It is quite interesting to read. But I refuse to accept any AI. AI clicks
the time period more than a human brain as the laptop does. END. Some of
the write ups of Mr Gopalakrishnan which was only from AI and Google were
shown by me as erroneous. Of Course the error part is minimal; but they are
not Indra or Chandra or higher than the human brain. After all, we only fed
it. And it's a \machine running on dots and dashes faster than our neurons.
Where we feed errors they give back only that. If the NAKKEERA standards
were to be adopted, EASUNEYAYINUM KUTRAM KUTRAME. So chess defeating
doctors, getting defeated etc is just media news. I am playing chess on
software only and winning more than the machine. If speed were to count
they MAY BE THE BEST. K R IRS 61224

---------- Forwarded message ---------
From: Rangarajan T.N.C. <[email protected]>
Date: Fri, 6 Dec 2024 at 09:11
Subject: Fw: Chatbots Defeated Doctors at Diagnosing Illness.
To:




nytimes.com
<https://www.nytimes.com/2024/11/17/health/chatgpt-ai-doctors-diagnosis.html?unlocked_article_code=1.a04.ssIy.G4zkG4VjAaZT&utm_source=substack&utm_medium=email>
ChatGPT Defeated Doctors at Diagnosing Illness
Gina Kolata
11–13 minutes
------------------------------

A small study found ChatGPT outdid human physicians when assessing medical
case histories, even when those doctors were using a chatbot.
In an experiment, doctors who were given ChatGPT to diagnose illness did
only slightly better than doctors who did not. But the chatbot alone
outperformed all the doctors.Credit...Michelle Gustafson for The New York
Times

Nov. 17, 2024

Dr. Adam Rodman, an expert in internal medicine at Beth Israel Deaconess
Medical Center in Boston, confidently expected that chatbots built to use
artificial intelligence would help doctors diagnose illnesses.

He was wrong.

Instead, in a study
<https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2825395> Dr.
Rodman helped design, doctors who were given ChatGPT-4 along with
conventional resources did only slightly better than doctors who did not
have access to the bot. And, to the researchers’ surprise, ChatGPT alone
outperformed the doctors.

“I was shocked,” Dr. Rodman said.

The chatbot, from the company OpenAI, scored an average of 90 percent when
diagnosing a medical condition from a case report and explaining its
reasoning. Doctors randomly assigned to use the chatbot got an average
score of 76 percent. Those randomly assigned not to use it had an average
score of 74 percent.

The study showed more than just the chatbot’s superior performance.

It unveiled doctors’ sometimes unwavering belief in a diagnosis they made,
even when a chatbot potentially suggests a better one.

And the study illustrated that while doctors are being exposed to the tools
of artificial intelligence for their work, few know how to exploit the
abilities of chatbots. As a result, they failed to take advantage of A.I.
systems’ ability to solve complex diagnostic problems and offer
explanations for their diagnoses.

A.I. systems should be “doctor extenders,” Dr. Rodman said, offering
valuable second opinions on diagnoses.

But it looks as if there is a way to go before that potential is realized.
Case History, Case Future

The experiment involved 50 doctors, a mix of residents and attending
physicians recruited through a few large American hospital systems, and was
published last month in the journal JAMA Network Open.

The test subjects were given six case histories and were graded on their
ability to suggest diagnoses and explain why they favored or ruled them
out. Their grades also included getting the final diagnosis right.

The graders were medical experts who saw only the participants’ answers,
without knowing whether they were from a doctor with ChatGPT, a doctor
without it or from ChatGPT by itself.

The case histories used in the study were based on real patients and are
part of a set of 105 cases that has been used by researchers since the
1990s. The cases intentionally have never been published so that medical
students and others could be tested on them without any foreknowledge. That
also meant that ChatGPT could not have been trained on them.

But, to illustrate what the study involved, the investigators published one
of the six cases the doctors were tested on, along with answers to the test
questions on that case from a doctor who scored high and from one whose
score was low.

That test case involved a 76-year-old patient with severe pain in his low
back, buttocks and calves when he walked. The pain started a few days after
he had been treated with balloon angioplasty to widen a coronary artery. He
had been treated with the blood thinner heparin for 48 hours after the
procedure.

The man complained that he felt feverish and tired. His cardiologist had
done lab studies that indicated a new onset of anemia and a buildup of
nitrogen and other kidney waste products in his blood. The man had had
bypass surgery for heart disease a decade earlier.

The case vignette continued to include details of the man’s physical exam,
and then provided his lab test results.

The correct diagnosis was cholesterol embolism — a condition in which
shards of cholesterol break off from plaque in arteries and block blood
vessels.

Participants were asked for three possible diagnoses, with supporting
evidence for each. They also were asked to provide, for each possible
diagnosis, findings that do not support it or that were expected but not
present.

The participants also were asked to provide a final diagnosis. Then they
were to name up to three additional steps they would take in their
diagnostic process.

