I used Claude Code to get a second opinion on my MRI

https://antoine.fi/mri-analysis-using-claude-code-opus

by engmarketer • 24 days ago

566 714 24 days ago

antoine.fi

Aeolun• 24 days ago

I would not use Claude to get a second opinion on anything that’s an image.

maxall4• 24 days ago

Especially an MRI which is a 3D medium —something current LLMs are very bad at.

amluto2• 24 days ago

I know little about radiology, but MRI is a 3D medium. I would not be at all surprised if one could slice an MRI the wrong way to produce a 2D image that fails to show a feature that exists in the source data.

lostlogin7• 24 days ago

MRI which is a 3D medium

The finer detail (which you may already know) is more complicated.

MR does ‘2D’ scans which are a slice, then a gap of non-imaged tissue (typically 10% the slice thickness) then a slice. Each slice is an image with a number of pixels, say 320. Each pixel in the slice is small, eg 0.5mm but very thick due to the slice being thick, which is required for MRI signal. The pixels are 3mm in the shoulder scan done here.

‘3D’ scans don’t have a gap between slices, and are often isotopic, meaning the same resolution in all directions. The voxel (a pixel with depth) would be something like 1mm x 1mm x 1mm.

3D scans are slow, prone to movement artifact and never as pretty in plane as a good 2D. You can reformat them to look ok in any plane.

yolo3000• 24 days ago

I used it on an ankle fracture xray, it was quite useful to make sense of things. But not like a 2nd opinion.

behnamoh• 24 days ago

What's wrong with Claude? I've asked it to analyze images and even Opus 4 would perfect nail it.

throwrioawfo• 24 days ago

Sure, it can see obvious stuff in images, but as far as I'm aware it is not designed for (or tested on) performing the kind microscopic analysis that radiology involves

nostrebored6• 24 days ago

Claude is the worst FM at image understanding. Prior to gpt-5.4 the only usable models were Gemini and Qwen.

damontal• 24 days ago

Throw a chess board on there. See how it does. It always gets pieces and positions completely wrong because it’s terrible at analyzing images.

rmbyrro2• 24 days ago

I agree with you for some kinds of images, but not all.

LLMs are the best PDF-to-markdown converters, in my experience. I have a CLI that converts PDF to PNG, then run a background agent to "read" each PNG and write it down as markdown; it works flawlessly even for complex math formulas, it can "translate" complex charts, graphs, and tables into words.

It's slow and arguably expensive compared to traditional OCR, but very effective and precise.

skybrian• 24 days ago

Getting an actual second opinion seems like the next step?

sxg10• 24 days ago

I'm a radiologist but can't really weigh in without seeing the full 3D MRI dataset. Regarding this point:

They performed shockwave therapy on my shoulder even though a recent clinical practice guideline says clinicians should not use or recommend shockwave therapy for rotator-cuff tendinopathy without calcification; I was told during ultrasound that there was no calcification.

Ultrasound isn't a great way to assess for calcification. It'll find large calcification but easily miss small ones. Plain radiograph would be more helpful, but the MRI may have revealed it as well. Either way, shockwave therapy isn't harmful in the absence of calcification--it's just not helpful.

Edit: when a radiology report says something isn't present, there's always an implicit caveat that the finding isn't present within the context of the modality and images obtained. So an ultrasound report can state there are no calcifications while a plain radiograph can report the presence of calcifications without being inconsistent. Obviously very confusing to patients and people unfamiliar with medical jargon, but clarifying this in reports would make them sound even more qualified, "hedgey", and annoying to read than they already are.

tiahura2• 24 days ago

Why isn’t diagnostic ultrasound used in orthopedics? They inspect fetus hearts and other organs everyday, why not shoulders? Seems much cheaper and faster.

sxg10• 24 days ago

They do. Ultrasound in orthopedics is a relatively newer field, and there aren't quite as many sonography techs and radiologists experienced in reading these studies, which is likely why you don't see it offered more widely.

Edit: I should mention that ultrasound is basically unusable for evaluating bones. Sound waves can't penetrate bone, and so you end up just seeing a huge black void. That's a huge orthopedics use case that ultrasound just can't benefit. However, ultrasound is fantastic for evaluating muscles, ligaments, tendons, and other superficial soft tissues.

bflesch2• 24 days ago

It's a manual, non-standardized process without a standardized output. Image quality depends both on user skills (how deeply they press the sensor on the skin) and the machine they have. Unlike CT/MRI the examination results cannot be easily shared and compared between patients for studies.

scrollop• 24 days ago

We order ultrasounds all the time for shoulders (for like soft tissue issues; for trauma, you'd start with an xray). For other joints, such as the knee, MRIs are a better choice (unless htere has been substantial trauma, in which case xray initially or further), though more expensive, unless you're excluding a Baker's cyst, in which case an ultrasound is fine.

Since MRIs are more expensive, private doctor's might order them instead of an ultrasounds.

(I'm a doctor)

prdonahue• 24 days ago

They're used quite a bit for nerve entrapment—both in diagnosing and treating.

trentor• 24 days ago

Ultrasound was overlooked by US medicine as a first line imaging tool for a long time because it takes real skill and experience to do it right. But it's making a comeback. We've had Chinese, Indian, Australian, and American doctors visit us for one to two month stints to build up their skills.

Given the skill involved, it's probably a liability concern they don't want the exposure over there.

foobarian2• 24 days ago

Huh, I'm reading and looking up these words you guys are saying and it is starting to look exactly like the symptoms I have been having with my own right shoulder! I feel like a giant gaping rabbit hole just opened up next to my desk.

sxg10• 24 days ago

We're discussing calcific tendinitis (https://radiopaedia.org/articles/calcific-tendinitis?lang=us). If you think you have it, you can see a doctor and consider shoulder radiographs to start.

engeljohnb4• 24 days ago

I'm a radiologist

Any comment that doesn't start with this or similar qulaification should be taken with a grain of salt (yes, including this one).

Medical imaging is one of those things everyone thinks is simple because they don't know what they don't know. I'm a cardiac sonographer, and I have to assume radiologists hear at least as many eye-rolling takes on AI coming for their job as I do.

lostlogin7• 24 days ago

Ahh, AI is coming for your job.

Full sarcasm, is there one that’s that’s more immune?

ambicapter3• 24 days ago

So an ultrasound report can state there are no calcifications while a plain radiograph can report the presence of calcifications without being inconsistent. Obviously very confusing to patients and people unfamiliar with medical jargon

This is being overly nice, I think. Anyone who doesn't understand this is an idiot imo. You would have to assume that every type of diagnosis instrument has infinite clarity and is always correct to be confused in this case.

Reminds me of the Babbage quote where somebody asked him, if I put the wrong question into this computing device, will it still give me the right answer? His response, paraphrased "I can not fathom the logic of the minds which would come up with such a question".

Paracompact4• 24 days ago

"On two occasions I have been asked [by members of Parliament], 'Pray, Mr. Babbage, if you put into the machine wrong figures, will the right answers come out?' I am not able rightly to apprehend the kind of confusion of ideas that could provoke such a question."

akoboldfrying• 24 days ago

Anyone who doesn't understand this is an idiot imo

I disagree. A priori it's not obvious to a layperson whether or not a statement that uses unconditional phrasing is intended to be authoritative or conditional on something unspecified, like the resolution of the measuring device. This goes for any sufficiently technical field.

If you got the brakes checked on your car, and the mechanic did <something> and told you there are no issues with them, and you then took your car to a different mechanic who did <something else> and told you there is a problem, you would not be an idiot for thinking that these conclusions contradict one another.

MattyMc• 24 days ago

Anyone who doesn't understand this is an idiot imo

I don’t think that’s true. Avoiding this mistake requires knowing that an ultrasound may not detect calcification. For a patient reading their own report, I don’t think that’s intuitive. I would expect most people to read “no calcifications” and assume that their joint has no calcifications.

Georgelemental• 24 days ago

You would have to assume that every type of diagnosis instrument has infinite clarity and is always correct to be confused in this case.

There's a difference between 99.9% clarity and 50% clarity. Even if neither exactly equals 100%, it's understandable that a layperson would expect different language between them

BrokenCogs• 24 days ago

This comment sounds like it's written by someone who doesn't interact with real people very often

BurningFrog• 24 days ago

Anyone who doesn't understand this is an idiot imo

Even if this is true, so what?

Idiots get sick at least as often as others, and the medical system needs to work as well as it can for that population too.

DrewADesign3• 24 days ago

I don’t think people are idiots if they don’t understand how a normally intelligent person might not intuit that. I do think they have a seriously underdeveloped theory of mind.

dd8601fn2• 23 days ago

It’s funny that the answer to this has increasingly become “yes” over the last few decades.

2ap2• 24 days ago

Agreed. Not a radiologist, but I do a fair bit of MRI research. Experts vs lay people probably have different success with getting the right diangosis out of a frontier model. Subtle changes in prompts can cause different diagnosis[1]

[1] https://www.nature.com/articles/s41591-026-04501-8

RA_Fisher• 24 days ago

So Opus might be correct?

backtoyoujim• 24 days ago

Does radiology really make +$700,000.00 a year ?

Someone on reddit claiming to be a radiologist claimed that.

I wonder where the savings will go when those jobs are gone.

the_real_cher• 24 days ago

To the consumer! Haha just kidding. We all know where they'll go.

Eji1700• 24 days ago

Does radiology really make +$700,000.00 a year ?

The radiologist I know does not, but they are paid very well (and these numbers are always dumb when you're not sure if they're living in Manhattan vs literally anywhere in Kentucky)

Like most medicine, a large % of the job could be done by any decently talented person willing to follow instructions and shadow for a few months.

Like most medicine, the remaining % is what you're paying for, because it is literally life and death and you can't do things like "pull the logs" or "lets turn it off and take it apart" or "huh i need to put this down and come back later". Even in radiology, because "well lets just do it again to be sure" is often not a viable option.

While there is a problem in how we have inflated the cost of education for medical fields, the insane health insurance issues (US obviously, but it does have some effect globally when the expert radiologist you hire from the US to help with research costs that much), and probably some better ways to approach splitting the work for the entire field, like most professions dealing in life or death, medicine likely will always be paid well.

blanched• 24 days ago

You know the radiologist you're responding to is a real person? Your last line seems needlessly callous.

sarchertech3• 24 days ago

Physicians salaries account for about 8% of healthcare costs in the US.

recursive• 24 days ago

The savings go straight into patients' worse outcomes.

rylando2• 24 days ago

As a rad tech, YOU TELL ‘EM DOC! I do like some uses of AI I’ve seen that help patients advocate for themselves or understand basic things like blood panel numbers, but it’s really bad at glazing people and leading them down medical rabbit holes kind of like the OP.

You would think that the AI would point out that calcium is best demonstrated on Radiographs/CT imaging vs Ultrasound or something to that effect.

garciasn• 24 days ago

Semi-related: my father has complications from a motorcycle accident ~25y ago that crushed arteries in his leg coupled with diabetes (insulin / kept sugar at ~100 and his A1C was kept under 6.7 for ~15y). 6w ago had to have his toes removed due to dry gangrene; they eventually (2.5w ago) had to remove his leg below the knee because of the severe blood flow issues below the knee.

Between the toes and the below the knee amputation, there were no less than 15 different doctors and PAs / related personnel who COULD NOT COME TO A CONSENSUS. They would just tell my mother and I (PoA) the details; they refused to come up with a singular plan of action moving forward, leaving it up to us to make 'an informed decision,' something that's IMPOSSIBLE when you have to take up to 15 different opinions into consideration.

What exactly are we supposed to do as patients/family members when medical personnel cannot give reasonable paths forward and instead just throw a bunch of shit over the fence at you and tell you, "you decide what to do from here," regardless of how many VERY DIRECT conversations I had w/the 'care team' on doing better to provide a limited array of options and reasons/likelihood of 'positive outcomes'.

I'm used to dealing with a wide variety of stakeholders/SMEs in decision-making; it's my job to apply my extensive industry experience to present our clients with their options, ranked and reasoned. Doctors, in my experience and most recently with my father, clearly do NOT do that (I assume due to liability; but, no real idea, honestly). So; when dealing with LIFE CHANGING circumstances, what are we supposed to do except rely on what might be able to offer more analysis and option narrowing w/AI?

I certainly don't want to make the job of medical staff more difficult by putting out crazy theories I found on the interwebbernets through my own research, etc; but, when we're having to deal with uncertainty and insanity, what else can we do?

Eufrat4• 24 days ago

I feel like the promise of these models is to help people make more informed decisions. Improving the knowledge economy and general understanding.

The problem is these are just statistical models at the end of the day, so you need to know something to be able to identify the errors. You can’t let them really be autonomous and you also can’t really have people turn into glorified approvers. If the machine is correct 89% of the time, you cannot make people responsible for that 11%. It’ll just cause automation fatigue.

tl;dr: the actual use cases of these LLM (or generative AI in general) is rather limited, so it is offensive how much hay has been given to them eating the entire capitalist system. They are not fit for purpose.

mring33621• 24 days ago

i'm sorry, but AIs only "know" about stuff that they have been trained on.

If we would allow AIs to be trained on the petabytes of medical data hidden in hospital systems, they would most likely be much better at diagnosing illnesses and conditions than the average doctor.

(Justifiable) Privacy around medical records so far prevents this.

You think you're cheering for humans, but in fact you are gatekeeping healthcare.

Fr0styMatt884• 24 days ago

Your see this in coding agents too. The only times so far I’ve really seen Opus tie itself into a knot is where I’ve asked it to fix something that I thought was broken but actually wasn’t in the way I had described. It will bias towards your description (I’m guessing because that’s the most recent context it has?).

haldujai2• 24 days ago

Radiologist who does read shoulder MRI would like to add that over half the annotations are wrong, glaring mistakes in anatomy and cardinal direction which begs the question of how is it making these findings without knowing what it’s looking at (here’s a hint, it’s hallucinated based on reports it sees).

red75prime3• 24 days ago

What is "it"? Claude Opus 4.x? ChatGPT-5.x? GLM? DeepSeek? RadFM? Med-PaLM?

odiroot2• 24 days ago

Can vouch for it. Ultrasound hasn't found calcification in my shoulder but MRI did. Exactly as you said, because it was very small.

ricardobayes4• 24 days ago

That might be doctors new nightmare: people who second guess everything with AI. Previously it was "google your symptoms".

ilovecake1984• 24 days ago

Indeed. I don’t even get what OP thinks they are getting out of this other than doubt.

weatherlite7• 24 days ago

Nightmare because they're always right and the A.I second guessing is always wrong, or because they just don't like to be second guessed?

vimda• 24 days ago

Nightmare because users approach LLMs with the false confidence that they're always right, and present LLM outputs as fact to Doctors who have to waste time explaining that it's wrong most of the time. It hurts more than it helps.

drw853• 24 days ago

Nightmare because the AI is just generating a random text that fits the question.

mixologic• 24 days ago

Its a nightmare because it erodes trust. Doctors are not "always right" which is why "always get a second opinion" is codified in culture.

