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70% of medicine is minimizing unknown unknowns by knowing as much as you can, and knowing the boundaries of what is unknown to you. I believe a more concise way of expressing that is "knowledge". Regretfully, the books are fat and intimidating for good reason, there's are a lot of things to know.
30% of the rest is reasoning from knowledge, clinical experience (yet another form of knowledge, just the stuff the textbooks don't tell you) and pattern recognition.* This is more dependent on your wits, or your fluid intelligence, if I'm being precise.
The best doctors both know a lot, and are bright enough to apply that information well. The former is indispensable, you simply cannot figure out medicine by sitting in a cave and thinking very hard. I don't know if some superintelligence can look at a single human without the aid of tools, ponder very hard, and figure out everything work knowing. All I can say is that it's beyond any actual human.
(IQ/g also correlates strongly with memory, so the relative importance of both is very hard to tease out. Especially when there's a high-pass filter with
allmost of the idiots and amnesiacs strained out by the end of med school)Let me put it this way: I was a bright kid, and felt like I knew a lot of medicine before entering med school, both due to cultural osmosis and because I took an interest in it. You would not have wanted me as your actual doctor. I did not know nearly as much as I thought I did.
Later, I was a med student, a year or two in and confident that I knew the gist of it. I felt ready to make my own medical decisions, at least about myself. I thought I was smart and that I did my due diligence (reading things online, including research papers). It was insufficient, I did potentially permanent damage to my own health (I'm not going to go into details). I would not want that me as my doctor either.
Now, I am a lot older and a little more knowledgeable, if not necessarily wiser. You could do worse as your doctor, at least if we're sticking to psychiatry. You could probably do better too, but I have a place on the free market. I'm cheap, I give away my advice for free on the internet to anyone who asks nicely, and many who don't.
Along the way, I almost killed people through ignorance. Thankfully, nobody died, my colleagues caught it, or the pharmacist did, or I had a sudden sinking feeling in my gut and ran back to double check. Medicine recognizes that any human is fallible, and there are plenty of safeguards in place. Every junior doctor has their story of close calls, and hopefully nothing more than close calls. All senior doctors start as junior doctors, I hope.
Consider something else: most doctors will seek out a different doctor when they suffer a condition that isn't covered by their own specialty. Sometimes even then.
If a cardiologist feels funny in the head, he'll seek a neurologist. If a neurologist feels heart palpitations, he'll go talk to a cardiologist.
Why is that? Could they both not just open the relevant textbooks and figure out what the issue is? Can a cardiologist not take his med school knowledge of neurology and then skim something Elsevier put out?
These are people with complete medical training, genuine intelligence, and full access to literature, and they still defer to each other. That's not false modesty or liability management, it's that they've learned, through experience, exactly where their pattern recognition breaks down. They know the limits of their own competence.
Maybe. It might work out fine 90% of the time. But most doctors can handle ~90% of conditions, because most conditions are common and usually simple to manage. I apologize for the tautology, I can't see my way around it.
The other 10% are where the specialists come in. You cannot take a psychiatrist (even a smart one) and give him access to UpToDate and expect him to be as good a cardiologist as an actual trained cardiologist. He might do okay, but he's going to kill people along the way.
And that is a fully qualified doctor dabbling in another branch of medicine. A "bright undergrad with access to uptodate and a bunch of case histories, both with semantic search" will crash and burn. I'd bet good money on it, it'll happen sooner rather than later.
If they set up shop and started seeing patients, bumbling their way through things and furiously looking things up as soon as they could, they might successfully treat the colds, stomach upsets, sore throats and so on. That's the bulk of undifferentiated medicine, as you'd expect. They might catch some of the rarer stuff. They will also be very poorly calibrated and commit significant iatrogenic harm. But rest assured they will kill people eventually (at a rate massively higher than a doctor normally does).
That's not even getting into time pressure, or physical findings and techniques that are impossible to adequately convey over just video and text.
LLMs? They narrow the gap significantly, but do not have thumbs. The bright undergrad would benefit immensely from ChatGPT, but rest assured that most of the performance would come from ChatGPT itself, and they would add little. Handcuffing a child to a man does not make their combination superior.
The combination of factors that make a good human clinician are rare. And when you do find them, you're investing a great deal in training to get them up to scratch. Most of this is the bottleneck of information transfer/learning, which LLMs neatly sidestep. GPT-4 did well, and it was dumb as bricks compared to current models. Turns out an encyclopedic knowledge of medicine will get you very far, even if you're not very bright. But it was also able to access and process this information faster than your thought experiment of a human with a computer.
But if you want a final answer: 60-70%. Best estimate I have.
*Sufficiently advanced pattern recognition is indistinguishable from intelligence. It might well be intelligence. You know LLMs, you know this.
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