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Comment by onlyrealcuzzo | Hacker News Reader

It's almost as if you'd want to not feed what the patient says directly to an LLM.

A non-trivial part of what doctors do is charting - where they strip out all the unimportant stuff you tell them unrelated to what they're currently trying to diagnose / treat, so that there's a clear and concise record.

You'd want to have a charting stage before you send the patient input to the LLM.

It's probably not important whether the patient is low income or high income or whether they live in the hood or the uppity part of town.

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> It's almost as if you'd want to not feed what the patient says directly to an LLM.

> A non-trivial part of what doctors do is charting - where they strip out all the unimportant stuff you tell them unrelated to what they're currently trying to diagnose / treat, so that there's a clear and concise record.

I think the hard part of medicine -- the part that requires years of school and more years of practical experience -- is figuring out which observations are likely to be relevant, which aren't, and what they all might mean. Maybe it's useful to have a tool that can aid in navigating the differential diagnosis decision tree but if it requires that a person has already distilled the data down to what's relevant, that seems like the relatively easy part?

Yes - theoretically, some form of ML/AI should be very good at charting the relevant parts, prompting the doctor for follow-up questions & tests that would be good to know to rule out certain conditions.

The harder problem would be getting the actual diagnosis right, not filtering out irrelevant details.

But it will be an important step if you're using an LLM for the diagnosis.

By the way, the show The Pitt currently on Max touches on some of this stuff with a great deal of accuracy (I'm told) and equal amounts of empathy. It's quite good.

I generally agree, however socioeconomic and environmental factors are highly correlated with certain medical conditions (social determinants of health). In some cases even causative. For example, patients who live near an oil refinery are more likely to have certain cancers or lung diseases.

https://doi.org/10.1093/jncics/pkaa088

So that's the important part, not that they're low income.

Sure, but correlation is correlation. Ergo 'low income', as well as affections or causes of being 'low income' are valid diagnostic indicators.

Studies like that, no matter how careful, cannot say anything about causation.

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