But AI's problem is that its completely full of shit, sometimes, and the people most qualified to evaluate whether its full of shit are the doctors, not the patients, but just like OP's original article, patients are left feeling like their second opinion from AI might be more trustworthy than their doctors opinion.

tuvix• 24 days ago

There’s more than two options here. It was already difficult to deal with self diagnosis for doctors, now we have a machine that outputs recommendations, and does it with confidence whether it’s correct or not.

The same issues that were present with search-engine self diagnosis are still present with LLMs. If you provide Google with an incomplete list of symptoms and can’t interpret the information you find correctly, you will likely get an incorrect diagnosis. The same is true for LLM output.

b800h4• 24 days ago

Well it was a nightmare for my mother's do-nothing GP surgery in the UK. She had several conditions which were being handled completely separately without central coordination, and her health was in serious decline. We went in with a list of 20 AI-generated questions based on her conditions and treatment (which I was able to screen as I have a bio postgrad, but not medical training), including those related to NICE guidelines and procedure, and, frankly the GP bricked it and ordered a load of new interventions. My mother started to get proper treatment.

I wouldn't trust AI to make a diagnosis, but I would absolutely trust it to notice where procedure hasn't been correctly followed, where a treatment is counter-indicated because someone has missed a line on a health record, or where there's a clear potential alternate diagnosis which has been missed for spurious reasons. Also, unfortunately, where doctors aren't doing a decent job - often because they're overworked or underfunded.

SeriousM• 24 days ago

And say it's true because the AI said so.

mettamage6• 24 days ago

Well I live in the nightmare that is the Dutch healthcare system [1]. There are many things that they will fix but they didn’t fix my sleep. A friend fixed my sleep. He is a doctor and prescribed me the right thing. The thing is, he shouldn’t have had to intervene. Without him I could have ended up poor and destitute as my sleep was wrecking me.

And yea, I already did all the standard things. CBT for insomnia helped somewhat. My insurance didn’t fully cover it either, unless I was willing to wait for 8 to 12 months.

And I recently met someone with slow moving metastatic cancer. Thanks to LLMs they will most likely live another 3 to 5 years extra since the Dutch conventional mainline treatment hasn’t been taken yet. But it is German doctors that helped them and Belgian doctors that pointed out in a second opinion that a lot more can be done.

LLMs have a part to play. The false positives are awful, but I have seen an average of 5 out of 10 care when things become too complicated.

Except for trauma treatment. The Dutch healthcare system is amazing once they diagnose classic PTSD.

So it’s definitely not all bad but the trust I had when I was younger has been eroded quite a bit and LLMs can meaningfully step in, in my case at least.

[1] I know there are worse systems. But from what I have heard there are clearly better systems nowadays. It has slipped a lot

simianwords6• 24 days ago

Hey what did you do to fix your sleep? Help us all and maybe an llm will index your diagnosis (hi ChatGPT)

nosioptar• 24 days ago

I asked a clanker about symptoms I was having. (I'm not an idiot, I was already on my way to hospital, clanker was just to take my mind off symptoms during the drive.)

The clanker said I'd be fine, I just needed some rest and OTC meds.

The medical staff immediately turfed me to surgery because the same set of symptoms I told the clanker were enough to concern them that I needed emergency surgery.

Had I have listened to the clanker, I'd be dead because I did need emergency surgery. (Hell, I almost kicked the bucket because I waited for someone to wake up to give me a lift because.my insurance probably doesnt cover an ambulance ride.)

throw310822• 24 days ago

Very curious what made you run to the emergency first thing in the morning that an LLM understood as "just normal, take some OTC meds and wait".

consp• 24 days ago

It can be helpful in your understanding the choices made by asking questions and thus in reassurance, but it requires something most people lack: understanding you are likely wrong since you are just collecting information without understanding it.

Pretty much the like most manager these days, so I understand the frustration of the GPs.

gruntled-worker• 24 days ago

This is obviously going to happen. But sub-par and sloppy doctors are a thing too. Medicine has been using semi-intelligent systems for years that were nevertheless found to improve outcomes.

We need studies that quantify error rates from each source type, then we need to account for the fact that the artificial type will keep improving.

js2• 24 days ago

The NYT did this profile a while back: "Ben Riley was already writing about the risks of chatbots when his dad started trusting A.I. over his doctor."

The dad was a retired neuroscientist who delayed cancer treatment against medical advice because he was certain he had been misdiagnosed based on his own research that he did with the help of A.I.

https://www.nytimes.com/2026/04/13/well/ai-chatbots-cancer.h...

There's a comment on the article from Ben Riley:

I am very grateful to Teddy Rosenbluth for sharing my father's story with the world, her kindness and curiousity proved to be restorative in ways I didn't anticipate.
The two words that everyone used to describe my dad: "intelligent" and "kind," and he was indeed both of those things. The sad irony here is that it was his human intelligence, combined with these strange new tools that purport to be a form of 'artificial' intelligence, that led to his ill-advised decision to forego the treatment he needed for his CLL. A doctor has already commented on this story with the observation that AI "confidently asserts erroneous conclusions," and we simply have no idea how often this is happening or the magnitude of the harm that results.
Not a day goes by that I don't feel the pang of my father's absence. He might still be here if not for AI. I try not to think about that, but sometimes I can't help myself.

ieie3366• 24 days ago

GPT-4o, which is what that article is most likely about, was an older low param count slop model which was known for abusing emojis and sycophancy. It does not really have any relevance to latest claude frontier models.

Your comment is akin to saying "Karen from facebook who is a human pushed essential oils and ivermectin as a cure to cancer. Now doctor Y is suggesting chemo. Both are humans, humans cannot be trusted!"

rvnx5• 24 days ago

The context is very important: decades of a poorly-diagnosed chronic illness had left him deeply distrustful of the medical system.

This is the real root issue.

At 75 years old, he was stubborn. Is that reasonable ? Yes, perfectly. Could he have been right since the beginning ? Certainly. Did he deny evidence ? Yes.

Zero doubt that he was intelligent, everything points toward that direction, but that doesn't make a person less stubborn, because accepting the evidence, is also accepting that you were wrong if you initially postured yourself as adversarial instead of cooperative.

He would have read Wikipedia, scientific papers, etc, even without AI.

He did not want to be convinced. It works both ways:

https://www.foxnews.com/health/woman-says-chatgpt-saved-her-...

https://www.today.com/health/mom-chatgpt-diagnosis-pain-rcna...

Nonetheless, someone very smart, just didn't want to move from his position.

bensonperry• 24 days ago

i mean, other smart people have famously delayed cancer treatment without needing poor guidance from LLMs! that's not at all new or unique to LLM chatbots

rvnx5• 24 days ago

No, this flow is actually very good.

Like any domain, when you have questions or need a solution, you make research first, then you ask a specialist.

If you explain well the symptoms and context you can have proper advices and then decide on the path next:

    Case A) It looks benign and advices / information that you collected seem reasonable, then you go your way.

    Case B) You need second opinion of a specialist because the subject is too complex, or there are medications that you need approval.

Once you have challenged LLMs, and read about the topics over and over then you genuinely become really good at understanding it (especially if you triangulate over LLMs and ask them to challenge, you start to have genuine questions). No matter if the answer is right or wrong, you have elements. Maybe you missed the point, but you come prepared.

At home you have the time to assess the options, pros and cons of each approaches, the possible questions to ask and then challenge the doctor.

Shared decision-making is an actual evidence-based model of care, and patients who arrive understanding their condition and carrying specific questions tend to get better attention and better outcomes.

Some doctors get annoyed, because they have big ego and choose to be patronizing, but it is exactly their job to answer such questions.

    With LLMs, it's quite good, you get nuanced and rather useful answers.

    Before LLMs, no matter the topic you searched for, the answer was the same: "you have cancer / an [obviously deadly] rare disease"

The other problem, in many places:

    • The doctors are not affordable
    • They are too busy for you (< 15 minutes)
    • You may need to wait months to get an appointment
    • They are not good (country-side is an example, and sometimes even country-level)

+ you can have all of these factors together.

So, you have something deeply bothering you, your only appointment is in 4 months. It would be insane not to take the time to explore different solutions and not to come informed about the topic.

If you express your prompt properly and do not rely on imagery, you can absolutely have top-tier advices.

neonstatic2• 24 days ago

Agreed. This gets worse in cultures in which Doctors have no habit or haven't been trained that educating the patient is part of the job. Whenever I am back to my birth country, I specifically avoid doctors that are older than mid 30s, because they all have the same, terrible bed manner. They might be good at diagnosing and treating, but they never, ever explain anything, even when asked. Some even have "helpful pamphlets" to hand to the patient - anything to avoid explaining. It seems that in their view their job is not helping the patient, but completing a task - running a scan, performing a procedure, administering medicine etc. The human, that is subject of the task, is invisible.

bilsbie2• 24 days ago

It’s funny every profession deals with customers making their own guesses at diagnosis.

I told my mechanic the film flam is broken but he said it was the rim ram. He fixed it and we all went in with our lives.

But doctors insist on this God like status so it’s a “nightmare” when patients try to help themselves.

nicman232• 24 days ago

you are literally taking sleeping pills ..

__MatrixMan__• 24 days ago

I dunno man, it's one thing to have your car still be broken because you were wrong, it's a different thing poison yourself on the basis of having done your own research. The mechanic can laugh at you, it hits a doctor differently.

gib444• 24 days ago

It's so much worse than some Google results: people see LLMs as a trusted friend who never talks back and never questions you, who is excellent at convincingly communicating their bs, reeling you in with "tell me more so I can really lock this down", continuing to fool you

A con artist, a fraud

raincole• 24 days ago

People should've googled their symptoms and especially the prescriptions they got. It has always been a good practice. If[0] AI proves to be the new google then people should ask AI too.

[0]: IF.

sarchertech3• 24 days ago

Do you know how many life threatening illnesses I’ve diagnosed myself with by googling symptoms?

w10-1• 24 days ago

It's not just the second-guessing. It's the getting in the ballpark but striking out: explaining in detail why they are not correct. A little bit of patient knowledge requires a tremendous amount of doctor time to explain away the ignorance.

It's a 180 for me: While I believe doctors should explain diagnosis or treatment decisions when asked, I don't believe they should be taxed with explaining away alternatives. In my anecdotal 2nd- and 3rd-hand experience, doing that is taking at least a third of their time (on roughly 5% of the patients who think demanding answers will make things better) -- with zero improvement to diagnostic accuracy or treatment effectiveness. Doctors already consult with other doctors, and it makes no sense for them to have to consult with ignorant patients or treat their AI psychosis on top of their disease. It doesn't increase patient autonomy any more than adding a steering wheel for child car seats would help toddlers learn to drive.

mindslight• 24 days ago

Explaining diagnosis and treatment recommendations decisions inherently involves explaining away the alternatives. In this world where patients are ultimately responsible for our own care, explaining your rationale is a straightforward part of the job - otherwise there is nothing for patients to base their decisions on apart from how the options make them feel. If visits haven't been allotted enough time to get the job done, then that is something you need to take up with health plan bureaucrats rather than taking it out on patients.

TSiege• 24 days ago

Always worth a share for this scenario. It's not clear if LLMs are capable of doing actual analysis on medical imaging. For details see this article https://futurism.com/artificial-intelligence/frontier-models...

As detailed in a new, yet-to-be-peer-reviewed paper, a team of researchers at Stanford University found that frontier AI models readily generated “detailed image descriptions and elaborate reasoning traces, including pathology-biased clinical findings, for images never provided.”
In other words, the AI models happily came up with answers to questions about a supposedly accompanying image — even if the researchers never even showed it an image.
As opposed to hallucinations, which involve AI models arbitrarily filling in the gaps within a logical framework, the team coined a new term for the phenomenon: “mirage reasoning.”
The effect “involves constructing a false epistemic frame, i.e., describing a multi-modal input never provided by the user and basing the rest of the conversation on that, therefore changing the context of the task at hand,” the researchers wrote in their paper.
The damning findings suggest AI models cheat by diving into the data they were given — and coming up with the rest based on probability, even if it’s almost entirely conjecture.

appplication2• 24 days ago

It makes a lot of sense if you understand how these models work but this was a cool read anyways and studies like this are impotent for curbing the unfortunate fever dream some folks seem to be collectively having about LLM omnipotence

tracerbulletx• 24 days ago

The absolute only thing that matters is if they are provided an image what's the success rate.

seanmcdirmid2• 24 days ago

I don’t understand how this is a different result than giving any LLM a task that is not completely grounded? I’ve observed this in coding tasks, if I forget to include a file referred to in the spec, the LLM will just hallucinate a version of it and my results suck. If I give it the file (and really, all the information I claimed it had access to), the task works fine. I fixed this in my pipeline with a prompt that does an extensive grounding analysis to determine if the assets I’m giving it are complete with respect to the spec (and that the spec is grounded as well, ie it doesn’t refer to something that is undefined).

I wonder if the above problem can be fixed similarly? Just ask the LLM to do a conservative grounding analysis before jumping to the main task?

pickleRick2432• 24 days ago

It's not different- there's a line of research and reasoning where people who don't use LLM's regularly point out issues that have been known (and more or less solved) for more than a year now (which is an eternity in the LLM space).

consensus12• 24 days ago

But why should I care? If you demonstrated that a model can perform more accurate diagnoses than a doctor, but also it had this strange behavior when no image was presented, why should that deter me from using the model?

swiftcoder3• 24 days ago

Because you don’t have any way of telling if it actually used the image presented, or based it’s conclusions on a different image it made up

kierangill• 24 days ago

I work at a telemedicine company. We’ve benchmarked a few frontier LLMs on public medical imaging datasets. One test included high-quality and high-consensus otoscopic images. We didn’t anticipate the models to do well on something so niche, but what concerned us was how poorly calibrated the models were.

