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Comment by JPLeRouzic | Hacker News Reader

Healthcare is more than having medical knowledge.

Ten years ago, in France, two doctors (one in a professional setting and the other during a private consultation) asked me about a wound I had on my shoulder; obviously I couldn't identify what it was, and they offered no suggestions, so I supposed it was not something important.

It took a visit to a cardiologist—for an entirely different reason—for him to suggest that I rapidly consult a dermatologist.

It was a carcinoma, and surgery removed it. If ChatGPT had existed back then, this carcinoma would have been removed several years earlier.

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This sounds like a competency problem on the part of the GPs. They’re supposed to make these calls.

They are supposed to, but often times they don't and there are no consequences for it.

Current diagnostic setup relies on humans having vast expert knowledge, when in fact it's almost always impossible.

A well trained neural net/LLM will always be better at visual detection because of sheer number of examples it sees during training, compared to a dermatologist which, if lucky will observe no more than 20 patients/day x 270 days a year x 40 years of practice i.e. around 220k samples throughout his lifetime.

MD with other specialties will see significantly less and we are talking about top of the top specialists.

An average MD knows more amount medical diagnostics than than the average Joe, but in principle much less than a well trained AI.

Do we have those kinds of models already? Maybe not yet but, ceteris paribus, we will definitely have them in the future.

IMHO we do have those models already but they aren't available to the public, though their availability would certainly lower cost for healthcare providers.

Yet here we are

Maybe if chatgpt existed back then you'd have had your carcinoma extracted along with 10 other benign anomalies.

Automation doesn't make up for carelessness.

Skin cancer is easily treated with excisions if it’s caught early. Better to have ten small false positives than a single miss.

Even if addressing each false positive would carrying low but real risk of death or complications?

Is your "low but real" risk comparable to the risk of driving a motorcycle, of riding in a car, or of using the bathroom?

Reasonable treatments for small, non-aggressive skin cancers (or suspected cancers) are extremely low risk. And reasonable practitioners will often suggest that you merely keep an eye on an abnormal spot - because it doesn't look worth the bother of any sort of treatment for now.

That's not how risk management works, you don't disregard one because another is higher, because risk compose. At the end of the day you'll be in a car accident coming from a surgery you didn't need.

Not sure why this is getting downvoted. In its specific case that's quite obviously not a good example because removing benign spots isn't harmful, but overlooking malignant ones is, so there is no downside.

But if we think a little further and generalize then there is great risk (and by extension, harm) to delegate diagnosis and treatment (of health issues in general, including potentially or supposedly fatal ones) to ChatGPT and similar tech. That we'd end up with a net positive is far from obvious.

I still maintain my point that it isn't harmless to blindly address benign anomalies. Every medical procedure carries risk.

Your point doesn’t really make a lot of sense. Even with ChatGPT existing and making 90% bad calls, a doctor isn’t likely to just “blindly” be cutting out anomalies.

As opposed to what OP said?

Your original comment seemed to imply that if ChatGPT had existed, maybe they’d have had ten benign things removed. But that’s not how it works.

Conversely, ChatGPT can help avoid false negatives.

  It was a carcinoma, and surgery removed it. If ChatGPT had existed back then, this carcinoma would have been removed several years earlier.

My point is against this technical positivism.

Obviously, error rate of ChatGPT should be measured by comparing to human diagnoses and when it plateaus, we should investigate a possibility that the number is driven mostly by human errors.

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