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Dr. K's avatar

Vinay, This is my area of expertise on which I have been publishing since the very first article on Medical Informatics I wrote for Science many decades ago. ChatGPT, on which I have pretty deep experience, is a language engine, not an all-knowing "artificial intelligence". As you play with it more, you will discover that we have yet to achieve "artificial stupidity"....and it is a long slog from there to anything "intelligent".

I am shocked to see you endorsing "cookbook medicine" as the better default for the future. Without an ontologic understanding of what is happening with each patient, ONE BY ONE, there can be words that sound good but that will likely be wrong. None of that is today possible (or even being pursued) in large language engines. The cookbook will be often wrong in unpredictable ways. I know that the government (witness the cookbook response to covid) would love this kind of health care...but it is wrong on every level.

Half a century ago there was a program called Eliza that, similarly (but much more simply) did psychiatric interviews with users. It was very persuasive (and people would interact with it for hours) but, in actuality, had nothing to contribute. Perhaps large language engines may facilitate writing notes and replace scribes...I agree that much medical documentation is nonsense. But the leap to "doctoring" and the default that doctors will just be dumber (yes, happening now but that is LCME's fault and the failure of schools like UCSF (and mine) to push back) but cookbook language processing will take over is a leap way too far.

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Adrian Gaty's avatar

“This point has been made by others, but the deeper point I want to make is just how silly it is we spend so much time documenting. This is largely done for billing purposes, and these documents are mostly read by no one. This entire billing system needs reformation.”

This is so true. Imagine if lawyers had to document this thoroughly for every hour they bill us, or if your mechanic had to write a paragraph justifying each oil change… it’s just insane and I can’t believe this is real life

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