I know you can’t trust an LLM’s self-assessed “confidence” of a prediction, but I’ve found that confidence can at least be directionally correct for some tasks. For our benchmarks, however, confidence was poorly correlated. What’s worse is that binary classification models (“Do you see $diagnosis in this photo?”) highly influenced the LLM to confidently predict $diagnosis.

I’m concerned for those using LLMs for diagnostics, and getting confidently led to the wrong conclusion.

nostrebored6• 24 days ago

But the binary classification models can be made ternary easily. RL on congruence plus penalty for misdiagnosis is easy to set up and gives great results.

What I’ve seen be the true bottleneck is people not setting up the structured data. But making a tiny reasoning model with OPSD -> GRPO is totally doable with a bit of money.

fabioz• 24 days ago

I wouldn't trust anything from Claude here image-wise (maybe to get a 2nd opinion on the report itself and treatment it's reasonable), but also, on the cases there is something something serious, go to at least 2 different doctors and if they have different opinions go for a 3rd for a decisive vote, besides doing your own research (it's not that uncommon for hard cases to be badly diagnosed).

rafterydj• 24 days ago

I feel like I'm going nuts.

There are other commenters saying this is a good practice they've also done for other injuries. You are saying you are an actual radiologist and immediately clock the problems with its advice.

I have seen this pattern over and over again. Anytime someone is an actual expert at anything, AI output appears insufficient or incomplete or outright misleading. It is only when you do not know what the AI is being asked to do is it likely you will find the output helpful.

This is itself alarming to me, but no one else seems to find this to be quite damning for the AI services being offered, preferring instanced to be wowed by the convenience and speed at which they can be delivered unreviewed and unproven information.

highfrequency• 24 days ago

Seems natural enough. There will always be complexity and nuance that is missed by an AI model or person - the world is just super detailed. The more expertise you have the more you will be aware of that nuance. That doesn't mean the model or person is not useful as a starting point.

sbarre• 24 days ago

Anytime someone is an actual expert at anything, AI output appears insufficient or incomplete or outright misleading

Yes, this is exactly so. AI is able to confidently sound plausible enough to convince laypersons or anyone who isn't very familiar with the subject matter, which is a big part of the mass-appeal "magic" of ChatGPT and other similar tools. It's like having a know-it-all friend (who also makes shit up to bridge their own knowledge gaps).

In many non-advanced non-specialized situations, AI is right enough to be at best useful or at worst not harmful (usually landing in the middle somewhere).

But speaking for myself, in areas where I consider myself quite proficient, I can very easily spot the subtle inconsistencies and naive conclusions that AI responses provide, and I have to guide/steer/correct it a lot to get good results when the subject matter is complex enough.

nlawalker• 24 days ago

no one else seems to find this to be quite damning for the AI services being offered, preferring instanced to be wowed by the convenience and speed at which they can be delivered unreviewed and unproven information

"Be wowed by the convenience and speed", or merely "take advantage of the mere availability"? What most people find to be damning about expert advice is that they simply can't get it anywhere, at any cost that they can afford.

whatever1• 24 days ago

So if you want to do a surgery but you don’t see any surgeons around you ask a grocery butcher to have his way?

newsclues• 24 days ago

LLM is not necessarily an expert system. Once there are expert systems for law, healthcare, accounting, governance…

https://en.wikipedia.org/wiki/Expert_system

microgpt8• 24 days ago

Didn't they try that in the 80s and 90s but discover the real world is too variable for that to work?

parineum• 24 days ago

I have seen this pattern over and over again. Anytime someone is an actual expert at anything, AI output appears insufficient or incomplete or outright misleading.

AI isn't even the first instance of this phenomenon, news articles are like this as well.

https://en.wiktionary.org/wiki/Gell-Mann_Amnesia_effect

appplication2• 24 days ago

This is the root of AI psychosis. There’s a lot of unpack here, and I won’t go too deep because you can’t really have a discussion with affected folks because their fundamental basis is not evidence, it’s belief.

It is weirdly religious in a way, because if you were to present contrary evidence (e.g. experts in a field weighing in about how plausible sounding responses are bunk), you would only be told you don’t believe enough in the long term potential and capabilities.

Don’t get me wrong, I think we all agree capabilities will eventually improve (and farther-future capabilities could reasonably surpass experts), but really is unclear if the current transformer architectures with their probabilistic/hallucinatory outputs will plateau before they surpass current experts abilities in all promised fields.

lazide9• 24 days ago

I don’t think they will improve, there is too much incentive to poison the datasets going forward.

A lot of the models up to this point have been benefitted - like Google did - from essentially ‘pre SEO’ internet.

Now the same tools are being used to generate nigh infinite good sounding bullshit, which poisons the dataset in all sorts of hard to detect ways.

To add insult to injury, the human experts are also not as. Naive, and have many incentives to poison their own input in subtle ways too.

sublinear• 24 days ago

Human expertise is also improving all the time and not limited to just connecting dots. When AI seems to surpass a particular human, it's just because the human lacks broader knowledge and fails to investigate further.

An expert already knows they don't know everything. That was never the point. Critical thinking cannot be delegated to AI any more than it can be delegated to a book. There is nothing new going on here.

cheschire• 24 days ago

I was a very early adopter in my circles with AI and I shared it with many people. Strangely, I seem to be the most skeptical about AI in my circles as well, but because I was the gateway for a many folks, they want to come back and share their experiences with me.

And it's so much like listening to someone in a church congregation sharing their experiences with god. Clear and obvious gaps are hand-waved away exactly how you're describing.

TomasBM• 24 days ago

Why is it psychosis and not lower standards?

While I can understand being skeptical of non-experts' claims that such answers are enough, I don't understand why you call it "psychosis" and not simply naivety or lack of expertise.

At the same time, the new so-called "models" haven't been pure transformer-based LLMs, but entire systems with tools (with access to the Internet), data storage, and the options to trigger additional instances for different tasks.

operatingthetan14• 24 days ago

This is the root of AI psychosis. There’s a lot of unpack here, and I won’t go too deep because you can’t really have a discussion with affected folks because their fundamental basis is not evidence, it’s belief. Treating it as if it is an intelligence is the problem.

The problem is that AI psychosis is fundamentally the belief that an LLM is "thinking" at all. Outputs are just believable word vomit which resembles factual information.

perching_aix4• 24 days ago

There’s a lot of unpack here, and I won’t go too deep because you can’t really have a discussion with affected folks

Do you think it is any more possible to have a proper discussion with someone who preemptively paints the other person as mentally ill? Or someone who preemptively victimizes themselves?

Cause I don't think these are the hallmarks of an honest discussion. See also the entire past decade of political discourse.

Like, consider this:

It is weirdly religious in a way, because if you were to present contrary evidence (e.g. experts in a field weighing in about how plausible sounding responses are bunk), you would only be told you don’t believe enough in the long term potential and capabilities.

A trivial counter to this is that you can just be an expert at something (e.g. your own work), use the damn thing yourself (professionally), and evaluate the outcomes for yourself. Then maybe remark "LLM good".

Now you come and remark "LLM bad", and point at random "evidence", either of outright other workloads, or even the one at hand: you're asking someone to reject the reality they've already experienced, entirely based on the assumption that they're "merely religious" or "in psychosis". You tell me if that's any more epistemically rigorous and sensible than their story.

hectdev3• 23 days ago

I _believe_ the term "AI Psychosis" is a "thought-terminating cliché" that readily puts you in a position to disarm any criticism to your point of view, which, if you're aware of it or not, it's a belief in and of itself. I'm more willing to bet your can't have discussions because you're trying to have debates.

But on your actual point, I don't think AI needs to "surpass current experts abilities in all promised fields" as a marker of its ability. The immediate gains has already shown some remarkable promise and more LLMs should have had safeguards around mental health up front. If I were to put it on a scale, I would say it is net positive long term with a strong negative spike up front which was somewhat preventable. But who knows, maybe is just have "AI Psychosis" and you can easily dismiss me.

sxg10• 24 days ago

I see your argument, but it's not exactly news that an expert found a flaw in a popular tool. You could say the same about Wikipedia--experts have tons of issues with it, but Wikipedia still provides value to non-experts. The most likely alternative to Wikipedia for non-experts is simply not trying to learn anything new.

Similarly with LLMs, you can't just write them off entirely because they sometimes provide misleading or incorrect advice. The positive utility maximizing view is to learn when you need to call in an expert. I recently moved in to a new house and have used Claude extensively to figure out basic things (e.g., adjusting the garage door height, how to mount a TV). However, when the HVAC suddenly stopped working, I gave Claude a shot for an hour and tried some non-destructive fixes, but then realized I had to call in an HVAC expert.

ohyes4• 24 days ago

The free alternative to Wikipedia is the library, not “don’t learn anything new ever”.

I find Claude is surprisingly similar to a confident but incorrect coworker, with the benefit that Claude will reevaluate when I correct it.

frereubu3• 24 days ago

Slightly OT Nitpick: in regard to experts and Wikipedia, when doing a neuroscience-adjacent MSc, experts in the field actually directed me to Wikipedia as an excellent source for high-level neuroanatomy, including recent research, so I'm not sure your blanket description about experts and Wikipedia is correct.

Applejinx• 24 days ago

You 100% can write them off entirely and go about your business as you previously had done. Ignoring the errors, it is very debatable whether there are even productivity gains beyond: human programmer or whatever is excited and cranked up to unsustainable degrees of activity and thinking to 'keep up' with what he thinks is an AI doing the work.

I'm seeing this fairly often and when it isn't garbage it's a capable person who has gotten inspired by their 'collaboration' in which the busywork is being done by a machine, but they're doing so much directing and correcting that it's not unlike what would happen if they got heavy into meth and went on a tear.

You absolutely can write them off entirely and decide for yourself what your comfort level of human-killing speed-freakism you want to pursue in your productivity. There's a long history of humans managing astonishing levels of productivity through self-destructive means. This is not even cheaper, once the 'first one's free' wears off: it's just a novel method of getting humans to burn themselves harder in the belief that they have a magic feather.

The ones who're really throwing themselves into the situation are the ones who'll burn out, but who aren't setting themselves up for atrophy and learned helplessness. Anyone who believes the technology lets them be a lazy manager just getting paid, is in for an unpleasant discovery.

kryogen1c• 24 days ago

On the flip side of this problem, novel best practices lag the medical standard of care, other human failures like corruption and competing priorities notwithstanding.

For example, we had to advocate for certain practices during the birth of our first child that became routine during our second several years later.

So, neither side is guaranteed correct, doctor or citizen researcher (which did not include LLMs in my case, for the record). The truest answer is also the most useless one, applicable to all fields: it depends.

The real question is: if you embrace being a layman, whom do you trust more: LLMs/the internet or experts, like doctors? I think the answer is pretty clearly experts.

beering• 24 days ago

TFA doesn’t actually state where the bit about shockwave therapy came from and it wasn’t the main point of the article. The concern was about being given useless therapies. The homeopathic analgesic is concerning, at least to me.

I.e. nothing this radiologist said was related to the LLM’s advice.

jstummbillig2• 24 days ago

No, not anytime someone is an actual expert at anything, AI output appears insufficient. That is why experts in various fields use AI.

Then to say "Aha, but all of that is AI psychosis" makes obviously no sense: Why would we trust experts when they offer critique but not when they say "this is helpful"?

Overall: People are not insane. AI makes mistakes and, often, fails completely. AI also helps them do things better, quicker, increasingly so. The jaggedness of AI is confusing and real.

torben-friis• 24 days ago

How many times have you seen an expert go "yeah these results are good consistently enough for a non expert to trust them without expert assistance"?

There is a huge difference between having a chance of a good result, which can be useful for experts able to filter out the bullshit, and consistent success. I would generate code as a helper, I would never allow a guy from marketing to merge unreviewed AI code.

lazide9• 24 days ago

I’ve never seen an expert use AI in their field beyond the initial ‘oh interesting’ stage.

silisili• 24 days ago

This is natural and even logically expected. It's just Gell-Mann amnesia in action. The world has more people spouting on things than it has people knowledgeable in said things.

Apply that to the Internet at large, and realize where LLMs got their training. They're basically ConfidentlyIncorrect personified.

tomaskafka• 24 days ago

Yes. The PM’s “with AI I know enough to be dangerous, haha” means “I’m actually dangerous and I don’t realize”

meindnoch2• 24 days ago

We're past the point of Gell-Mann amnesia. This is full blown Gell-Mann psychosis.

suttontom• 24 days ago

Your instinct is correct, and in a lot of cases it's true. However, I've heard from enough doctors by now (a cardiologist, psychiatrist, and epidemiologist/former physician) that they use medical LLMs and find them extremely helpful, mostly as a way to either bring up knowledge they'd forgotten about or as a way to learn something new and then verify it. I'm extremely skeptical about LLMs in general and the connection to Gell-Mann Amnesia is apt, but I wouldn't necessarily write them off completely like that. There are experts using the models that find them genuinely helpful in their field.

GTP• 24 days ago

Probably this is the point, and it's a point that has been brought up a lot of times in the past, maybe less in recent times: you need to know the things you're applying an LLM to. In this way, you can keep the good outputs while having the expertise to discard the bad ones.

meowface• 24 days ago

I may be missing something, but I think it's unclear that the parent poster here is necessarily actually contradicting anything the AI said. It may depend on the exact information the OP wrote to Claude and GPT. The full transcripts would be needed. (Though there is definitely a separate point that a doctor would generally better know all the right questions to ask, while current LLMs may be making certain assumptions.)

The LLM may have, from its "perspective", implicitly thought the OP was telling it that he had strong reason to believe there was no calcification and was not considering the bigger picture of possibly receiving an incomplete/poor assessment from the medical staff. In fact, the issue here may be the LLM overly trusting doctors vs. trusting its own expertise.

je42• 24 days ago

The question is how far is AI off compared to the professional that we have access to. World best experts are not accessible to most of us. :(

qnleigh• 24 days ago

Totally agree. I'm a scientist, and like most scientists I have some specialized skills that most of my colleages don't. AI has empowered them to learn and build things that they might have otherwise needed me for. But there have been quite a few cases where it led them very far down a wrong path. This has started happening way more often in the last few months.*

We've known since the beginning that AIs confidently say incorrect things. But now that they can speak confidently about very complex topics, and mostly say correct things, we are letting our guard down and lots of subtle falsehoods are slipping through.

*In one case, I was able to put things back on track because the AI suggested my colleague talk to me; somehow it figured out we were co-workers.

bitlad• 24 days ago

very far down the wrong path.

