactic synthesizers I argue that theorists tend to adhere to the former, and practitioners the latter. Consider prototyping: For an expert, it costs nothing (or near nothing) to check the output. You even start better, because you kn…

> IF an LLM is able to do information synthesis, it is trivial to set up parallel prompts to work as teams. Try it out. What do you mean? I've had GPT-4 (3.5 I think too) talking to itself, setup as a planner and someone critiquing a plan, the end result is much better. > However, expecting to get reasoning right is the bridge too far. Hmm, how do you position othello-gpt in this? It builds a world model and makes mo…

1) Set up multiple prompts to work together and make a web page.

See how far that goes, before it’s nonsense talking to nonsense.

2) Production is proof. Get a working LLM based reasoning system that doesnt need its hand held. The process of failing is educational enough.

For the record, I would love it if these things work.

Re: Towards accurate differential diagnosis with large language models

#83
post #81

Earlier quoted context omitted.

I’m very glad you set the argument this way, since it very neatly sets the stage for the core disagreement to be argued. > Simply very good information synthesizers > Simple very good syntactic synthesizers I argue that theorists tend to adhere to the former, and practitioners the latter. Consider prototyping: For an expert, it costs nothing (or near nothing) to check the output. You even start better, because you kn…

Interesting comment. I think it is clear that GPT-4 contains a LOT of information. You can ask it explicit factual questions and it often gets the right answer. When it gets the answer wrong, its wording is typically syntactically correct English, or syntactically correct code. I'd argue that just because some of the errors it commits are "semantic errors" such as calling a method by an incorrect (but often similar)…

I have to admit, that discussing this topic is forcing a precision in the vocabulary used to discuss reason.

However, it is a TEDIOUS process. It’s simplest to just make something - the parallel prompts scenario for example.

Can you leave your LLMs to their own business, and will they have a workable product at the end of it?

As you said it would seem as if they have the “knowledge” of the task. It should not be an issue.

However you will not get anywhere. The issue isnt in the LLM - the issue is in misunderstanding what is going on, and therefore expectations.

LLMs don’t notice things - in the human manner you assumed they do. It isnt point out gaps, its repeating text patterns.

Our habit of dealing with humans is filling in these gaps and supporting an assumption of ‘noticing’ or ‘improvement’.

I think it is hard for us to consider changes in text, without seeing the changes in meaning as well.

With LLMs you have to accept that it’s not seeing meaning, it’s just seeing correlation.

Re: Towards accurate differential diagnosis with large language models

#84
post #81

Earlier quoted context omitted.

Interesting comment. I think it is clear that GPT-4 contains a LOT of information. You can ask it explicit factual questions and it often gets the right answer. When it gets the answer wrong, its wording is typically syntactically correct English, or syntactically correct code. I'd argue that just because some of the errors it commits are "semantic errors" such as calling a method by an incorrect (but often similar)…

I have to admit, that discussing this topic is forcing a precision in the vocabulary used to discuss reason. However, it is a TEDIOUS process. It’s simplest to just make something - the parallel prompts scenario for example. Can you leave your LLMs to their own business, and will they have a workable product at the end of it? As you said it would seem as if they have the “knowledge” of the task. It should not be an i…

> LLMs don’t notice things - in the human manner you assumed they do. It isn't point out gaps, its repeating text patterns. Our habit of dealing with humans is filling in these gaps and supporting an assumption of ‘noticing’ or ‘improvement’.

True. It is important to avoid anthropomorphizing LLMs, etc. I do this intentionally now and then but I agree it is dangerous to do it accidentally.

> I think it is hard for us to consider changes in text, without seeing the changes in meaning as well.

True, but since LLMs were trained on text sequences that had meaning, much of the meaning was accidentally embodied in the resulting model. Areas where LLMs seem to reason well happen to be the areas where the training data was sufficiently generalized and the language tokens used similarly enough... such as recipes.

> With LLMs you have to accept that it’s not seeing meaning, it’s just seeing correlation.

True. I think it is interesting how much it often feels like knowledge.

I think we also have to be careful not to overly glorify human "knowledge" as something other than producing a pattern of output signals in response to a pattern of input signals.

Re: Towards accurate differential diagnosis with large language models

#85
post #78

Earlier quoted context omitted.

I am a doctor, and I encourage you to learn about how diagnostic test performance is modelled, and the consequences linked to overtesting and testing without contextual knowledge. It may change your perspective and lead you towards less extreme opinions.

Are you a US doctor? I urge you to explain why you charge so much and have the poorest performance out of all 1st world countries? It may change your perspective on treating patients like idiots when really the US doctor is the epitome of fraudulent incompetence. Over testing is a problem. The way to lessen over testing is to not be an incompetent doctor so that patients don't take things into their own hands. Barrin…

I have worked in both the US and Europe. I am back in Europe now, as I vastly prefer it over the US.

> Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it.

