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Great Another AI Post.
On the front page of Meddit today is a post that basically goes "AI convinced my patient that eating toilet paper helps with constipation." This to my experience appears to be the norm.
In Medicine I've found AI to be of limited utility, because mistakes are not allowed and the required error checking usually nullifies productivity gains.
In Programming it seems to be hot shit because error checking is part of the job and required either way.
Other fields things get more complicated and I have less experience. But the usual people seem excited and the usual people seem frustrated.
So I want to know, for those of you who use AI for work outside of programming (and not to simplify tasks for hobbies/personal life) what are you actually using it for, how is it helping your discipline? I am endlessly fascinated by the immense gap between people who love it and hate it.
Also, for those of you who know a bit more about LLMs, the lack of true error correction seems to be a fundamental problem, is their any hope of this actually being addressed without completely changing away from LLMs?
I am not sure that if rigorously tested on frontier models which are adequately tuned, that the error rate would be much lower than that of physicians. The difference between medicine and programming is that medicine is a guild which a strong lobby that makes it very hard to innovate. While programmers literally give away their work through things like open source. OpenAI has tried to probe this space (and claims that even going back to GPT-4 their models could beat physicians in some settings, look up "HealthBench") but other companies have not done so yet. Quite unfortunate, given that healthcare spending is about 10-20% of GDP in developed countries.
That Reddit post has literally been made by people whose salary partly depends on the belief that these tools are bad and error-prone, so it can be filed away under "vibes".
Apparently the biggest recent adopter has been law.
"True error correction" doesn't exist for human physicians either. Which is why you pay malpractice insurance.
If AI was able to write prescriptions for me, I would choose Astra over 95% of doctors.
I think whether the doctors like it or not, their patients (maybe not the geriatric ones, but often they have younger family helping) will be asking AI questions. I will admit to using it for "does this merit going to the doctor?" Sorts of questions, and for "recommend some PT exercises for this nagging issue" (seems a blurry line between sports medicine and personal trainer). I trust the doctors I see, but copays are high enough that I don't go for just any sniffle, and I don't want to pester them with questions outside of appointments.
From using it in other fields, I'd expect it to be good at transcribing verbal notes (I hear doctors hate charting, maybe it could do that interactively with the patient?), and at pulling obscure facts from the training data. I know pharmacists are currently supposed to be checking drug interactions, but adding an extra layer of verification there seems an easy addition. I'd expect it to be good at triage, but I'm not sure exactly what that would look like.
I would not expect mass layoffs in medicine as a result. Demand for medicine is very elastic, and if appointments were cheaper, we'd probably just have more of them. The limiting factor seems to be the 300 seconds you get with a physician, and how many hours they have in a day.
The problem is that patients do this now and it's a disaster and they don't realize it. Everyone who does outpatient medicine is flooded with instances of patients being sure about something and it being wildly off base, useless, and time consuming because the patient has been convinced of some nonsense that we have to walk back. I'm sure some fraction of people are saving themselves time or getting useful information but it's not well represented in what we actually see.
Part of this is because people don't realize that a lot of medical work involves things like dealing with an anxious patient who repeatedly asks the AI until they get the answer they want, assholes, and things like rationing care (which the AI has no facility with).
Believe it or not a lot of visits (especially to the ED) are pointless and we'd love it if people were successfully using AI for triage.
They aren't.
Yeeees, you're probably not wrong, but if you reverse the viewpoint to get the patient's experience for these examples you get:
The doctor repeatedly dismisses your concerns.
The doctor dislikes you.
The doctor agrees you would benefit from something but refuses to give it to you anyway
And when you put it like that you can kind of see why so many people use LLMs. I think this is one of those 'the only way out is through' situations where it would be far more useful to improve the availability of testing while also training the AI to fluidly guide people through quick home diagnostics, so they can get solid evidence. The alternative seems to be sticking with the current situation of, "pay the doctor $500 dollars for twenty minutes of thought and hope desperately he/she doesn't think you're a whiny crybaby or too convinced of your story'.
You have to keep in mind that a relatively small fraction of the population (often with relevant diagnosis such as personality disorders, anxiety, illness anxiety disorder) are super utilizers of services, inappropriate users of services (such as misuse of mychart physician messaging) and are disproportionately the people complaining online (as well as misusing AI tools).
You see another version of this in the anti-psychiatry movement where people who can't recognize they have an illness because of the illness (ex: schizophrenia) are complaining about being forced into the hospital and take medication when that is the correct thing to do.
As for rationing the simplest example of this is as a good example of over utilization that many people fall into - suffering sometimes is part of life. If you have a viral illness you need to wait it out and take care of yourself most of the time, the doctor will not be able to do anything and rarely is it worth confirming which URI it is. Antibiotics will not do anything useful.
This does not stop people from emphatically making demands.
I can believe that. I guess what concerns me is that institutionally the same machinery has to apply to me and to Nutty Alice, and there seems to be a strong presumption that the role of a doctor is to constrain the patient and that a patient researching their own condition is essentially misbehaving. From there it's only a hop, skip and a jump to "people shouldn't be able to get medical advice from AI, and doctors should ignore it when they do".
Whereas instead we could work hard to make AI better at obtaining clinical histories and to make feedback loops with reality via diagnostics faster and cheaper. Maybe cutting Nutty Alice off if she exceeds some kind of monthly limit.
More broadly, and with what I hope is appropriate tact, I guess I see this as another skirmish in the long-running war over whether doctors should be respected servants or priests. It's simultaneously true that doctors have genuine expertise and it's often sensible "not to [flatter their patients' biases] due to the negative outcomes associated with that", while also being true that from the patient perspective doctors' anti-sycophancy training seems to be dialled so high that the relationship feels antagonistic. The default response to patients with their own opinions seems to be "no" rather than "yes, but".
To put it another way,
is true but doesn't seem to me to be striking quite the right attitude for a relationship that I conceive of as client and service provider.
A lawyer who tells you, "mate, it's not worth suing, even if you win the damages won't be worth it" or a plumber who tells you, "plastic pipes sweat a bit in the cold, it doesn't mean there's an issue" is worth their weight in gold. A lawyer who tells you, "all landlords steal your deposit, come back when you've got real problems" or a plumber who says, "pipes do that, call me when there's an actual leak"... not so much.
With respect to viral illnesses, I might have a better opinion of anti-virals than the doctor does, or I might suspect it's actually something else and want a test to check even if the doctor thinks I'm being silly, or I might just be really really interested in URI strains. In that scenario I think it's more productive to give me access to cheap good advice and make my wishes easier to fulfil than to litigate whether or not I'm permitted to have them. If Nutty Alice needs special accommodation I'd rather we tried to lay down some rules for her specifically than constrain everyone.
Caveats: some issues genuinely need gatekeeping, such as coordination problems like antibiotics or medical interventions with genuine health risks. I'm talking about a change in the relationship during diagnosis and exploratory treatment, not opening up the medical cabinet to all comers.
Caveats the second: I have experience with the British private system but not the American one (which might be quite different).
Intuition pump: debugging is usually the slowest and most annoying part of fixing any problem. Making each debugging attempt cost hundreds of dollars and take 20 minutes max and have a 25% chance of being refused outright is very inefficient.
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