Absolutely agree. Have seen this first hand

aspenmartin12• 24 days ago

Right but hallucination rates have been consistently decreasing every model iteration. It's about error rates. As also a fellow scientist, I also will mess something up. Humans have an error rate. Once that error rate is low enough, it doesn't matter that it's > 0, it matters that it's low enough to be trustworthy and useful. Coding agents of 2024-25 had error rates too large; you couldn't meaningfully vibe code anything and needed a ton of oversight. It's still true but FAR less so, and this is after like a year of iteration.

grayhatter2• 24 days ago

This is itself alarming to me, but no one else seems to find this to be quite damning for the AI services being offered, preferring instanced to be wowed by the convenience and speed at which they can be delivered unreviewed and unproven information.

Welcome to the club? This new awareness you've found over the true quality of LLM based GenAI output has been what "all the haters" have been mad about for-ever. That the output of LLMs are clearly defective, and merely have found a cute trick towards making humans think they're less defective than they are actually measured to be.

And the corresponding anger and frustration to push the risks of genai output out onto others, while also aggressively pushing it as a feature you should be using already. You're behind don't you know, and whatever other lie I have to tell to trick you into enough FOMO to pay me 200USD/mo so I can sell FOSS back to you.

An LLM can only output the mean next likely token, and then add a bunch of extra noise on top of that so it feels interesting and not repetitive. None of this is new, the problem is, 50% of humans are below the mean, but have no idea. So when an LLM tells them some lie: well, it sounds so helpful! It's impossible for someone who sounds this helpful to lie to me, liars never sound confident! It must be PERFECT! I'm gonna tell everyone how perfect it is. so the bottom 0-33% think LLMs are fantastic tools that make nearly 0 mistakes in comparison to the bottom 33%. 33-66%-ish aren't sure, some times it's great, but it will make that random mistake sometimes, but I can catch most (or all of them depending on ego). and the 66%+ are angry about how many people are getting tricked by something so obviously low quality, or are lucky enough to not have to care.

orangecat• 24 days ago

An LLM can only output the mean next likely token, and then add a bunch of extra noise on top of that so it feels interesting and not repetitive.

So when an LLM was asked to analyze the unit distance conjecture, it just spat out a bunch of average-or-random tokens that coincidentally happened to correspond to a valid proof that had eluded humans for decades?

Hikikomori• 24 days ago

It's like reading news articles. Seems reasonable until you read an article about something you know, then you see how wrong they can be.

mattgreenrocks• 24 days ago

You're not. This site was also bullish on using LLMs as therapists, which defeats the very point of them, and reflects a lack of knowledge on what exactly therapists do for people.

More on topic: if the article's author arrived at a definitively negative result would this have shown up on HN?

rapatel0• 24 days ago

You shouldn’t expect frontier models to work on medical imaging. There is much more that goes into building a medical imaging product. First and foremost is data. Medical imaging datasets are not prevalent one the public internet at the scale necessary to have good performance on medical imaging tasks especially MRI. Also the labels are super noisy.

This is completely different than asking for general medical reasoning which is more derived from papers, public standards and textbooks.

Text exists at the right scale but images don’t.

pwg• 24 days ago

Anytime someone is an actual expert at anything, AI output appears insufficient or incomplete or outright misleading.

The term for when the press "gets it wrong" is Gell-Mann Amnesia (https://en.wiktionary.org/wiki/Gell-Mann_Amnesia_effect).

In that case, when you have personal knowledge of the facts, or know the specific domain area, you can see where the reporter mixed things up.

AI is no different, it's just a bunch of matrix math substituting for "the reporter" regurgitating what it was previously told. So the Gell-Mann Amnesia effect would apply just the same. If you have domain knowledge, you immediately see where the AI got it wrong. When you do not have domain knowledge, you have less chance of seeing where the AI was wrong.

Aurornis4• 24 days ago

I have seen this pattern over and over again. Anytime someone is an actual expert at anything, AI output appears insufficient or incomplete or outright misleading. It is only when you do not know what the AI is being asked to do is it likely you will find the output helpful.

I always recommend people try asking LLMs a lot of questions on something they know first. Programmers should start by asking LLMs to work on a codebase they’re familiar with first.

You’re overstating the problem, though. Even for an expert the LLM will get a lot of things right and can be helpful under a watchful eye.

The real problem is knowing how to identify when it’s on the right track and when you need to correct it, because both cases are presented with the same tone and confidence.

An expert can better identify when the LLM output doesn’t sound plausible. Someone unfamiliar with the topic will think everything it says looks correct.

jefffoster• 24 days ago

AI is an expert in everything you are not.

sevenzero• 24 days ago

AI output appears insufficient or incomplete or outright misleading

It has been like this since the rise of "AI". The only people enthusiastic about it are usually the ones hoping to make a profit in one way or another.

stringfood• 24 days ago

what is happening is that the gap between what the experts and AI know is getting smaller each year. this year sure radiologists are mocking AI's ability to interpret MRI results, but they are a lot better at that this year than last. In five years perhaps radiologists will truly appreciate AI, but I am not holding my breath because radiologists are notoriously slow to adapt to changes in medical science compared to other specialists like anesthesiologists or surgeons

jrockway• 24 days ago

I came here to post this as my experience. AI is magical when I apply it to something I know nothing about. It far exceeds my expectations every single time. I know nothing, but here is a report with animated graphics explaining exactly what I asked it to explain!

In fields where I'm an expert... it makes a lot of silly mistakes that are annoying and I feel like they would just cascade if I didn't correct them early. (I still think it's a net win, but... I watch it and it watches me, and we both do better work. I'd even apply the "magical" adjective when it does stuff I hate but know how to do, like edit Helm charts. What would normally be 20 minutes of me griping about YAML indentation is just a correct diff in seconds. I'll take it!)

So with that in mind, I tend to distrust output that I can't verify. If a doctor was recommending surgery and I thought the plan was too aggressive, I'd get a second opinion. I don't expect Claude Code to have much medical diagnostic ability, as that is really not what the model is trained for, and I know how it performs on work that it's trained and fine-tuned for. That is not to say the output is wrong and that it can't have diagnostic value, just that I personally wouldn't feel safe trusting it. Wrap up the same model with fine-tuning in the domain and a harness that reminds Claude to do a lot of sanity checks, perhaps with a human in the loop to guide it back onto the rails when it gets hyperfixated on something that doesn't matter? That could very much be a useful AI product.

aerodexis• 23 days ago

I am personally very excited by the development of a medical AI-harness that would

1. operates against a well-defined DB of medical studies

2. intakes my basic demographics, vital signs and medical history

3. quantify uncertainty wrt a specific diagnostic (it's own or one received by a healthcare professional)

4. specify medical tests that can be executed, and how they can be obtained

5. provide scripts for interacting with healthcare professionals/functionaries

I would imagine that the thing would need distinct operating modes:

1. A diagnosis generator

2. A diagnosis evaluator/critiquer

3. A patient educator

scosman• 24 days ago

I dunno. I know a lot of software engineering experts. AI isn't always right, but neither are the people, and it's getting better and better.

Software is one domain where it excels because of structured training data and simulation environments, so I'm well aware it's better here than other areas.

Still there's somewhere balanced between saying every time it's "insufficient or incomplete or outright misleading" and "just trust AI". AI's a useful source of information/reasoning/research, but know you need to validate it's answers for important decisions.

gofreddygo• 24 days ago

This is true in broader contexts too. Bunch of experts can't agree on something fundamental which is hard to prove/ disprove, and they have strong opinions on the topic.

AI is much worse.

stymaar• 24 days ago

I have seen this pattern over and over again. Anytime someone is an actual expert at anything, AI output appears insufficient or incomplete or outright misleading

AI assistant are industrializing the Gell-Mann amnesia effect.

serf• 24 days ago

I have seen this pattern over and over again. Anytime someone is an actual expert at anything, AI output appears insufficient or incomplete or outright misleading

media is awash at the moment with experts chiming in to support AI, saying their fields are being revolutionized, etc.

it seems unsurprising to me that the laymen opinion would follow the loudest media trumpets.

xivzgrev• 24 days ago

Well that's part of the problem. AI is not accountable - if you take its advice and hurt yourself, who is responsible?

A real doctor is accountable.

They might both "know" a lot of things but implicitly the party who is accountable is going to be more trustworthy.

And I don't see that going away until AI companies must be licensed for application x and can lose their license / be sued if engaging in malpractice.

david-gpu2• 24 days ago

Last week I went to a highly-specialized tertiary clinic about further treatment for a rare medical condition that I was diagnosed and treated for as a child. The two very specialized doctors I met there confirmed a diagnostic mistake that a specialist had made ten years ago. The only reason I pursued a second opinion, ten years later, was because Google Gemini had explained to me that the specialist ten years ago had performed the wrong type of test for my condition.

Do these LLMs make mistakes? They sure do, I see it all the time. But they can also help people make breakthroughs.

And this isn't the only time that Gemini has helped me diagnose long-term health issues, either.

I am not advocating to trust anything they say blindly, but they can be a great place to form new hypotheses and learn the right terms to look for when you are unfamiliar with a subject.

wasabi991011• 24 days ago

Can you elaborate on how you use Gemini to diagnose long term health issues? Considering doing the same for myself, but I have no idea what is too much vs too little information, and generally the type of prompt engineering to do.

baxtr• 24 days ago

This is a serious issue for young people I think.

I have seen outputs that look good but the actual content is bad. If you’re inexperienced in a field you can’t see it because AI makes anything look right.

I have gotten very good results with AI but you can’t take the first answer at face value. You need to be suspicious and challenging until you tweak out the right answer over time.

dang• 24 days ago

(We detached this subthread from https://news.ycombinator.com/item?id=48709121.)

intoXbox• 24 days ago

Radiologists very often have to weigh up different theories, guidelines based on the symptoms. The certainty of their diagnosis is their added value, or if they don’t know they will tell you why.

An AI telling you it could be X or Y because theory ABC… is the academic answer and a luxury clinicians don’t have. AI doesn’t give you what you want. I don’t see any added value in using generic AI models for this

neilv• 24 days ago

This could be a starting point for consulting a different human expert for a second opinion (e.g., specific questions to ask about), but I wouldn't put much trust in Claude alone on this.

IME, on an almost daily basis, claude.ai and Claude Code are confidently wrong about something, and use polished language to assert nonsense.[*]

If it's doing that on something easy, like factual knowledge available in text on the Internet, or programming code that can be inspected easily and follows well-known rules, and I can tell, because I understand those things... then there's no way I'm going to assume that Claude doesn't also BS when it comes to someone else's field. Especially not a field that requires some of the smartest people to go a decade of training, just to get started in the field.

[*] And if I confront Claude with its mistakes, eventually it apologizes, and acts as if it's learned something, again mimicking word patterns it's heard real people use and mean, without meaning any of it. I wonder whether the AI user experience would be better, if LLM-ish interfaces weren't implicitly created in the image of fake-it-till-you-make-it overconfident performative sociopathic techbros.

jeswin• 24 days ago

I would not trust AI on images. But I once had ChatGPT tell me that an MRI report was very likely to be incorrect based on the text, and offered a different diagnosis. Since it was semi insisting, I visited another doctor who made me do a retest. Long story short, ChatGPT was correct.

Again, this is just one single person's experience. So not worth much.

nostrebored6• 24 days ago

I think that much of the visual gap is because what to attend to in images is less structured. Anecdotally small qwen finetunes (ie less than 10B) take task accuracy from sub 30% on FMs to 90%. We have sold some of these for outcome based back office tasks.

I think we’ll see a lot of specialized VLMs that provide real value.

energy123• 24 days ago

Anecdote but I gave Gemini Pro an image of an individual with Herpes Zoster which the doctor said was something else. Gemini gave the correct diagnosis which allowed for correct treatment and cure.

I don't understand why doctors don't prompt LLMs before saying wrong things. Is it ego?

I can understand for radiology because you need a specialized convolutional network, but for more knowledge based things...

alwa• 24 days ago

“A man with a watch knows the time; a man with two watches is never sure.”

I imagine reasons for what you’re asking might include:

* Prompting an LLM is work, and they’re already overworked just doctoring—every conversation with a computer is a conversation you’re not having with a patient;

* They’re probably right more often than they’re wrong;

* “When you hear hooves, think horses, not zebras”: the 15th case today of strep throat is probably strep throat, regardless of today’s 15th falsely-confident LLM weighing-up;

* They tend to have spent many many years honing a clinical intuition that makes an examination, to some degree, hard to articulate fully to the LLM;

* Liability/overdiagnosis: All this stuff is probabilistic. Inevitably, there’s going to be a time when the LLM throws out something I thought unlikely that turns out to be right, and there will be other times when it’s wrong but now I have to document why. How many false leads do I need to chase per one true differential? Does this really compare favorably to seeking a second opinion from another human doctor?

* Not everything needs to make it into the record. Once it’s in the LLM, it’s discoverable and litigable and hackable and permanent;

* Medicine is practiced in very different ways in different contexts—even in this thread, one radiologist routinely orders ultrasounds for soft tissue shoulder problems, and the other medical-world person replying has never heard of such a thing—presumably both within US health care contexts. Some doctors hand out antibiotics like candy, others are more cautious with respect to resistance. What’s right can depend on the time, the place, the clinical setting—more than just the immediate patient-level facts at hand, in ways that become awkward or unwise to express explicitly.

And of course… who’s to say they don’t do LLM-assisted research, in cases where they think it might be helpful?

fc417fc8022• 24 days ago

I don't understand why doctors don't prompt LLMs before saying wrong things. Is it ego?

Either that or laziness I'd imagine. This isn't limited to LLMs. Expert digital assistant systems that you query have existed for a long time. A good physician will double check anything even slightly unexpected against one.

senectus1• 24 days ago

mate the other day chatGPT (enterprise) told me that the kernel 7.0.2 was older than 6.69

you cant trust these toys at all. that doesn't make the useless, just untrustworthy.

HPsquared• 24 days ago

6.69 hasn't been released yet, to be fair.

ferfumarma• 23 days ago

This sounds fascinating. Can you provide any detail regarding the nature of the diagnosis or problem it identified?

mistic92• 24 days ago

I have used Gemini 3.1 Pro through CLI to analyze my DICOM images. It gave me the same diagnosis as radiologists. But it was just interesting test

simianwords6• 24 days ago

Everyone talking about how doctors know better or have some context that is not shown here.

But are you all forgetting that they literally injected a homeopathic drug on the author?

