Medicine is so much more than "knowledge, experience, and pattern matching", as any patient ever can attest to. Why is it so hard for some people to understand that humans need other humans and human problems can't be solved with technology?
Now replace some / all of those humans with... A machine whose function also needs insurance approval.
It's gonna end badly.
There is an intermediary between customers and seller and it's allowed to take percentage of the sale. No such entity will ever work in the interest of the consumer. It has every incentive to inflate prices. Intermediary is needed but it should be financed by buyers with flat fee (possibly for additional incentives that reinforce the desired behavior). The tragedy here is that initially it was. But it was deemed too expensive for the buyers and got privatized which made it vastly more expensive in the long run.
Insurance is also wrong. Insurance is gambling and gambling needs restrictions. You are allowed to take people's money without providing any service most of the time, so you shouldn't be allowed to refuse legal service for that privilege.
It doesn't have opinions, research, direction of its own. Is this a path of codifying the worst elements of human society as we've known it, permanently?
This even translates to the pediatric space. I took all of my kids to the pediatrician because either they don't make comments to me like they do to my wife, or I don't take shit from them. I'm not sure which. Here's an example:
My wife and daughter were there and the doctor asked what kind of milk my daughter was drinking. She said "whole milk" and the doctor made a comment along the lines of "Wow, mom, you really need to switch to 2%". To understand this, though, you need to understand that my daughter was _small_. Like they had to staple a 2nd sheet of paper to the weight chart because she was below the available graph space. It wasn't from lack of food or anything like that, she's just small and didn't have much of an appetite.
So I became the one to take the kids there. Instead of chastising me, they literally prescribed cheeseburgers and fettuccine alfredo.
My daughter is in her 20s now and is still small -- it's just the way she is. When she goes to see her primary, do you know what their first question is? "When was your last period."
Is that supposed to be a problem? How does it connect to the story in your comment?
The question seems to be warranted to me, since being underweight can stop you from menstruating. So if you find someone thin and her last period was off in the distant past, you can conclude that there's a problem and something should be done about it; if it was a couple of weeks ago, you can conclude that she's fine.
(It could also just be something that is automatically assessed as a potential indicator of all kinds of different things. Notably pregnancy. For me, it bothered me that whenever you have an appointment at Kaiser for any reason, part of their checkin procedure is asking you how tall you are. I'd answer, but eventually I started pointing out to them that I wasn't ever measuring my height and they were just getting the same answer from my memory over and over again. [By contrast, they also take your weight every time, but they do that by putting you on a scale and reading it off.] The fact that my height wasn't being remeasured didn't bother them; I'm not sure what that question is for.)
However, your argument focuses on the routine intake instead of any listening part. The fact that the doctor measures height, weight, temperature, and blood pressure on intake and then asks about LMP doesn’t surprise me… that’s the part of the script where you just provide the data before you bring up concerns.
Not to say the doctor was not a jerk, just that your argument doesn’t do much for me.
I wonder how many units of their training courses are spent on this and how much is spent on the cultural reinforcement of it.
theyre also going to tell you things other than just what your insurance is agreeing to.
a robo doctor will be corrupt in ways that a regular doctor can be held accountable, but without the individual accountability
Ok fellas put your money where your mouth is. It’s easy to talk until you put your money behind it (or lack of by getting rid of spending on it) if you are so confident in doctor as a service by llm.
If I were picking a specialty now, I'd go with pediatrics or psychiatry over something like oncology.
You, on the other hand, are confusing LLMs from the past with current SOTA LLMs, which can tell how many rs are in strawberry.
But most of us live in America in 2026. There are a lot of interests that don't give a shit about you who would love if you to got your medical care from a machine that "cannot tell how many r's are in strawberry". And there a lot of useful idiots with no real medical issues who will loudly claim the machine is great.
patients -> AI -> diagnosis (you know, with a camera, or perhaps a telephone I guess)
What REALLY happened
patients -> nurse/MD -> text description of symptoms -> MD -> question (as in MD asked a relevant diagnostic question, such as "is this the result of a lung infection?", or "what lab test should I do to check if this is a heart condition or an infection?") -> AI -> answer -> 2 MDs (to verify/score)
vs
patients -> nurse/MD -> text description of symptoms -> MD -> question -> (same or other) MD -> answer -> 2 MDs verify/score the answer
Even with that enormous caveat, there's major issues:
1) The AI was NOT attempting to "diagnose" in the doctor House sense. The AI was attempting to follow published diagnostic guidelines as perfectly as possible. A right answer by the AI was the AI following MDs advice, a published process, NOT the AI reasoning it's way to what was wrong with the patient.
2) The MD with AI support was NOT more accurate (better score but NOT statistically significant, hence not) than just the MD by himself. However it was very much a nurse or MD taking the symptoms and an MD pre-digesting the data for to the AI.
