[ke88y]

> 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]

> 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]

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]

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.

[awestroke]

You forgot to explain why it is so dangerous for people to self diagnose

[namaria]

The human body is way more complex than you think, even if you take this warning into account. Being confidently wrong about your own health based on random tidbits you know and ignoring the vast amount of knowledge you don't have is incredibly dangerous.

[awestroke]

You are arguing against a strawman of your own making

[namaria]

No, I'm telling you why people who don't have training and a decades worth of education self diagnosing is dangerous. You're just deflecting because you don't like how obvious the answer is.

[haldujai]

I assumed it was obvious like “only a fool has himself as a lawyer.”

Would you do your own code review?

It’s impossible to be objective regarding your own health. It’s an ethics violation and sanctionable for physicians to do so for themselves.

[awestroke]

Yes, I review my own code all the time. Right before commit, I read through the diff carefully. Then of course my team reviews the code further.

The same approach works for my health, I MUST review and evaluate my health, it's just not reasonable to expect every single human in the world to go to a doctor every other week. If I come to suspect I have a serious illness, I take it to the next level of review - a doctor. You are painting a very dogmatic, black-and-white picture that cannot include this kind of nuanced approach

[haldujai]

You’re arguing over semantics and seem to be focusing on minor ailments which is obviously not the point I was making.

Evaluating your health =/= reaching a diagnosis (or self-diagnosis). By all means, you should be conducting self-assessments and patients can absolutely diagnose/manage minor ailments. No one is suggesting you need to see a doctor for every ache, cold, fever or headache.

Part of our job in most patient encounters is providing education on when to escalate care/return for reassessment so you are clearly not expected to go to a doctor every other week.

What is dangerous is like in the rectal bleeding example I gave, one may Google their symptoms and “self-diagnose” hemorrhoids missing (consciously or subconsciously) that concurrent colon cancer is not uncommon (especially these days) and they should be seeing a doctor to assess their risk and plan further investigations.

This is a recent example that happened in a young physician whose delay in seeking care upstaged their cancer to stage IV.

> You are painting a very dogmatic, black-and-white picture that cannot include this kind of nuanced approach

Not really, I’m obviously speaking generally on a message board and not writing a position statement. I was also clearly talking in the context of potentially serious symptoms.

> Then of course my team reviews the code further.

This being the operative part of that. I would hope no one is pushing unreviewed commits to a production environment which is essentially what self-diagnosis is, except to your body.

[coding123]

With the wrong doctors it's downright dangerous to see a doctor.