Between that and Claude sometimes hallucinating, it’s probably worth encouraging patients to take second opinion always.

sxg10• 24 days ago

But are you all forgetting that they literally injected a homeopathic drug on the author?

I'm no fan of pseudoscience either, but this is where things get blurry. The placebo effect is real even if patients are aware of it. If you give a patient a homeopathic drug while informing them of potential side effects (if any), and then they feel better, have you hurt them? Or have you helped them?

I personally have no interest in trying homeopathic medicines, but the reality is that many patients do take these and are adamant they help. As long as any risks are communicated and there are no serious side effects, it's difficult to make an argument against their use in patients who report a subjective benefit.

ashikns2• 24 days ago

This is relying on the patient being stupid. I would always prefer just an honest explanation of things rather than pseudo-science drugs. And if I do discover that it's a pseudo-science drug then I've lost all confidence in that doctor. Doctors should stop pretending that they have access to some divine knowledge and everyone else is stupid.

And this interpretation is charitable, assuming that they wanted the patient to feel better via placebo. A different (and more likely) interpretation being they just wanted to charge for something extra.

late2part• 24 days ago

If you have 2 clocks you have none.

mcapodici• 24 days ago

Or you have an interval?

jochem9• 24 days ago

Right now the article reads as "AI can play doctor if you give MRI scans".

If the author would actually go for a second opinion (maybe bring along the AI to let it explain it's findings), then the article could read as "AI did MRI analysis and proved my doctor wrong" (or: "AI did MRI analysis and failed").

VladVladikoff• 24 days ago

Hey OP my wife had a subscap tear and went through with surgery. Recovery was ROUGH, she couldn’t use that arm at all for almost two months. It’s amazing how much this can cripple a person, we don’t realize how much we use both our hands for our daily lives until one is gone. Even basic stuff like cooking, bathing, etc. If you can avoid surgery you should. Try doing the Buckburger 12 (spelling?) shoulder physiotherapy regiment. You’ll need to even if you get surgery, but this can help with tedonopathy. Also try to identify what is causing the repetitive stress and cut back on that activity.

busymom0• 24 days ago

I do powerlifting and couple years ago, I developed bicep tendinitis on my right arm. Even a tiny bit of weight on it while palm facing up would cause crazy pain. It was funny how I weight from lifting heavy weights to not even being able to carry a plate of food, not being able to press soap dispensers, or give a spot to someone at the gym.

Even a tiny injury can severely cripple us.

dwd2• 24 days ago

Same, sprained my wrist/forearm a while back and couldn't rotate it without pain or take any weight palm up. Couldn't even rotate a door knob.

It wasn't until I pushed through with weights, avoiding any underhand grips or rotation, that it started getting better. Doing bicep curls but keeping the thumb up strengthened the forearm to the point where I was back to the weights I was lifting and could then gradually add some rotation.

hennell• 24 days ago

Personally my favourite feature of the new ai world is not when I use it directly but it's when one of my managers uses it to try to fix a problem, then issue to me their findings and I have to defend my process to someone who understands neither my process, their suggested solution nor often the problem they're solving in the first place.

willsmith72• 24 days ago

True, but this was a problem long before AI (read this article, met this guy at a conference who told me x, my boss said blah)

AI probably exacerbates it but crappy managers exist regardless

nitwit005• 24 days ago

Before maybe you had to deal with someone hiring schetchy consultants once in a while, but now the managers have a limitless well of dubious answers to draw on at any time.

cube00• 24 days ago

It gets worse when they challenge your solutions by feeding it back into the LLM and sending the response on to you, arguing with an LLM is exhausting, arguing by proxy with a human parroting its responses is excruciating.

On the plus side when they do this they can't flood your calendar with those "quick chat" meetings because they know they won't be able to hold a conversation on the issue beyond the first minute.

lukeinator42• 24 days ago

This happened to me on a paper I submitted recently where it was clear the reviewers used AI. Revising a paper based on LLM review is also exhausting, haha.

NegativeK• 24 days ago

I've seen coworkers do this to each other when their expertise is in different domains.

I find that AI can be incredibly useful, but just text dumping its output into a conversation feels insulting.

duxup• 24 days ago

Sometimes I get a lot of "Do you want me to work up how the UI will look."

They give me what they'd like the UI to look like, but none of the actual content fits outside the one situation they're thinking of.

¯\_(ツ)_/¯

Thankfully where I work now everyone is good about taking no for an answer.

mystifyingpoi• 24 days ago

Fight fire with fire. It's over the top passive aggresive, but it works. Whenever I get a JIRA ticket that was clearly AI generated and is 10x too many words, I tell Claude to respond to that ticket with my actual real opinion or suggestion, but make it 10x more words.

eqvinox2• 24 days ago

My hope is that in a couple of model generations, we'll trust AI to review MRIs the way we trust it to proofread our emails.

https://www.nature.com/articles/d41586-026-01947-1

I've started asking my doctors whether they use AI, and if they say yes look for another one.

throwatdem12311• 24 days ago

I don’t even trust AI to proofread my emails.

rmbyrro2• 24 days ago

That study seems to be confounding factors and rushing to a questionable conclusion.

A very plausible explanation for the adenoma detection rate to have gone down is simply that its prevalence went down among the population in the second three-month period.

This was not a randomized trial. Concluding that "AI usage degrades physicians' skills" is questionable at the very least.

eqvinox2• 24 days ago

There's a whole bunch of other studies on this topic, as well as metastudies, and from what I can tell the problem is real.

https://www.sciencedirect.com/science/article/pii/S245195882... (+ cf. its references)

dazhbog• 24 days ago

You should always be getting a second or third opinion from real doctors for matters like surgeries, radiology, etc.

One doctor diagnosis + LLM is gonna throw you off. You need more datapoints.

ChrisMarshallNY2• 24 days ago

In the US, this is standard advice. I note that the OP is in Germany. Maybe they do things differently, there.

Aurornis4• 24 days ago

The OP describes getting injected with a homeopathic botanical formulation and receiving another type of therapy that wasn’t indicated for his condition.

I wonder if this person was going to a traditional doctor or if they were visiting some type of specialty clinic as a second opinion. For most conditions you can find specialty clinics that will prescribe and administer (and bill for) a lot of non-indicated treatments, but some patients like being in the care of doctors who take action and do things after being recommended more conservative treatments by primary doctors.

tsss• 24 days ago

In Germany we get zero-th opinion because you can't even get an appointment within the next 8 months.

lucfranken3• 24 days ago

Why wouldn’t you as a doctor by standard run the images through a certified compliant LLM? The actual cost won’t be it and then you can see if you get any new ideas from it. See if it’s just wrong or that it spotted a little detail you missed?

The LLM doesn’t need to be leading or whatever but then you can have a conversation with the patient. If their ChatGPT reports has differences it can be analyzed as well.

It feels like the time constraint of the 15m doctor sessions is the thing. But if prepared immediately after the scan then why not?

There is always time needed to factor in new developments and innovations and that’s fine. Just moving blindly work from human to LLM is wrong. But learning on and testing with all the ai tools incoming constantly won’t be a waste. There will be more and more tools in those processes outside of human judgement, better improve the workflows now to be able to test and plugin new models and systems when they are ready.

foobarian2• 24 days ago

I've been starting to think of LLM as a great tool for "lead generation," borrowing a term from sales. Most of the things it comes up with don't pan out, but in many cases it's things we wouldn't have thought of, or at least not as quickly. This is especially in the context of web service or SAAS outages.

KaiserPro• 24 days ago

standard run the images through a certified compliant LLM?

Because they don't exist, yet.

In the UK MRIs and other imaging systems need two opinions. there has been a move to allow the first opinion to be ML based.

The _problem_ is that you are basically doing grey smudge analysis, and thats fucking hard.

yread2• 24 days ago

Because they might bias you. And because you have your own brain, training and experience

lucfranken3• 24 days ago

That does make sense but the order of it might be: doctor analysis. Then show LLM as double check to doctor. Doctor assesses and may keep en improve the doctors first analysis?

mootothemax• 24 days ago

Can any LLM give you the rough pixel coordinates of an item it identifies in an image?

I found that while Claude, GPT etc could describe an image, there was no way to link the description back to specific pixels in the image itself. Not even to a bounding box or segment.

gs17• 24 days ago

Not as smart as modern frontier models, but Moondream and Molmo can do that sort of thing.

LogicFailsMe2• 24 days ago

I did the same exercise here with medical reports and CT scans for a friend's cancer diagnosis and I got ahead of the oncologists predicting they were about to be cured. Spoilers: yep, cancer free now.

And well, yes, I have the appropriate life science degrees to navigate clinical trial reports and research publications, and that was likely indispensable for steering Claude Code where it went, the radiologist's caution is merited here. But it's just not amateur hour for me to do this, it's 2 decades of academic research in my rearview mirror.

linsomniac6• 24 days ago

~2 years ago I used ChatGPT "deep research" to investigate a chronic sinus infection I'd been fighting for ~3 years. After seeing 3 GPs and 3 visits with an ENT, I fed all the observations I had into the AI. In particular, I couldn't get the ENT to explain why he visually saw, via a scope, evidence of allergic reaction in my sinuses, but then later concluded, after an allergy test, that it couldn't be treated via allergy medication. I asked this question a few times and he just never answered.

ChatGPT surfaced a NIH study that concluded that 20% of people have allergic reactions that are isolated to a body location, and that shoulder "skin prick" testing may not reveal. I asked him about that and he said "that's not how allergies work". Full stop. He was unwilling to even look at the study.

He prescribed a CPAP and regular nebulizer treatments. Side story: the CPAP place sent me a SMS message that I couldn't recognize was not a phishing attempt, and when I reached out to inquire who they were they never replied.

So I decided: Let me just try taking a second-gen allergy tablet every day and see what happens.

My sinus infections have gone away. Previously I was getting a major sinus infection at least quarterly. Maybe he's right that allergies don't work that way, but allergy tablets have absolutely solved my problem. Which I'm thankful for because I tried a CPAP for a solid month a few years ago and I just could not get used to it, and was sleeping like crap.

nostrebored6• 24 days ago

Daily allergy tablets are associated with huge increases in early onset Alzheimer’s. Glad you found something that works, but might be good to get some of the allergen injections :)

tnchr• 24 days ago

I believe it depends on which ones, the older gen or certain classes of antihistamines

cenamus• 24 days ago

Where are getting that from?

All I can find is about 1st gen antihistamines (i.e. Benadryl, which I doubt many people take daily, because of the drowsiness).

Even for those, evidence seems to be mixed at best. "Huge increases" seems like hyperbole.

darkwater3• 24 days ago

Wait, what?? Now I'm getting in panic mode because I do take regularly anti-hystaminic tablets/pills (the newer ones, based on ebastine because they don't make me feel sleepy)

meindnoch2• 24 days ago

Misinformation.

Only first-generation antihistamines with anticholinergic effects are associated with cognitive decline in elderly patients.

fuomag92• 24 days ago

Only first gen, 2nd gen does not have this issue anymore or it’s greatly reduced

linsomniac6• 24 days ago

That seems to be only for first generation, drowsy-making, tablets. Second gen formulas don't cross over the blood/brain barrier.

https://www.myalzteam.com/resources/zyrtec-and-alzheimers-me...

There IS one year-old finding that suddenly stopping Zyrtec after daily 3-month use may lead to nasty itching, and if that happens you can re-start and then taper off. https://www.fda.gov/drugs/drug-safety-communications/fda-req...

braiamp2• 24 days ago

Ok, there's a lot to unpack here and you really had the deck stacked against you. First, lets go from the top, once a test says X, disproving that X is really hard. And that's not unique to the medical profession, it's inherent to all humans and we suck at revisiting or revising our decisions, much less at looking at the possibility to even reverse it.

Which moves us to the next two issues: liability and time. Any moment that you ask someone to revise a decision and specially with the stakes that the medical profession has that nobody has the time nor the inclination to open themselves for a mess.

Now, if you really want to be successful, you have to, before they even have a case with you, and specially before the diagnostic loop closes, to suggest the tests that the study has, since that has the biggest chances of looking at the right thing to look. Just be straight that you walked in with a theory. Doctors notice when they're being steered way faster than they notice when you're actually right. That's how you work with the systems that have a overworked mass trying their best.

linsomniac6• 24 days ago

before they even have a case with you

My problem is that I needed information from 2 ENT visits to feed into ChatGPT to get that study. On the first visit he scoped my sinuses and immediately said "I can see evidence of allergic reaction, see those white bumps?". On the second visit I got an allergy stick test and it came out negative.

Those helped lead to that NIH study. It would have been very hard to have walked in with that study in hand.

throwaway20374• 23 days ago

    > Let me just try taking a second-gen allergy tablet every day and see what happens.

Stupid question: Why did you wait three years before trying this tactic?

linsomniac6• 23 days ago

Not stupid. Because it wasn't on my radar that it was allergy related until the ENT mentioned allergies.

darepublic• 24 days ago

I would like if we could have a site where you submit your MRI then doctor commenters anonymously post their opinion. In general I want a forum where.. when people come with questions for which there are varying opinions we don't just have people leave their 2c and then jet. The thread persists, duplicated ideas get merged, erroneous statements get purged and gradually we refine shining truth

lostlogin7• 24 days ago

I’m wondering how many radiologist want to work all day, then come home and work.

Many can get paid fee-for-service for after hours work, so would probably prefer that.

agos• 23 days ago

there's plenty of doctors doing volunteer work, this would be just another medium to do it

terzioglubaris• 24 days ago

Hey, glad you did that , I have done the exact same think last week but the radiologist interpretation and claudes interpretation was pretty much the same ! you want my doctors number ? lol

nostrebored6• 24 days ago

I don’t understand the negative reactions. Medical care as it exists requires the doctor and patient to have their brains switched on. I’ve almost never had a problem where a doctor provides me with a diagnosis and I go about my day. Most of the times that I have, I’ve been confident about the problem and known what I needed. The doctor was a barrier to accessing care.

Dr. GPT is a good brainstorming tool. It helps synthesize information in a way that primary texts don’t. But it does force you to say “that doesn’t make sense”.

I do think that people saying “doctors don’t know the state of the art” have a weaker case. If you think about it in terms of token density during pretraining and how post training datasets are constructed, I think it would take us a very long time to adapt to any fundamental shifts. If we have forgotten how to cure scurvy, how many journal articles would it take before we adapt to a discovery?