3) Diagnoses were correct in the sense that it followed diagnostic standards, as judged afterwards by other MDs. NOT in the sense that it was tested on a patient and actually helped a live patient (in fact there were no patients directly involved in the study at all)
If you think about it in most patients even treating MDs don't know the correct conclusion. They saw the patient come in, they took a course of action (probably wrote at best half of it down), and the situation of the patient changed. And we repeat this cycle until patient goes back out, either vertically or horizontally. Hopefully vertically.
And before you say "let's solve that" keep in mind that a healthy human is only healthy in the sense that their body has the situation under control. Your immune system is fighting 1000 kinds of bacteria, and 10 or so viruses right now, when you're very healthy. There are also problems that developed during your life (scars, ripped and not-perfectly fixed blood vessels, muscle damage, bone cracks, parts of your circulatory system having way too much pressure, wounds, things that you managed to insert through your skin leaking stuff into your body (splinters, insects, parasites, ...), 20 cancers attempting to spread (depends on age, but even a 5 year old will have some of that), food that you really shouldn't have eaten, etc, etc, etc). If you go to the emergency room, the point is not to fix all problems. The point is to get your body out of the worsening cycle.
This immediately calls up the concern that this is from doctor reports. In practice, of course, maybe the AI only performs "better" because a real doctor walked up to the patient and checked something for himself, then didn't write it down.
What you can perhaps claim this study says is that in the right circumstances AIs can perform better at following a MD's instructions under time and other pressure than an actual MD can.
100% of the cases where some headline makes big claims about "AI" based on some study, you take a good hard look at the study and none of the big claims stand on their own.
It's all heavily spinned, taken out of context, editorialized... It's become almost a hobby of mine lately. And I am glad for have read so many papers and reasoned critically about methods and statistics. But it is also scary to realize just how much people take at face value of bombastic interpretations of datasets that support no such claim or much weaker versions only.
Chasing down sources is something that I often do and I've learned that people take a lot of liberty when divulging opinions about sources they don't think will be checked. Even in high trust environments. I have first hand received work by post-doctoral fellows where some articles in the bibliography didn't even exist.
Excellent. We should be striving for a world where humans are meat puppets for machines.
Humans (doctors/nurses) can still be there to make you feel the warmth of humanity in your darkest times, but if a machine is going to perform better at diagnosing (or perhaps someday performing surgery), then I want the machine.
Even now, I'll take a surgeon that's a complete jerk over a nice surgeon any day, because if they've got that job even as a jerk they've got to be good at their jobs. I want results. I'll handle hurt feelings some other time.
The truly compassionate surgeons will want to improve their skills because they care about their patients. They care if they develop complications and may feel terrible if they do, the jerk may not. Being a jerk may mean that the surgeon can rise to the top, but it may not be due to surgical skill at all, they may be better at navigating politics etc.
This seems like an incredibly poor line of reasoning.
Hospitals are often desperate for surgeons. The poorly mannered ones are often deeply unsatisfied, angry at the grueling lives they've opted into, and the hospitals can't replace them. The market is not exactly at work here.
Dude you removed my right thumb I was in for an appendectomy!?
You are so right! I ignored everything you asked for. I am so sorry. I am administering general anesthesia now, then I will prepare you for your next surgery.
For instance, transportation is a "human problem". It's being successfully solved with such technologies as cars, trains, planes, etc. Growing food at scale is a "human problem" that's being successfully solved by automation. Computing... stuff could be a "human problem" too. It's being successfully solved by computers. If "human problems" are more psychological, then again, you can use the Internet to keep in touch with people, so again technology trying to solve a human problem.
Sure, some kinds of such "human problems" can be reduced to physics and technology, that's the point. This also doesn't necessarily mean that solutions produced by such reductions are effective: is surveillance good at preventing cheating during exams? Kind of. Does it often fail to catch cheating students? Absolutely.
However, indeed, there can be many different (perhaps equally correct) definitions of what a "human problem" is.
I know. I know. Part of it is that talking to patients on average is useless but still this can’t be really used for an argument against AI.
Still doctors can have a more broad picture of the situation since they can look at the patient as a whole; something the LLM can’t really synthesize in its context.
- looking at their medical history/charts
- asking follow up questions
An LLM based system is trivially capable of doing both of those.
I think you'd be incredibly surprised how often charts are super, super incomplete or wrong. Like "pt has no pancreas and presented with pain and weeping from a 6yo pancreatectomy scar" but the chart doesn't mention the surgery or the entire missing organ wrong. Like "pt is a twin whose sibling died traumatically of cancer in front of them a year ago and presents with probable hypochondria about cancer" but the chart doesn't mention any family history wrong. Like "lifelong history of severe cognitive impairment substantiated by a psych eval; attended annual physical before being sent to imaging for head trauma because of observed impairment" but the chart doesn't mention cognition (someone was too polite to note it) nor the psych eval (records sharing wasn't allowed) wrong.