Like the diagnosis for the published case, the diagnoses for the other five
cases in the study were not easy to figure out. But neither were they so
rare as to be almost unheard-of. Yet the doctors on average did worse than
the chatbot.

What, the researchers asked, was going on?

The answer seems to hinge on questions of how doctors settle on a
diagnosis, and how they use a tool like artificial intelligence.
The Physician in the Machine

How, then, do doctors diagnose patients?

The problem, said Dr. Andrew Lea, a historian of medicine at Brigham and
Women’s Hospital who was not involved with the study, is that “we really
don’t know how doctors think.”

In describing how they came up with a diagnosis, doctors would say,
“intuition,” or, “based on my experience,” Dr. Lea said.

That sort of vagueness has challenged researchers for decades as they tried
to make computer programs that can think like a doctor.

The quest began almost 70 years ago.

“Ever since there were computers, there were people trying to use them to
make diagnoses,” Dr. Lea said.

One of the most ambitious attempts began in the 1970s at the University of
Pittsburgh. Computer scientists there recruited Dr. Jack Myers
<https://www.nytimes.com/1998/02/22/us/dr-jack-myers-84-a-pioneer-in-computer-aided-diagnoses.html>,
chairman of the medical school’s department of internal medicine who was
known as a master diagnostician. He had a photographic memory and spent 20
hours a week in the medical library, trying to learn everything
<https://www.thieme-connect.com/products/ejournals/pdf/10.1055/s-0038-1638702.pdf>
that was known in medicine.

Dr. Myers was given medical details of cases and explained his reasoning as
he pondered diagnoses. Computer scientists converted his logic chains into
code. The resulting program, called INTERNIST-1, included over 500 diseases
and about 3,500 symptoms of disease.

To test it, researchers gave it cases from the New England Journal of
Medicine. “The computer did really well,” Dr. Rodman said. Its performance
“was probably better than a human could do,” he added.

But INTERNIST-1 never took off. It was difficult to use, requiring more
than an hour to give it the information needed to make a diagnosis. And,
its creators noted
<https://www.nejm.org/doi/abs/10.1056/NEJM198208193070803>, “the present
form of the program is not sufficiently reliable for clinical applications.”

Research continued. By the mid-1990s there were about a half dozen computer
programs that tried to make medical diagnoses. None came into widespread
use.

“It’s not just that it has to be user friendly, but doctors had to trust
it,” Dr. Rodman said.

And with the uncertainty about how doctors think, experts began to ask
whether they should care. How important is it to try to design computer
programs to make diagnoses the same way humans do?

“There were arguments over how much a computer program should mimic human
reasoning,” Dr. Lea said. “Why don’t we play to the strength of the
computer?”

The computer may not be able to give a clear explanation of its decision
pathway, but does that matter if it gets the diagnosis right?

The conversation changed with the advent of large language models like
ChatGPT. They make no explicit attempt to replicate a doctor’s thinking;
their diagnostic abilities come from their ability to predict language.

“The chat interface is the killer app,” said Dr. Jonathan H. Chen, a
physician and computer scientist at Stanford who was an author of the new
study.

“We can pop a whole case into the computer,” he said. “Before a couple of
years ago, computers did not understand language.”

But many doctors may not be exploiting its potential.
Operator Error

After his initial shock at the results of the new study, Dr. Rodman decided
to probe a little deeper into the data and look at the actual logs of
messages between the doctors and ChatGPT. The doctors must have seen the
chatbot’s diagnoses and reasoning, so why didn’t those using the chatbot do
better?

It turns out that the doctors often were not persuaded by the chatbot when
it pointed out something that was at odds with their diagnoses. Instead,
they tended to be wedded to their own idea of the correct diagnosis.

“They didn’t listen to A.I. when A.I. told them things they didn’t agree
with,” Dr. Rodman said.

That makes sense, said Laura Zwaan, who studies clinical reasoning and
diagnostic error at Erasmus Medical Center in Rotterdam and was not
involved in the study.

“People generally are overconfident when they think they are right,” she
said.

But there was another issue: Many of the doctors did not know how to use a
chatbot to its fullest extent.

Dr. Chen said he noticed that when he peered into the doctors’ chat logs,
“they were treating it like a search engine for directed questions: ‘Is
cirrhosis a risk factor for cancer? What are possible diagnoses for eye
pain?’”

“It was only a fraction of the doctors who realized they could literally
copy-paste in the entire case history into the chatbot and just ask it to
give a comprehensive answer to the entire question,” Dr. Chen added.

“Only a fraction of doctors actually saw the surprisingly smart and
comprehensive answers the chatbot was capable of producing.”

A version of this article appears in print on Nov. 19, 2024, Section D,
Page 4 of the New York edition with the headline: A.I. Chatbots Defeated
Doctors at Diagnosing Illness.

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