StefanBatory3• 24 days ago

I do think that people saying “doctors don’t know the state of the art” have a weaker case.

This is kinda the case though. In Poland I met only one psychiatrist that knew about DSM-5. In this year. DSM-5 was a thing from 2013.

Doctors are people just as us, not every single of them is good.

bonesss• 24 days ago

Many DSM-5 diagnosis come into effect with the ICD-11, ICD-10 doesn't have a good deal of them, and that rollout is still fresh & ongoing.

It is kinda spooky, though, to have freshly minted doctors from a few years back whose school-knowledge will forever be "outdated and archaic" based on standards published before they were in school.

Some good advice I got: treat this as a generation shift, find younger and newer doctors who are familiar with the "modern" standards.

roryirvine• 24 days ago

Why would you expect a Polish psychiatrist to understand the differences between different versions of a diagnostic manual used only in the US?

nostrebored6• 23 days ago

Oh I agree with you, it's just that I don't think LLMs are either. If you think of LLM knowledge, especially in scientific/engineering fields, as a lossy representation of the density of ideas, then you'd expect to see some weird behavior. I'm sure there is some sort of a temporal discounting and people thinking about this, but a naive NLL or Reverse-KL on medical literature would engrain some weird, wrong ideas.

throwforfeds• 24 days ago

I've seen a lot of friends and family members almost immediately get offered surgery for shoulder pain. It's just often the default for people that do surgeries for a living.

I also had a pretty painful shoulder issue at one point, where the pain just wasn't subsiding for months. I tried massages and acupuncture as I didn't want to do surgery, but it wasn't helping at all. The thing that fixed it for me was just really focusing on doing pull-ups. I couldn't do them at all when I started, so I began with dead hangs and scapular pull-ups, eventually progressing to regular pull-ups, and then training with a "grease-the-groove" method once I could get a few per set. I stopped the training schedule once I was getting in around 17 pull-ups per set, and now just do 6 sets of about 7-8 pullups 3x per week spaced throughout the day. I'll also do some shoulder mobility drills [1].

Whenever I get lazy about keeping up with them inevitably discomfort will start arising again, but it goes away once I get back to strengthening.

[1] https://www.youtube.com/watch?v=vP8YmmRMz6I

alistairSH3• 24 days ago

On the flip side, when I had rotator cuff issues, the surgeon recommended months of physiotherapy before resorting to the knife. And it worked. And by weight training regularly with a focus on correct shoulder movement, the pain stays away.

It really seems like if you, as a patient, go looking for a quick fix, that’s what you’ll be offered. And if you educate yourself a bit and then go t for the best fix for you, you usually get they.

huhtenberg• 24 days ago

What did you have exactly?

With calcifications, physio without the shockwave component definitely doesn't allow going back to the normal gym routine. It's just not enough.

preg_match• 24 days ago

Physical therapy is very often under recommended in the US under the belief that insurance won’t cover it. They might. And, for anyone reading, you don’t even need a referral for the first 30 days in some states. Physical therapy is for more than just hip replacements and car accident trauma. Like regular therapy, a lot of “normal” people can benefit from it. It’s also not just stretching.

blitzar• 24 days ago

the surgeon recommended months of physiotherapy before resorting to the knife

In my limited experience, "If all you have is a hammer, everything looks like a nail", rings particularly true with medical professionals.

ktosobcy2• 24 days ago

I had issues with my shoulder for years. Tried PT as well as pull/push-ups but doing that made the pain worse (if I wasn't doing any exercises involving the shoulder it was "fine")…

dripdry452• 24 days ago

same here. I started doing yoga and rock climbing, and it stretched everything out, and strengthened all the muscles around it. I rarely have an issue now.

dguest• 24 days ago

Personally I've always appreciated talking to nurses I know.

The respectable ones know they aren't doctors, but they've seen a lot more recoveries and cases where minimal intervention was required. As some people have said some surgeons like to cut people up.

avgDev• 23 days ago

I have a story about this very issue.

I have hip impingement, I played sports and got a labral tear in one of my hips. My hip would get sore and painful after a lot of activity. I've seen a top surgeon in the US. After we just met, he looked at the MRI(yes there was a small labral tear there) and said he can have me on an operating table in 2 weeks.

I was shocked, because the recovery absolutely sucks. So, I got 2nd and 3rd opinion.

3rd opinion was a doc with 20+ years of experience. Asked me if I plan on going pro in any sports, I said no, he said the surgery is not worth it. I did some PT and barely have issues with that hip.

Then, Obama admin created a website to see what gifts($) physicians accept. The 1st surgeon had accepted six figures+ from stryker. The older doc? 0.

There is no money in PT for a surgeon. I would thread lightly with popular and young surgeons.

quacked2• 24 days ago

The thing that annoys me about AI discourse is that AI is a mathematical technique of rapidly increasing efficacy, and yet everyone personifies it. It would help if every time someone said "AI" they supplemented "a mathematical method where extensions onto a very large corpus of information are statistically simulated".

It's not true that "AI makes mistakes" or "ChatGPT is sycophantic". It's just that sometimes the simulated extensions to the training material are accurate, and sometimes they're not.

hawkice• 24 days ago

I think this draws too strong a line between the matrix-math core and the harness that uses it. Those harnesses undoubtedly were built with purpose and the systems fail to achieve that goal. Common usage says the the DMV can make mistakes, like any systems, despite the DMV itself not being a person (and it is common to allege large organizations make mistakes even when no specific individual is making an identifiable mistake). This isn't person-language it's systems/purpose-language.

quacked2• 24 days ago

I understand and somewhat agree with your point, and might have phrased my comment differently. I think my main point is that experts aren't always going to beat "a dynamically simulated extension onto the training material". Often they will, maybe even usually, but sometimes they won't, and I feel like the people in this thread insisting that the experts will always know better are thinking about a competition between experts and a crazy robot instead of a competition between experts and math.

Kapura• 24 days ago

I asked a bird about my father's potential prostate cancer. It gave extremely good advice.

rasmus16102• 24 days ago

As a radiologist I have found Claude and ChatGPT to be absolutely terrible at MRI and I would not trust it one bit. It has its merits if you need to research stuff that is more text based, but radiological images is just something that they cannot interpret good enough (yet)

lostlogin7• 24 days ago

AI makes up for its poor reporting by enhancing the images.

Current Siemens MR software ‘Deep Resolve’ makes up the signal (adding about 50%), then makes up every second pixel, and then, for 3D sequences, makes up every second slice. It’s locking about 59% of the time off each sequences. And it’s really really good. I’m an MR tech.

microgpt8• 24 days ago

Sorry? You use AI to hallucinate medical images and that's good?

rasmus16102• 24 days ago

but those are two different things. Of course something like Deep Resolve is great, as are modern model based reconstruction algorithms for CTs, but here we are talking about LLMs and their ability to interpret medical images, which has nothing to do with what you said.

throwawayffffas2• 24 days ago

Sure but claude and ChatGPT are not Siemens 'Deep resolve'.

pickleRick2432• 24 days ago

It's like people who expect ChatGPT to be really good at chess because chess engines with super-human performance have been around for decades, so obviously the latest frontier LLM that took billions to train should find the task trivial.

Actually, I'm curious what ChatGPT 5.5's ELO is- I wouldn't be too surprised if it's 2000+ just from its basic understanding of chess principles from all the content it has digested.

nicksergeant2• 24 days ago

Interestingly LLMs are extremely bad at chess position _images_. I have to imagine if you give it positions in text it'd be pretty great but when I was learning chess and pasting images of positions in for analysis I couldn't believe how wrong it was. I actually thought it was looking at the board in reverse but even when pointing out problems it seemed completely incapable of understanding what it was missing (of course... it doesn't really "understand" anything).

LLMs truly are marvels with text but anything spatial seems to really mess it up, somehow.

simonreiff• 24 days ago

ChatGPT is completely unplayable at chess on its own. It's unable to keep track of the state of the chess position and therefore will make an illegal move within about 10-12 moves. I would put GPT-5.5's rating at 400, since it can't even make legal moves reliably.

I've tried to pay chess with GPT-5.5, even played it again tonight, allowing it to use `python-chess` to keep track of the state of the position and to get a list of legal moves at each turn, so that it was fair. I also gave it blindfold odds, again to make it a fair fight, but it was not even close. GPT still isn't better than maybe 1000 Elo, maybe 1200 tops. Even with what amounts to being able to see the position and also being unable to make an illegal move, GPT-5.5 hangs material left and right, doesn't make a plan, and got smoked even when I gave it blindfold odds, to the point it's boring for me to play even under those conditions. I'm not sure it's better than whatever the GPT model was that was out about 8 months ago. I also thought it might be somewhat better than a beginner due to reading chess books, but no, it's complete garbage at playing chess, not even average-level skill.

AceJohnny2• 24 days ago

There's something incredibly peaceful about being in the hands of an expert you trust. [...] AI can absolutely shatter that feeling in an uncomfortable way [...] but I don't know if I can fully trust AI either.

This really is key. We know we can't trust the AI, but at the same time we're also more comfortable asking the AI for clarifications or confronting it. Not having a time-bound appointment or paying by the hour helps a lot. But even then, more information doesn't necessarily help!

I once brought my 11-year-old car, a Civic with 150k miles, to multiple garages. I figured I'd play the "second opinion" game to correlate what the garages recommended to decide on what needed to be done...

I got 3 completely unrelated recommendations, including one that I knew was invalid! I felt worse off than when I started!

The solution to uncertain information isn't more information, which the AI can certainly provide, it's better information, and AI cannot currently provide that.

010101010101• 24 days ago

The solution to uncertain information isn't more information, which the AI can certainly provide, it's better information, and AI cannot currently provide that.

I'd argue that AI _can_ currently provide that, but that it can't do it _reliably_, and that to non-experts it's impossible to differentiate, which makes it all the more dangerous.

margorczynski• 24 days ago

Isn't that the case with human "experts"? If you had encounters with doctors, mechanics, etc. you'll know you can get a completely different diagnosis for the same problem which obviously means (in most cases) that the person you thought an expert is wrong.

What is needed are studies that will take a cold look at the actual results because AI seems to be required to be perfect or it is useless. It just needs to be as good as a human for most stuff, but in the long run it will be much better. At least that what extrapolating current reality shows us.

ed_elliott_asc• 24 days ago

The soothing sound of ChatGPT telling us how right and clever we are…how could it possibly hallucinate, certainly not 5.5

nonethewiser2• 24 days ago

You’ve really honed in on the key issue. This is exactly how keen hackers news commenters approach this.

Aurornis4• 24 days ago

I have multiple LLM subscriptions at any given time, plus an array of local models.

When I ask a question outside of my domain of expertise I like to ask all of the LLMs I have access to. I also create separate sessions and ask the same question multiple ways.

It’s revealing to see how many different and contradictory answers I get, most of which are presented confidently.

The last time I ran a medical question through Claude I couldn’t even get consistent answers between sessions.

It’s also scary how easily you can lead each LLM to the answer you have in mind. When I would start asking questions about different options that other LLMs had presented, each session would drift toward that explanation.

Esophagus43• 24 days ago

Have you ever let the LLMs “discuss” with each other to see if that would give better answers?

You might end up with the answer from the most persuasive LLM, but you might also end up with better results.

Wonder if there is a paper out there on this.

marcus_holmes4• 24 days ago

In my day job we tried creating a credit assessor tool using LLM as the credit assessor.

It did great, generated a report on the assessed business that was incredibly detailed and plausible.

Then I started running tests and getting into the details, and found that if you ran the same report on the same data, it generated completely different, still very plausible, results. I could run the same source data through the assessment process 10 times and get 10 very different results. We had to can the project and go a different route.

LLMs are designed to produce plausible results, not factual results. We can fix this when using them for software dev by using linters and tests (though we've all had the experience where the LLM invents an API endpoint). I would not trust raw LLM output in any situation where that kind of testing and verification capability isn't present.

dirkt• 24 days ago

What happened to VERIFYING an answer? Does nobody do that anymore?

When I ask an LLM, I trace the sources, and see if they make sense.

More often than not the sources don't actually say anything about the topic in particular...

It’s also scary how easily you can lead each LLM to the answer you have in mind.

Exactly. Which is why "treat an LLM like a human expert who can answer your question" doesn't work. It's more like a human bullshitter who makes up convincing looking answers, and tries to please you. If the answers have actually some grounding in the training material, that's useful as some kind of holistic google, but often it's not.

palata4• 24 days ago

It’s also scary how easily you can lead each LLM to the answer you have in mind.

Scary in this context of course, but I find that it is an interesting thought for coding: it suggests that maybe, a developer who knows what they are doing will end up leading the LLM to coding something that make more sense than a developer who doesn't know and just vibe-codes blindly.

Sounds pretty obvious, but I wanted to say it.

base698• 24 days ago

My step mom was having debilitating pain. A year of going to doctors and no one was able to find a cause. I scanned her discharge paper work which had her prescriptions on it and gave it to Claude. It identified a prescription that had that exact side effect. They later confronted her primary care that concurred and took her off it.

A friend of mine's wife recently passed. They were chasing a suspected heart defect for over a year. She had been intermittently fainting. At about the year mark they decided to scope her digestive track. They found bleeding ulcers from cancer that was all over her body. I input her fainting symptoms into Claude and gastro impact was number two suspected after heart issues.

I have a few of other cases it's helped with. I'm not sure it could do worse than my own experience with the medical system. This is doubly true in places that lack any sort of medical care.

LogicFailsMe2• 23 days ago

As someone who uses Claude Code to summarize published research, you have to ground it in peer-reviewed results or it gets lost. But also, I am grounded with two degrees in the source material. So I am feeding it my views and asking if the published work agrees or disagrees with my opinions and I get fantastic results that way to the point of knowing current clinical trials and treatment regimens than most of the oncologists and which led to a great conversation with the clinical trials team. This doesn't replace people, but it augments existing expertise amazingly well.

But also, I hear so many tales of running out of tokens. I ask Claude Code to build a tool to perform a task. I review the tool and then I let it rip if I'm happy with it. As I understand things, most just ask Claude Code to do the task. That seems a bit fraught.