Those are a very few examples off the top of my head. I worked in EMR. I don't know shit about medicine, but man, do I know a lot about the complaints physicians and their staff send when they think it's the records system's fault that the chart was wrong or missing info.
In a big chunk of cases, the MD/NP/whatever's in-person role is determining what's not on the chart so that they can then ask appropriate follow-up questions. Given the massive range of possible dx for a given issue, and how much of getting the right dx doesn't have to do with probabilities/numbers of similar patients with the same symptom:dx data that'd be in the training set, I have major doubt that an LLM can appropriately intuit or appropriately question in order to diagnose.
But two facts are also true: a) diagnosis itself can be automated. A lot of what goes on between you having an achy belly and you getting diagnosed with x y or z is happening outside of a direct interaction with you - all of that can be augmented with AI. And b), the human interaction part is lacking a great deal in most societies. Homeopathy and a lot of alternative medicine from what I can see has its footing in society simply because they're better at talking to people. AI could also help with that, both in direct communication with humans, but also in simply making a lot of processes a lot cheaper, and maybe e.g. making the required education to become a human facing medicinal professional less of a hurdle. Diagnosis becomes cheaper & easier -> more time to actually talk to patients, and more diagnosises made with higher accuracy.
Unfortunately is this not likely to happen. More like:
Diagnosis becomes cheaper & easier -> more patients a doctor is expected to see in the same period of time as before
Even if your statement is true, it's questionable. People also tend to prefer hearing what they want to hear to hearing what they need to hear, and rank the former interaction higher.
Basically, tech's favorite feedback mechanism, customer reviews, cannot actually be relied upon to tell you how good something is.
One was against it, the other one saw it as a good idea.
I would love to have real data, real statistics etc.
How are you defining technology? How are you defining human problems? Inventions are created to solve human problems, not theoretical problems of fictional universe. Do X-rays, refrigerators, phones and even looms solve problems for nonhumans?
Claiming something that sounds deep doesn’t make it an axiom.
A) nice chatty friendly and cool doctor and can diagnose correctly 50% of the times. B) robotic ai that diagnoses 60% correctly.
What you chose? If you have a disease than can kill your, the ai is 20% more likely to help you and probably prevent. I can’t see too many people choosing human doctor. Anyway I’m sure there will be people that will chose doctor with 10% correctness vs a 100% ai no matter what.
I time is clear there very little human element.
I don't need to "talk to a human", I need a problem with my meatbag resolved.
> humans need other humans and human problems can't be solved with technology
WTF are you talking about? Is this bait? You can't possibly mean this. Yes humans are social creatures, but what does that have to do with medicine? Are you talking about a priest, a witch doctor, a therapist? Because if you're not, that sentence is utter BS.
Perhaps because they have been persistently failed by other humans, but not by technology; and/or because they believe they don't have the right and/or capability to improve other humans, but may be able to improve the technology?
For complex human reasons, I am effectively deprived of healthcare, in a country where healthcare is socialized. Other services provided by the state are also gatekept by my nominal healthcare provider, making certain "normal" things, indeed things that are required of me in order to participate in society, technically impossible.
(I will not go into concrete detail, because when I request help from anyone with my situation, the "help" consists of implorations to comply with painful nonsense, combined with a random helping of rudeness and idiocy. Yes, we exist.)
If I had "open source" access to just the "knowledge, experience, and pattern matching" that is presumably still involved in medical practice besides this nebulous "talking to a human" (which the other human usually actively works to make impossible, having been fundamentally socialized into language use by means of violence - and thus, the more intelligent my interlocutor, the more quickly they begin to feel threatened by understanding what I'm talking about), I would be able to maintain my body to a better standard than the standard of care that the institutional medical establishment has kindly deigned to make available to me.
Meanwhile, I don't even have "open source" access to the designs of the motor vehicle which hauls said body around. Being a car mechanic is so much more than "knowledge, experience, and pattern matching", too - it's being a part of a web of trust and tacit collusion; a.k.a. a guild.
Come to think of it, I don't even have "open source" access to the internals of the device I'm writing this from. Though at least in the domain of computing there are valiant attempts to produce libre software and hardware.
I'm happy that "talking to a human" has helped you. In my case, requesting help has a >10% likelihood to endanger my life, >25% to imperil my health, and >50% to degrade my sanity. Rough ballpark, eh?
A fully "open source" OS, device, vehicle, body, and mind, would presumably allow me to solve my immediate problems without needing other humans to perform the inexpicably painful sacrifice of comprehending my communications. Without access to these basics, consent to "healthcare" is impossible; we just put our lives in the hands of the medical technopriesthood and hope they don't leave us with permanently crossed fingers.
