[rylando]

As a rad tech, YOU TELL ‘EM DOC! I do like some uses of AI I’ve seen that help patients advocate for themselves or understand basic things like blood panel numbers, but it’s really bad at glazing people and leading them down medical rabbit holes kind of like the OP.

You would think that the AI would point out that calcium is best demonstrated on Radiographs/CT imaging vs Ultrasound or something to that effect.

[garciasn]

Semi-related: my father has complications from a motorcycle accident ~25y ago that crushed arteries in his leg coupled with diabetes (insulin / kept sugar at ~100 and his A1C was kept under 6.7 for ~15y). 6w ago had to have his toes removed due to dry gangrene; they eventually (2.5w ago) had to remove his leg below the knee because of the severe blood flow issues below the knee.

Between the toes and the below the knee amputation, there were no less than 15 different doctors and PAs / related personnel who COULD NOT COME TO A CONSENSUS. They would just tell my mother and I (PoA) the details; they refused to come up with a singular plan of action moving forward, leaving it up to us to make 'an informed decision,' something that's IMPOSSIBLE when you have to take up to 15 different opinions into consideration.

What exactly are we supposed to do as patients/family members when medical personnel cannot give reasonable paths forward and instead just throw a bunch of shit over the fence at you and tell you, "you decide what to do from here," regardless of how many VERY DIRECT conversations I had w/the 'care team' on doing better to provide a limited array of options and reasons/likelihood of 'positive outcomes'.

I'm used to dealing with a wide variety of stakeholders/SMEs in decision-making; it's my job to apply my extensive industry experience to present our clients with their options, ranked and reasoned. Doctors, in my experience and most recently with my father, clearly do NOT do that (I assume due to liability; but, no real idea, honestly). So; when dealing with LIFE CHANGING circumstances, what are we supposed to do except rely on what might be able to offer more analysis and option narrowing w/AI?

I certainly don't want to make the job of medical staff more difficult by putting out crazy theories I found on the interwebbernets through my own research, etc; but, when we're having to deal with uncertainty and insanity, what else can we do?

[resonious]

This lines up with my experience with my mother, though it played out differently. In her case, she would switch doctors every ~5-10 years and each time they'd basically say everything the previous doctor said was wrong. First it was "you have Lupus", second it was "actually it's some other autoimmune disease", then it was "actually whatever you had has been in remission for some time now and you've been taking brain-numming medicine for no reason." Then it was "you have cancer", "it's a rare one", and "oh turns out the brain-numming meds have a correlation with rare cancers". The cancer part was handled well (albeit unsuccessful) though. After such a bad time with rheumatologists, I was shocked by how competent people were when it came to cancer.

All of the above was intertwined with brief stints with doctors that would just berate her for being a painkiller junkie, even though she hated the stuff and just wanted to find/fix the problem.

Kind of a rant, really. I'm not sure how to tie it back into AI. I do wish we had AI at the time so that we could at least cross-check, but I also understand that doctors are already sick of patients self-diagnosing on the web and that AI probably just makes that worse. At the same time, if our medical system could catch up a bit (more doctors? less corruption/paperwork? not sure what it needs) then maybe people would be less inclined to take matters into their own hands.

[picofarad]

I recently discovered I am allergic to hydrocodone and codeine, and the effort I had to go through to get oxy instead was stressful and I felt I had to bring all of the extra pills with me everywhere to show I wasn't drug seeking or selling them. And I pointed out that inwaa shooting myself in the foot for all future desires by asserting I am allergic.

P. S. Opiates work, very well. If you tale one and it doesn't work, you might also be allergic. Hydro didnt really work, then itching and puking started after 2 days of untouched pain(essentially, a reduction of 2 points). Codeine nausea.

I wasn't aware of the possibility.

[anon84873628]

I'm sorry to hear that. The accusations of drug seeking are particularly galling.

AI is absolutely a god send for patients navigating the medical system.

I know the US system is horrible and I sympathize with doctors doing their best within it. But we must admit, they are also responsible for the countless stories just like yours, and have contributed to the public's deteriorating trust of medical institutions. It's not just the insurance companies and conglomerate CEOs.

[osmano807]

Probably liability... on the amputations I indicated and contraindicated, it's increasingly difficult to navigate trough patient perceptions while not disclosing so much as to give them rope to hang us. Some decisions are a game of probability that often we don't have clear numbers. In trauma, I have both cases where I recommended an amputation and at last minute decided to see that happened and the patient is walking with their leg today; and cases where I didn't recommend and later had to amputate as the lesion evolved. With cancer it's more straightforward, the cancer is what dictates the surgery... some cancers have poor response to other treatments, so we amputate. Some cancers had invaded the neurovascular bundle, so curative options involve necessarily amputation to get good margins. In cancer there's less doubt in the prognosis, so less chance of legal ramifications.

[rylando]

Keep in mind I’m not a doctor, just the guy who takes your images, but I believe it’s all liability. I really wouldn’t want to be a doctor from all the crazy stories of liability stuff I hear everyday.