Anyway, you have to impose constraints IMO and ask the right questions to get the answers you need or yes Claude Code (or any other LLM) will eventually just agree with you.

parpfish• 23 days ago

LLMs are well suited to my (some would say annoyingly) curious nature.

when i get an answer, and my first instinct is to ask a ton of follow-ups and "what about"s. i've learned to tamp this down with fellow humans, but with LLMs its great because most of the time the response is "you're right, something doesn't add up... let me try again". i think we eventually converge on to something reasonably true

ComputerGuru• 23 days ago

Yup. This works until it doesn’t (fairly soon thereafter), both from experimentation and understanding of theory. Here’s an illustrative example: https://old.reddit.com/r/Bard/comments/1l1qxk9/why_does_gemi...

andai• 23 days ago

Yeah a lot of focus lately on making context windows enormous and putting everything in them. (It should know every detail of your life!) But in my experience LLMs are extremely "prime-able" and also tend to hyperfixate on details.

So when asking difficult questions I tend to remove as much context as possible, rather than adding it. I don't want it to reflect my own ideas or biases back to me, I want an actually fresh perspective.

john-tells-all• 24 days ago

There's a big difference between a _puzzle_ and a _mystery_. In a puzzle, the goal state is known, and as more pieces - data - appears, the goal gets closer. You know how far you are from the goal.

A mystery is worse. With each additional piece of data, the goal gets farther away. Everything is more and more confusing.

(Popularized by Malcom Gladwell)

mrlongroots7• 24 days ago

Maybe I am missing something but I just find this wrong.

Everything is a puzzle: there is one "Truth" or one diagnosis. You (a smart human) should be able to converge on it by cross-examining your LLMs. By themselves, they have no interest in revealing this, no stakes, which makes them tools only useful at the hands of a capable investigator.

Bratmon• 24 days ago

To provide a competing point of anecdata: A Gemini diagnosis saved me $3,000 in unnecessary repairs on my Civic.

dyauspitr• 24 days ago

Saved me $2000 on a koi pond pump and filtration system

fluidcruft2• 24 days ago

YouTube has saved me at least that much in appliance repairs... and it doesn't even have an AI. It's amazing how valuable access to information can be.

ahepp• 24 days ago

I would love to hear more about this

serial_dev• 24 days ago

These tools can’t reliably fix a 4px misalignment on my icon, better ask them about a medical report… but honestly, I would do the same.

Gigachad• 24 days ago

Tbh LLMs pulling data out of medical documents in it's training set and searchable online is likely a much easier task than fixing some weird CSS alignment issue.

UltraSane• 24 days ago

There's something incredibly peaceful about being in the hands of an expert you trust

This is the primary business model of enterprise IT and is why companies pay so much for 4 hour disk replacement.

nonethewiser2• 24 days ago

You only got 3 opinions on your car? Why not 50? You could have found a more useful signal by getting more information.

I get it - getting an opinion from a mechanic is time consuming. Not true of AI though.

jdblair• 24 days ago

The best mechanic I ever had kept my ‘98 Subaru going past 200k miles. Once during a repair I asked him to do an inspection and tell me if there was anything else I should replace. He told me not to do that, and that any mechanic would always find something, but not necessarily the next thing to break.

He said it better using an expression I hadn’t heard before or since, something like “don’t go looking for goats when your herd is already with you.”

dumb12243• 24 days ago

Exactly. Old parts of the system will be working if you leave them undisturbed. Mechanics have very good intuitions of this sort of thing.

I read about before there's proper engineering / physics theory about this too, it's like a car as a machine is a linear/smooth physics system with multiple weaknesses. Overtime longtime period of running many places might weaken but it still evolves into a slightly different smooth system, until you introduce a replacement which cause a mis-match of impedance or something like that.

tass• 24 days ago

Maintenance-induced failures are what it’s called with small aircraft.

You’ll do something to prevent a failure (like, replace an old but functional alternator) but cause an oil leak or engine vibrations because you had to remove the propeller to complete the job.

ryukoposting2• 24 days ago

I got 3 completely unrelated recommendations, including one that I knew was invalid! I felt worse off than when I started!

I almost had a very similar experience with my beater Lexus. It took 2 independent shops and 3 dealers to finally figure out what was causing the ABS to go off randomly at low speeds. Turns out there's some obscure Toyota-specific tool from the late '90s that picked up a proprietary diagnostic code, and the third dealer was the only one that still had that particular piece of equipment.

...and of course, the thing that's broken has been out of production for 20 years and remanufactured ones cost more than the car is worth. I ended up just unplugging the ABS control module.

Point being: once I knew what was wrong, all the seemingly contradictory information from the other 4 shops suddenly fit together. It's just such a weird thing to go wrong that no reasonable tech would ever have considered it.

weatherlite7• 24 days ago

it's better information, and AI cannot currently provide that

It sometimes can, if it straight out never can no one would use it. People use it , lots of them.

dumb12243• 24 days ago

I tried that AI diagnosis for my 15 old Ford C MAx too, however with a diagnostic problem the issue is unless you've got the ground truth, there's simply no way to verify any tool / human with a metric that you can compare and decide on future tasks.

The AI might be very good at diagnosing all minor issues, but might not lead to a successful repair, whereas human mechanics are extremely good on 80% of major issues that's not the ground truth, but will lead to successful repairs (that might not address the root but simply patch it). So it comes down to manage expectation / outcomes.

darkwater3• 24 days ago

I got 3 completely unrelated recommendations, including one that I knew was invalid! I felt worse off than when I started!

I would frame it differently: you now know which shops are not to be trusted. So, next time you need one, you will take a better decision.

abirch• 24 days ago

There are few things better in this world than having a car shop you can trust. I found one and pray that management doesn't change.

throwaway20374• 23 days ago

You nerd sniped me with the story about your used car. What happened in the end? I really want to know! There are some fun YouTube channels that basically do the same. Someone who is an expert auto mechanic takes a used car to various repair garages and asks them to recommend a course of action.

namelessone• 23 days ago

Sounds like a fun watch! What is the name of the channel?

jbs789• 23 days ago

Especially in the medical field where the placebo effect / mindset shapes outcomes.

clates• 23 days ago

The solution to uncertain information isn't more information, which the AI can certainly provide, it's better information, and AI cannot currently provide that.

Aside from the LLM-ism (it isn't foo, it's bar) - this is a thought terminating cliche. You definitionally don't know if some information is better or not given that you were uncertain about the information in the first case.

"I went to three mechanics and got three different answers" - your takeaway is just "Ah - I clearly need better informed mechanics."

Which is on it's face absurd because if you could clearly judge the ability of the mechanics you wouldn't need their evaluation. You'd just do the evaluation yourself.

rockostrich3• 23 days ago

There are 3 kinds of mechanics:

Scammers who do the lowest effort diagnostic and "fix" to get you to pay a smaller amount of money to fix the problem in the short term even though it'll re-present itself a week/month/year later.

Upsellers who will find other things "wrong" with your car and pressure you into paying to fix them because they sound a lot worse than they are.

Good mechanics that will explain what they did to diagnose the issue and recommend different options depending on what the issue is.

Funnily enough, I've found that doctors tend to also fit into these 3 archetypes.

palata4• 23 days ago

Yes, and that's a problem. Doctors (or experts in general) hate it when people don't trust them, but the thing with experts is that people have to trust them. And in my life (and a few times just in the last few years), enough doctors have been wrong enough that I cannot just trust them anymore [1]. If it is important, I will ask them to explain to me, and sometimes I will just ask for a second opinion.

I have read about doctors complaining that "with AI, patients now come with their own diagnosis and don't trust us when we say it's bullshit, and it is a problem". I can feel for them, but if they give the feeling that they don't listen to the patients and the patients don't trust them, it's not only the patients' fault, I would say.

[1]: I have more than one examples of my relatives like this: A doctor says "wow that's bad go to the ER", the ER says "nope it's all good, go home", first doctor learns about that and says "WTF you GO TO THE ER, call me and I will insult them on the phone", and finally resulting in a surgery where the doctors say "they were lucky we could operate right now, because in a matter of hours they could have died from this". How in the world can I trust them after one event like this? Happened to me (in some variation) 3 times. Not based on an LLM diagnosis in the first place: based on a doctor's diagnosis.

nums3• 23 days ago

Maybe a difference here is asking AI for conclusions. When I have it do a buyer's report for me, I ask it for "what questions should I be asking? What are typical things that go wrong with this type of vehicle?" I don't delegate conclusions to the AI but use it to educate myself. Then, I can gather further information to make MY decision .. to buy it or not.

davikr• 24 days ago

You can try sending basic chest radiographs to GPT and it'll fail at interpretation. I'd be wary of premature conclusions.

hectdev3• 24 days ago

My only issue with this was the restriction of "Do not look at any data outside of our working folder" is preventing the tool from doing what it does best. I would have given it access to PubMed to pull the latest research on the subject and validate.

I wouldn't consider Claude itself to be the tool that does a job like this, but the tool that pulls in the best data and gives a supported suggestion. And then go through a number of iterations on where it failed to hone in its assessment.

cityofdelusion• 24 days ago

Its very interesting how people trust LLMs in domains they know little about.

Instead, it is my experiences with LLMs in a domain that I know very well that makes me skeptical of their performance across the board. I find issues in code review multiple times a day with their output, and they are explicitly and extensively trained on this use-case, unlike with the MRI data. Sometimes I veer into other domains I have decent knowledge about (construction, carpentry, landscaping) and LLMs disappoint me there as well.

I suppose Gell-Mann amnesia is a universal human quirk and not restricted to just the news.

lutusp• 24 days ago

There's something incredibly peaceful about being in the hands of an expert you trust. You don't have to worry anymore and can let them guide you through the process.
AI can absolutely shatter that feeling in an uncomfortable way ...

I see this as a field report in a time of fundamental transition, from a world without AI, to one that accommodates/incorporates AI. For this to happen, AI will need to become more trustworthy. As for the U.S. medical system, it can't get much worse.

I recently had a similar experience (meaning walking a fence between old and new methods), where I was told I could get an appointment with a human medical practitioner in nine months. So, to resolve my anxiety I consulted AI and got an instant diagnosis, one that was later confirmed by the inaccessible medics.

Being a born skeptic I wasn't going to act on AI's diagnosis, I just wanted to know what was going on, resolve some uncertainty. Another advantage: an AI chatbot doesn't say, "Wait, you're on Medicare? Hmm. See you in nine months."

Don't take this as an endorsement of AI's diagnostic abilities -- it's way too soon for that. In my case it was a slam dunk, about a condition I knew nothing about.

dwa3592• 24 days ago

Was it 2016 when Geoff hinton said that radiology was a dead career?

Well, we now have the best model of our time (trillions of $$$ of investments) telling us something completely different(and wrong) from a human expert. I would really like someone calling out dario, sam, elon on these things and hear their explanations but alas, a man can only dream.

nicman232• 24 days ago

yeah that is why you would not use a random llm that is not trained in radiology lmfao

diffusion models are probably a better bet for identifying irregular structures

tarellel• 24 days ago

It’s an odd field, obviously it’s in high demand for diagnostics and anytime you have to do an xray, MRI, etc you have to wait hours for one to become available.

I think they’re artificially stunting the field to raise their wages. For example in my city the medical school only accepts 11 people into the program a year. (With an average graduation rate or 3-5). My niece has been trying for 2 years and finally got in this last year. Even radiology is doing AI assisted diagnostics. Half my MRI’s from this year has Doctor notes and HealthBot (AI) notes attached to them.

~ I’m assuming other schools severely limit their radiology admissions as well. To keep the wages high and the field desirable.

calvinmorrison• 24 days ago

free market solution is just order an x-ray machine from alibaba and setup shop. you could add a credit card swiper + ID + facial recognition to plausibly avoid over-xraying people

These days Xray machines - they don't even suit up in lead or stand behind a wall , just point and shoot. In fact they're nice and portable. I wish i had a xray machine at home.

muldvarp• 24 days ago

Was it 2016 when Geoff hinton said that radiology was a dead career?

Funny how the jobs most at risk of automation now are tech jobs.

Gareth321• 24 days ago

I have had terrible experiences with medical professionals. Especially the experienced/senior/specialists. First, they just don't have the time to do a thorough research of my medical history. Second, they are often arrogant and resistant to any kind of critical questions. They have an apparently unwavering belief that they are correct. In fairness, they probably usually are, but they are not infallible, and they are at their weakest when it comes to the edge cases.

AI is completely without ego, and can process all my medical records in minutes. In truth, even today, I would rather have an AI analyse my records.

idopmstuff• 24 days ago

It might seem obvious to coders, but the difference between Claude Code and Claude.ai's chat is enormous, even if those two run the same model.

In my experience, Claude Code is vastly better for doing tasks, writing code, etc., but Claude.ai is better for analysis and high-level planning. When I'm working on a new project, I've started using the latter to do the initial planning, get feedback and draw up a spec, which then goes to Claude Code.

For this project, I probably would've done something similar - use CC to get whatever you need out of the image files, but have Claude.ai do the actual review/diagnosing.

Either way, I often think about how far behind most of the world is in really understanding AI. The overwhelming majority of people would never guess that you get vastly different outcomes from the exact same model in a different harness (tbf most people don't know what a harness is). I spend hours every day using AI for a broad range of tasks and still feel like I know a fraction of what there is to know. I haven't even tried the new GLM model (or really any of the open source Chinese ones of the most recent generation). With so many people thinking that the free version of ChatGPT is SOTA AI, a lot of folks are in for a very rude awakening at some point soon.

lycos• 24 days ago

I'm surprised about the 266 MB of DICOM images, I've never had an MRI but my CT results are generally between 1-2GB (zipped) and I always assumed an MRI would have more data, guess I was wrong about that!

anigbrowl• 24 days ago

I use LLMs every day and value the benefits they offer, but this approach seems misguided. A smarter way to use them would be to consult the LLM before seeing the specialist and ask it to bring you up to speed on capabilities/limitations and develop a list of important questions to ask.

gaolei8888• 24 days ago

I have already done that several times, and I found the comments from ChatGTP/Claude, is absolutely bullshit.

bryanrasmussen• 24 days ago

I am reminded of the old saying that anyone who diagnoses themselves has a fool for a doctor,

tsoukase2• 24 days ago

Medical opinion will remain one of the last frontiers of LLMs. There so many critical factors that are inappropriate for them. They cannot perform a clinical exam, they have to collect the needed exams and most importantly a life might be at stake (OK, you cannot die from a shoulder problem but you can become handicapped forever).

All that said, as a doctor I am totally open and even happy when a patient refers they took advice from AI. I explain the holes of their reasoning and integrate it with mine. It helps rather than hurts the patient-doctor connection.

fuomag92• 24 days ago

I wish you were my doctor!

chasebank2• 24 days ago

Do you think you would ever use LLMs in tandem in your practice to help diagnose and treat?

tsoukase2• 24 days ago

I often ask, usually Gemini, at a medium abstraction level (not general What the diagnosis is, neither specific like What this high serum Ca means). The answers are correct but not enough and ready for consumption without doctor guidance.

