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Comment by BTinfinity | Hacker News Reader

I did see one attempt[0] at creating a doctor from an LLM on Github. From their ReadMe.MD overview: "This is an open-source project with a mission to provide everyone their own private doctor"

Hard not to agree with your edit0 as well; search engines often give doomsday diagnosis, how long before we're all hypochondriacs under the latest LLM cult?

[0] https://github.com/llSourcell/DoctorGPT

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My biggest concern with that would be that very quickly health authorities or insurance companies will force these on people and you'll be forced to interact with an LLM and not get to talk to a doctor for most stuff.

Zero chance with regulation. We still don’t let machines final read ECGs and insurance companies pay a physician (typically a cardiologist) to overread them. These have been FDA approved algorithms for over a decade already.

I don't see why it would be the worst thing as a first level thing to interact with, freeing up doctors for more important tasks or trickier individuals.

How many people are showing up to doctors for bullshit, going to er for colds and mild flu's, or symptoms that can't be talked until tests are ordered

Last time I went to the Dr, I waited two hours, I finally saw a nurse who took down my symptoms, ordered a test, and said a Dr will follow up,who just gave me some antibiotics for a couple of days before even taking the test.

Why couldn't an llm take my symptoms, match it with similar tests needed and order the test automatically and have me leave with the same antibiotic?then follow up with a doctor when the lab is done.

Same for yearly physicals, just have an llm order all the tests and I'll talk with the dr later.

All sorts of low level stuff can be automated away.

“Bullshit” is almost always a post hoc diagnosis. In the last 2 years I’ve seen 3 20-somethings with a few days of flu symptoms having used a virtual walk in clinic service before coming to the ER (this is Canada where primary care is mostly non-existent) that had APL (highly treatable) and ended up dying within a few hours from DIC and intracranial hemorrhage (not treatable and how they ended up in my neck of the woods).

There’s still something to be said for the physical exam and eyeball test.

Obviously there’s a large element of survivorship bias at play here but I don’t believe the solution for poor primary care is to accept it will always be shitty and substitute a LLM.

I didnt mean it as primary care sucks so switch in an llm becasue it sucks as much.

But as away to free up doctors from low effort stuff, churn through lines quicker and get people who actually need focused attention the time with a Dr they need.

Maybe your right and nothing is truly low effort

You’re right that the vast majority of the time it’s low effort but it’s hard to identify those cases with high specificity up front.

The issue in medicine is there is huge class imbalance, 90%+ of encounters are essentially “negative” or normal. It’s easy for something/someone to look accurate or safe because of pretest probability. The hard part is getting above 90% and why we spend so much time in medicine training.

I hate the word but there’s something in medicine called “clinical gestalt” which is the overall impression one has from certain things in history and exam and doesn’t fit into a decision rule or algorithm, until we find a solution for that I’m not keen on adopting something that distances the patient from the physician.

We’ve tried that with mid levels at my hospital and it didn’t really work out.

Discussed here:

https://news.ycombinator.com/item?id=37105352

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