Comment by const_cast | Hacker News Reader

Comment by const_cast | Hacker News Reader

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The only reason this worked is because your situation was exceedingly simple.

The trouble is you are not educated enough to tell what is simple and what isn't. A cough could be a cough or it could be something more serious, only a "real" examination will reveal that. And sometimes even that's not enough, you need an examination by a specialists.

I'll tell you a story. Once upon a time I got pain in my balls. I went to a doctor and he felt around and he said he didn't feel anything. I went to another doctor and he felt something, but he had no idea what it was. He said could be a cyst, could be a swollen vein, could be an infection - he didn't even know if it was on the testicle or on the tube thingy.

Then I went to a Urologist. You can tell this man has felt up a lot of balls. He felt me up and said, "yup, that's a tumor" almost immediately. He was right, of course, and he ended up being the one to remove it too. Since I caught the cancer pretty early the chemotherapy wasn't too intense.

Point is, expertise matters when things aren't straight forward. Then, experience and perspective gets to shine.

As a competing anecdote, last summer my toddler woke up from a nap with bruises on his legs and swelling around his joints. We initially thought maybe he was tangled up in his crib, but later when changing his diaper found his testicles were swollen and rushed him to the emergency room. Over the next 6-7 days we saw no less that 5 doctors including his pediatrician, orthopedic specialists, and doctors at the ER and urgent care. None of whom were able to give us any answers about this weird bruising and swelling that randomly appeared on his legs. After all of this, during one of his flair ups, I took a picture of his legs and searched it with Google lens. The results set included pictures and symptoms of Henoch-Schonlein purpura [0], that were identical to what he was experiencing. We confirmed this with his pediatrician and decided on a treatment plan, but I was floored at how many doctors we had to see (and how much money we had to spend), only for me to diagnose this on my own with Google lens.

[0] https://www.mayoclinic.org/diseases-conditions/henoch-schonl...

I don't think this is the slam-dunk you think it is. You had to go to three doctors before someone recognized something was wrong. ChatGPT is the substitute for the first two doctors, not the third.

And even there, I bet ChatGPT would have told you to go see a doctor, since it can't feel your balls. And after your first appointment, if you had told it that you still thought something was wrong, it would probably have told you to go see a urologist.

I fall slightly on the “doomer” side of the safety spectrum, but if I’m being honest I’ll be first in line - rain, sleet, or snow - to buy the chatgpt that can!

>And even there, I bet ChatGPT would have told you to go see a doctor

So what is the value add of ChatGPT in this scenario? Either it says you don't need to see the doctor which could very well kill you or it tells you to visit the doctor and it doesn't actually help you in any way.

The value-add would be getting my insurance to approve me to go see a "specialist" (the urologist) immediately rather than forcing me to schedule an appointment with my primary-care doctor first, paying $200 for the office visit, and delaying care by 2 weeks.

So, a technical solution to a bureaucratic problem.

Also, even when I'm on a PPO plan instead of HMO...I know when I have a yeast infection. I don't want to pay $100 to tell a doctor that I have a yeast infection. They don't even look at my genitals - they just take my word for it. But I can't buy fluconazole without a prescription. Such a waste of everyone's time and my money.

So again, a technical solution to a bureaucratic problem.

Get a PPO plan, then? I can go directly to any specialist I want, although I find it’s better to always talk to my PCP first, who then makes a referral and often recommends the specialist she prefers.

(If your HMO charges $200 for a PCP visit - wow, I’d look for a different plan.)

My second example was specifically called out as an example of an issue even with PPO's. Also, not everyone (including myself) can easily change jobs or get insurance that simply isn't even offered by the employer. Worth noting that in my state for example, none of the public ACA health insurance options are a PPO.

Yeah, it's true that a lot of ACA plans are quite poor right now. The subsidy often isn't really worth it compared to a non-ACA plan.

That isn’t value created by the AI, it is valued bestowed on it by your insurance company. They could bestow that same value on a Google search or a call center worker in Southeast Asia and it would provide you the same value.

The AI is just making an already convoluted system more convoluted.

You're missing the case of it telling you not to see a doctor and it's right, in which you save a lot of time (and potentially money).

Mistakes will happen, that's the nature of statistics of this nature. But don't forget that saving 1,000s of people time is worth something, even if you never directly see it like you do the one case that it didn't catch.

> But don't forget that saving 1,000s of people time is worth something

How many unnecessary deaths does that buy you?

I don't know. But pretending there are no tradeoffs is stupid, and also disconnected from reality.

>I don't know.

Which invalidates the whole point. There are countless ways that the healthcare industry could save time if it was willing to sacrifice an unknown number of lives.

How is this scenario any different from some other arbitrary decision made for the sake of expediency such as doctors deciding to no longer collect medical histories from new patients? Think of all the time that could be saved if you never had to fill out those forms the first time you saw a doctor. Who cares if that leads to more people dying, it saves some time!

We’re discussing this on a thread about an attempt to answer that question!

When I say "I don't know", it means I genuinely don't know. Obviously, since this is a new technology, it's possible that it is better than doing arbitrary things like saying that people shouldn't fill out forms anymore.

You're saying "some change is bad therefore all changes are bad", which is obviously fallacious.

No, I'm saying change that even its supporters concede will kill people is bad if we can't actually quantify either its benefits or its cost in human life. You talked about a "tradeoff" while having no idea what is being traded for what. That is advocating for change just for the sake of change. Opposing that is not advocating against all change, it is saying "move fast and break things" is an immoral approach when dealing with human lives.

Your original comment argued there is no value add. I gave an example of the kind of value add that you can get (saving money/time on following up something wrong).

I did not advocate for this specific release being better, and I certainly did not say we should "move fast and break things". I don't know who you think you're arguing against but it's not me.

I only pushed back on the specific idea that this there is no possible value-add by this kind of software.

When you can't actually quantify the savings in time or the cost in life, you have no idea if this is adding value or not. I could just as easily flip a coin to decide whether to see a doctor, do you think that automatically "adds value" because the coin occasionally gives me the right answer regardless of how often it gives me the right answer?

Right, so as you've pointed out, chatgpt wouldn't have helped me in any way.

And, for the record, I was referred to a Urologist. The doctor was able to say "something isn't right but I don't know what" and he referred me to a Urologist and got my ultrasounds.

No offense to uh... AI... but it's not very good at being humble. It seems hubris wasn't in the training data. It's quite difficult to get an LLM to say "I don't know". Usually you have to prime it or ask leading questions, which at that point you already know that it doesn't know so therefore trying to elicit that response is worthless.

> I bet ChatGPT would have told you to go see a doctor, since it can't feel your balls.

Not _yet_!

> ChatGPT is the substitute for the first two doctors, not the third.

The third doctor used to behave more like the first two. In a world where ChatGPT replaced the rookies, how do we get good doctors?

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