Precisely not. That's exactly how you get unusable results with super expensive healthcare, because the follow up that a positive test dictates is often worse than the initial problem, and can impact the population at large (e.g. antibiotics use). All that in a context where the post test probability is very low. There are situations where this does not apply, because we have good exploratory AND confirmatory tests, but that's far from being the norm.

Regarding your other points, sure we should always listen to what the patient has to say. There even is a saying about it: "90% of diagnoses are made on personal history". That's because diagnostic tests often are far less useful than you'd expect. Again, I encourage you to learn about how medical testing works. You say you root for AI to replace docs, but apart from not being human anymore, I doubt you'll find your robot doc to be so different regarding your particular situation.

All that aside, I'm not rich. I chose to stay in Europe where I earn less because both US doctors and patients are so toxic. You are a prime example of this. In Europe, we test much less and overall both docs and patients are far less aggressive. Yet healthcare here is cheaper, universal and IMO better overall. Everybody profits from more relaxed doc-patient relationships. US Healthcare is first and foremost a cultural issue, and US patients are part of the problem as much as docs are.

Re: Towards accurate differential diagnosis with large language models

#86
post #85

Earlier quoted context omitted.

Are you a US doctor? I urge you to explain why you charge so much and have the poorest performance out of all 1st world countries? It may change your perspective on treating patients like idiots when really the US doctor is the epitome of fraudulent incompetence. Over testing is a problem. The way to lessen over testing is to not be an incompetent doctor so that patients don't take things into their own hands. Barrin…

I have worked in both the US and Europe. I am back in Europe now, as I vastly prefer it over the US. > Even if the disease is extremely unlikely, if the possibility remains valid based on the given symptoms and the patient requests the test you should allow it. Precisely not. That's exactly how you get unusable results with super expensive healthcare, because the follow up that a positive test dictates is often worse…

>All that aside, I'm not rich. I chose to stay in Europe where I earn less because both US doctors and patients are so toxic. You are a prime example of this.

I'm not gonna deny this. A lot of people in the US hate doctors. Part of it is the ineffectiveness of the health care and the other part is the price. We aren't getting what we pay for and we also don't trust the doctors. So there's both a lack of trust and a lack of respect. I enter any doctors office the same way I enter into a hardcore business deal which is I anticipate that the doctor is not in it to care for me, he's in it to get the most money out of me possible without breaking the law.

Re: Towards accurate differential diagnosis with large language models

#87

Earlier quoted context omitted.

> If it's not already obvious, LLMs are going to be doing most of the mental work currently performed by doctors, lawyers, accountants, etc. While I don't know you personally and I'm not talking about you specifically, "just" feeling very excited about something doesn't Make This About You, the prognostications don't actually help you Be a Part of This. This is the same energy as being really into COVID-19 (what was…

I have heard it described as a form of Pascal's wager. If you shout from the rooftops that LLMs are about to spawn a god machine, you get rewarded with attention, and if you're a researcher, job opportunities. There isn't nearly as much room for critics right now. And if a few years down the line it turns out that you were wrong, everyone else was to, so no big deal. In fact, you can already see it happening. Scaling…

Q* isn’t separate from LLMs. Q* supposedly gets you a shortcut to AGI using LLMs of current scale.

Re: Towards accurate differential diagnosis with large language models

#88
post #2

Yikes, do I read this correctly and the LLM alone outperforms clinician + LLM?

Makes sense. In many applications the ‘human in the loop’ will become the weakest link. Imagine giving alpha go to players as a suggested move assistant. Even the best players would have seen alpha go’s suggestions and thought they were an error. Can we eventually trust AI even if we can’t understand its reasoning?

Re: Towards accurate differential diagnosis with large language models

#89
post #69

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…

It seems they usually test for hyperaldosteronism if they see the obvious signs like low potassium levels. Maybe they did not observe this at the beginning?

My endocrinologist did mention that my potassium levels had tested out as normal. That is certainly true.

Re: Towards accurate differential diagnosis with large language models

#90
post #84

Earlier quoted context omitted.

I have to admit, that discussing this topic is forcing a precision in the vocabulary used to discuss reason. However, it is a TEDIOUS process. It’s simplest to just make something - the parallel prompts scenario for example. Can you leave your LLMs to their own business, and will they have a workable product at the end of it? As you said it would seem as if they have the “knowledge” of the task. It should not be an i…

> LLMs don’t notice things - in the human manner you assumed they do. It isn't point out gaps, its repeating text patterns. Our habit of dealing with humans is filling in these gaps and supporting an assumption of ‘noticing’ or ‘improvement’. True. It is important to avoid anthropomorphizing LLMs, etc. I do this intentionally now and then but I agree it is dangerous to do it accidentally. > I think it is hard for us…

I agree. I think precision in all cases makes it possible to pursue the technology, as opposed to almost dabbling in superstition and philosophy.

However, it’s taken an inordinate amount of time to achieve even the finesse shared in this comment chain. It’s a challenging topic.

We have to carve out levels of utility for systems that generate output given inputs. Some way to distinguish between what our wetware achieves, and what LLMs achieve - Without putting our models on a pedestal.

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