I empathize with you as my grandmother is also being what feels like gaslit by several doctors being told her symptoms are dementia and not from the chronic UTI’s she suffers from, but when the UTI’s clear all of a sudden no symptoms. Our medical system is very frustrating, between doctors who don’t have the time needed for complicated cases, or the threat of every patient suing them causing them to be overly cautious.

I think as long as you’re aware of the pitfalls of AI, as you seem to be, it’s a solid tool for helping to understand medical situations with the right amount of double checking.

I don’t think our system will improve until 1) We increase the amount of doctors in our country and tell Congress to quit limiting the amount we can train yearly, and 2) the system of liability for doctors is changed to be more like New Zealand’s where their liability insurance is nationalized and they’re not at constant threat of losing everything to a lawsuit over a patient who wouldn’t take their meds and got worse (the cases are generally much more complex than that, but the idea is it’s not always the doctors fault as media would have us believe).

[Fr0styMatt88]

Your see this in coding agents too. The only times so far I’ve really seen Opus tie itself into a knot is where I’ve asked it to fix something that I thought was broken but actually wasn’t in the way I had described. It will bias towards your description (I’m guessing because that’s the most recent context it has?).

[mring33621]

i'm sorry, but AIs only "know" about stuff that they have been trained on.

If we would allow AIs to be trained on the petabytes of medical data hidden in hospital systems, they would most likely be much better at diagnosing illnesses and conditions than the average doctor.

(Justifiable) Privacy around medical records so far prevents this.

You think you're cheering for humans, but in fact you are gatekeeping healthcare.

[prirun]

I dunno... if we gave an AI all of these medical records as training data, wouldn't it be trained to give the same answers as the doctors already gave, without knowing whether those diagnoses were correct or not?

[anon84873628]

Except it would see all the times similar starting conditions led to different diagnosis and recognize those contradictions. Or all the different treatments and their outcomes. And it would never forget or have bias.

It would be like the sum of all medical professors in existence.

[Eufrat]

I feel like the promise of these models is to help people make more informed decisions. Improving the knowledge economy and general understanding.

The problem is these are just statistical models at the end of the day, so you need to know something to be able to identify the errors. You can’t let them really be autonomous and you also can’t really have people turn into glorified approvers. If the machine is correct 89% of the time, you cannot make people responsible for that 11%. It’ll just cause automation fatigue.

tl;dr: the actual use cases of these LLM (or generative AI in general) is rather limited, so it is offensive how much hay has been given to them eating the entire capitalist system. They are not fit for purpose.

[anon84873628]

Why should we not expect a computer vision model to outperform humans on reading medical images?

The human experts are literally just a trained biological neural network. In this domain they are not capable of anything a computer can't already do.

[Eufrat]

> Why should we not expect a computer vision model to outperform humans on reading medical images?

Humans can identify. A computer vision model can return a statistical value. Both can make errors, but these errors are orthogonal to how we work and what is being asked of them. I think a CV model can absolutely provide value as augmentation. Identifying possible misses or a different diagnosis worth considering, but that is not what is being asked of them here. The pitch by Altman and Amodei is not to say, “This tool that might cost $1,000/month can help increase the accuracy of your diagnoses by 10%,” instead it’s, “This tool can allow you to keep 10% of your workers to monitor it and you can fire the rest. Also, the workers carry all the liability.”

> The human experts are literally just a trained biological neural network. In this domain they are not capable of anything a computer can't already do.

People need to stop making this baseless claim. Human beings are not stochastic computing devices, we are not neural networks. We don’t fully understand human cognition and intelligence. I have the highest confidence we will figure it out one day, though.

Yes, neural networks were based on a superficial view of the human brain, that’s it. For instance, it is biological impossible for the human brain to do backpropagation, which is kind of important for a modern neural net.

This really rubs me the wrong way because it's objectively false, but people keep bring it up because I think people want it to be true rather than accepting generative AI for what it is: a tool with a bunch of caveats.

[augment_me]

Whether brains do gradient descent is irrelevant to a CFO deciding whether to staff one radiologist or three. The market doesn't care if the model "identifies" versus "returns a statistical value", it cares what the error rate costs versus what the salary costs, and it prices liability into contracts either way, same as it already does with autopilot and compliance software.

Also disagreement among human radiologists has been documented for decades, so the clean expert baseline you're defending doesn't actually exist outside this argument.

When the identifiers pass human-detection-rate percentages, it will most likely be cheaper to hire a fall-guy for the liability with a much smaller salary, I think this will be a big market in fact.

[anon84873628]

Thank you. I think my comment was careful to specify "in this domain" and "computer vision model"; I didn't say anything about generative AI. The reference to neural networks was hopefully an obvious rhetorical flair, rather than a one-line assertion that computers and brains are actually equivalent.

I also didn't say anything about whatever Altman or any specific company is doing.

The simple fact is that we send humans to school for years to learn to read and classify these things. It's something computers will be able to do strictly better.

[Eufrat]

> It's something computers will be able to do strictly better.

I don’t think there’s any evidence that’s true.

[anon84873628]

Really? What about the use of computer vision for satellite imagery? Facial recognition?

The premise seems to be proven, just not extended to the medical domain yet.