A cardiologist friend goes in deep discussions with a specialised model and he is amazed.

Aurornis4• 24 days ago

They injected me with Traumeel, which is registered in Germany as a homeopathic medicine "without a therapeutic indication".

This single sentence provides a huge clue about what’s going on: This person’s medical team is not good. It’s not hard to get an LLM to perform better than a team that is injecting homeopathic botanical formulations and performing procedures that aren’t indicated for the condition.

I think the real takeaway from this article shouldn’t be “ChatGPT is better than doctors”. It’s a story about LLMs identifying that someone was not in good hands.

zer00eyz• 24 days ago

I won't go into the details, but he suggested I get an MRI, which the clinic conveniently had available.

And

They performed shockwave therapy on my shoulder

(a procedure that may not be effective, but is unlikely to cause any harm)

Its not just about LLM's being better, its about people not trusting DR any more: https://www.physiciansweekly.com/post/the-erosion-of-trust-i...

If we want to fault the article for anything it's that he didnt take that information and go get a 2nd opinion from someone who IS more informed.

Groxx• 24 days ago

Any medical-field-position that recommends homeopathic stuff is instantly in my "full of shit and not trustworthy on anything" list, and I'd go elsewhere immediately and file complaints anywhere I could. There's no excuse at all, they're either fools or scammers, and I want neither anywhere near my (or anyone else's) health.

That said, while I do see homeopathic stuff with that name, it's worth verifying that it isn't just a naming conflict. They're not always unique, particularly across countries, and Traumeel seems to be more of a brand than a specific thing.

ashikns2• 24 days ago

I am confused why none of the experts weighing in here address this at all. Like I get that AI is generally disliked, but ignoring facts only makes me want to not trust doctors.

zephen• 24 days ago

There's something incredibly peaceful about being in the hands of an expert you trust.

I want to know if this is a religious thing, or is related to never having had multiple doctors so bad it seemed like they were actively trying to kill you, or both. I've never had this peaceful experience personally within the realm of healthcare.

AI can absolutely shatter that feeling in an uncomfortable way

Good. Reality is always good.

but I don't know if I can fully trust AI either.

WTF??!? Why on earth would anybody ever think they could fully trust LLMs? Even their most vocal proponents concede they aren't infallible panaceas.

tibbydudeza• 24 days ago

I would trust a doctor with decades of experience and his diagnosis and treatment plan than some LLM.

It like using WebMD for any ache and pain and it is saying it might either be Lupus or cancer.

paul7986• 24 days ago

Went to a new dentist recently and his staff took x-rays of my teeth. I was then waiting for him to come speak with me about what the x-rays show him yet i just took a pic and uploaded it to Gemini. 9 months back my previous dentist said i should have a filling or potentially a crown was needed. I told Gemini this and that ive only about 3 fleeting pain issues in that area. With the x-ray and that info Gemini told me the exact same thing the dentist later came in and told me. If pain comes back and for long periods of time then there's an issue as the x-rays look fine.

Overall i see a great opportunity for x-ray techs (radiographers even when Jensen from NVidia says the first field he recommends not getting into - Radiology which is the step above) to open their own businesses for people who want to use AI for self care and help. Have one doctor or dentist on staff to use as needed.

algoth1• 24 days ago

I love how the doctors injected basically water. I imagine the doctor thinking "we did all we could"

YuechenLi• 24 days ago

Yeah, one of the big problems with that is that Claude/ChatGPT doesn't perceive images the way humans do at all, so when you upload an image to them, it gets tokenized in some form. This is why most LLMs are really, really bad at spatial recognition for image editing purposes for example.

So, unless you can turn the image into a natively tokenized format like JSON or something that somehow accurately tokenizes what's on there, I would NOT trust Dr. Claude's analysis. If you want a second opinion, talk to another doctor. A human doctor.

KerrAvon• 24 days ago

Given the tenor of the comments on this article, I think reading TFA is super important, especially the author's disclaimer at the end, where they state that they're definitely not blindly trusting the AI at this stage, just that they find the differential unsettling.

yaroslavvb• 24 days ago

I had similar experience, Claude made report of MRI for achilles tear, it measured the gap, but it was completely hallucinated. Achilles tendon is black on the MRI, it instead measured 13mm distance between two completely different things (looked white), the radiologist looked at and saw no gap at all

chpatrick• 24 days ago

I recently had a pretty bad injury and out of curiosity I asked Gemini what it thought based on some CT scan slice images (and no other information). Surprisingly it came to exactly the same diagnosis and treatment plan as my doctors, but the big advantage is that I could ask it follow up questions any time, whereas the doctors barely explained anything.

dwd2• 24 days ago

This...

Gemini will ask for the specific images it needs to see and show you examples of what each slice will look like.

But unlike the specialists who often come across as abrupt and rush you, Gemini will happily take you on a deep dive and continue to answer all you follow up questions indefinitely.

motbus3• 24 days ago

The only part of the message I think it would be interesting to the author: what if you set two instances to prove each other arguments wrong considering that each reads one of the report as their POV?

I didnt see the full process but I used unet models for tumor detection so I am somewhat familiar with the possible caveats of any evaluation from a engineer perspective.

First, I would like to point that unfortunately, it is not uncommon to go to two different human doctors and also get two unreliable diagnosis and treatment. The biggest problem, in the way people plan to use ai on health is the lack of liability.

A bug on a regular old web site doesn't kill anyway nor cause pain and suffering (most of the times) but misdiagnosis + the fact that a model is very good on presenting arguments even when it is completely wrong.

Claude code, and I am talking about opus 4.8 here, can tell rivers of information about code pattern and develop the poopiest code the next line.

This is a machine that will deliver a sort of templates document based on the input information but it is not exactly doing the work if you don't directly it to do it right constantly.

Because the model isn't thinking I wonder what happens if you set multiple agents to communicate and defend their point with some sort of harsh penalty prompt for not fulfilling its goal. There are some safety system prompts on Claude models that will trigger it to be very carefully to write. Like: you cannot make mistakes. "You need to ensure that it is correct or someone might end up hurt or even dead"

But you would need two agents and a setup to communicate via pipes or files.

matsemann• 24 days ago

I tried the same on images of disks in my back. The ai picked a slice not from the middle and used that to say they were too small (since it was looking at a slice towards the edge) and basically told me my life was over and my pain would last forever.

Luckily my disks were fine. Wouldn't trust it. Additionally, an MRI of a pain-free, healthy human still would show lots of things and damage. Unless it coincides with a symptom, it's probably harmless. That's why the history is important when looking at images. Can't just upload something and hope for findings.

twodave• 24 days ago

AI use is such a polarizing topic anymore. What ever happened to just waiting and seeing how it all plays out? Since probably none of us is going to be able to predict it anyway.

quarkcarbon279• 24 days ago

As a developer I have many times seen Claude's models confidently hallucinate, jump into conclusion. Fable though I used just for 2 days, didn't experience it much in the short-term.

piterrro2• 24 days ago

It funny to see the community here expects the human body to be treated like a deterministic function: for input X expect output Y - and that transfers to diagnosis - people expect to receive the same diagnosis from different specialists for the same issue.

Given human body complexity, the diagnosis is a compound output of the experience, knowledge gained throughout the career and diagnosis methods/equipment, the title (like Dr) is a certification imposed by the state so its "safe" to let people practice since they passed "the bar" - but that doesn't imply everyone will be treating the same.

Some specialists update their knowledge monthly, some yearly and some don't do it at all, there are so many variables in play here (geo, politics, even weather haha).

Having said that, choosing the specialist is really important, getting opinions about their practice and their speciality, you can only maximize your chance of getting the right diagnosis, but don't expect to get it right just because somebody is called a Dr.

b800h4• 24 days ago

I'm not sure what your point is. Are you saying that medicine is inherently fallible and therefore AI is more likely to make a good diagnosis - particularly a cluster of specialist AIs?

mrlongroots7• 24 days ago

Yeah I think the OP is muddling the point by conflating "physician's version of the diagnosis" with "The Diagnosis".

There is absolutely one "The Diagnosis". Human body is a machine, albeit a very complex one, and all measurement sources have noise. But they are all measuring one reality, and if there is a problem, there should be one explanation that all measurements align with. They can be noisy but can never be conflicting (instrument error notwithstanding).

Physicians' ability to arrive at "The Diagnosis" would vary, but it does not mean one does not exist. I am not sure if characterizing human body as derministic or not is relevant here.

charles_f• 24 days ago

It funny to see the community here expects the human body to be treated like a deterministic function

In a community largely made of people whose job it is to produce such functions, I'd say it's to be expected

KingMob• 24 days ago

It's funny (and a little depressing), because HN routinely assumes that their world view, and thus, their domain expertise, transfers.

There's no shortage of tech people convinced they deeply understand law, medicine, philosophy, etc. despite never having read much on the topics.

chasebank2• 24 days ago

Anecdote on healthcare, adjacent to this.

My dog had been acting off. Wouldn’t eat, was hunched over, looked sad. We took him to a local vet who did an X-ray because they suspected a blockage. They didn’t see one, so they sent us home with standard pain meds.

Randomly, we had a dinner party that night and another vet was there. She heard the story and immediately said, “Go home right now and take your dog to an emergency vet with ultrasound.”

Turns out, at the time, most vets had been trained to use X-rays to look for blockages, but newer evidence showed X-rays were only something like 20% effective compared to ultrasound, which was closer to 95%. (forget percentages but somethign like that)

The ultrasound found an avocado pit stuck in his intestine. He had emergency surgery that night.

That chocolate chunk of an English Lab ended up living until 15, and only needed two more blockage surgeries after that...

I know doctors hate patients reading the internet, and LLMs are going to make that 1000% worse for them. But hopefully over time, we all adapt together and end up better off in the long run.

sehw• 24 days ago

I used my dog to clean my room.

kgeist4• 24 days ago

A few years ago (before the AI craze), I was misdiagnosed with tuberculosis. I had a chronic cough, and an outsourced radiologist at a clinic found signs of tuberculosis. The findings were sent to the city's tuberculosis hospital, as required by the country's law. The doctors there took the radiologist's conclusion at face value and required me to stay at their hospital for at least 8 months under a strict, prison-like regime. There was no option to say no, because I was considered some kind of biohazard, and by law I had to comply.

Before I was admitted, I quickly found another radiologist, who diagnosed pneumonia instead. I sent his report to the chief doctor at the tuberculosis hospital, and after some deliberation they concluded that the original reading was wrong. Turns out the doctors there can't read scans at all and just believe whatever a radiologist says...

The funny thing is, they had already officially put me on the tuberculosis register and didn't want to admit they had made a mistake. So instead, they simply gave me another paper saying that I had been cured of tuberculosis by them... in 7 days. I'm probably the only person in the country to defeat tuberculosis in a week :)

So if you don't trust the radiologist/doctor, maybe find another doctor if you can afford it? You can compare their conclusions and see if they match. Two unrelated doctors or radiologists saying the same thing is probably about as close to the truth as you're going to get. I'm not sure though whether I should trust AI or humans more. AI can hallucinate, but I've been misdiagnosed by humans so many times too...

azan_• 24 days ago

How is it possible? You can't diagnose tuberculosis just based on imaging and tuberculosis hospital has to know that!

kgeist4• 24 days ago

Yeah, I know! It was strange. They gave me a test, and it came back negative, but they insisted it was negative because I had "latent tuberculosis," which supposedly wasn't detectable by the test yet but was about to become active.

I forgot to mention that, besides getting a second opinion from another radiologist, I also took a more modern test at another private clinic. That test has better detection rates than the one the state clinic used, and it came back negative too.

I have suspicions they had some kind of government quota to keep the hospital staffed with patients in order to receive funding. Or they were just completely incompetent. I pushed back by bringing them another radiologist's report and the results of a better test that I paid for myself, so I guess they decided to back down.

shiandow3• 24 days ago

Not only that, what is the point confining someone to prevent the spread of a disease about a quarter of the world is already infected with?

I suppose there could be reasons, but I don't know them.

comboy• 24 days ago

Incentives.

ryan_n• 23 days ago

Yea I find a lot of stories on the web about doctors misdiagnosing things to have oddities like this that don't seem to make sense. It often seems like the author is leaving something out. Not saying OP is lying, but tb is a very, very weird conclusion to come to from just one radiology report...

selfmodruntime• 23 days ago

Well you can't diagnose pyelonephritis without a urine culture as well, which my GP kindly noted after I already took a full 14 day dosis of antibiotics. The ER I was at before tried to, anyway.

igortg• 24 days ago

I had a similar experience. My son had pneumonia and was still filling pain after 10 days of antibiotics. Took an X-Ray to three different doctors, and only one got the right diagnosis (pleural effusion). It's really something we should have a central place with top notch professionals looking at it, instead having each doctor to find by themselves.

mncharity2• 24 days ago

I once worked on a medical hackathon concept for computer-assisted population screening for cervical cancer in a developing nation. Community health workers take photos. The AI would look at the images, and make a call of "clearly negative" vs "clearly positive" vs "needs (scarce) expert review". But taking good photos is hard, so it's also "photos insufficient" and "worker needs additional mentorship on taking photos". Only by computes reducing all three costs - expert workload, exam success, and quality-control/training - might successful deployment be financially and logistically plausible for that nation.

beacon2942• 24 days ago

What country / municipality are you in? This is not my understanding of Tuberculosis...

rpastuszak• 24 days ago

Asking for a friend, who is in a somewhat similar predicament — it wasn’t Portugal, was it?

engeljohnb4• 23 days ago

A second opinion is a smart move if one has doubts about their diagnosis. Doctors make mistakes, and even though I've worked with countless great doctors, I've never worked a job where there wasn't at least one who was undiscerning, or downright lazy and negligent. It's hard to tell people to trust their doctor when I know there are plenty of doctors out there like this.

But AI as of right now is worse than any bad doctor I've ever worked with.

CodingJeebus• 23 days ago

The healthcare affordability crisis is only going to exacerbate the trend of using AI as a replacement for a real doctor. I went to urgent care a few months ago to get tested for COVID and two other flu strains and it came out to almost $500.

Anecdotally, several people in my life who embrace less traditional (and sometimes more conspiratorial) views on modern healthcare tend to be the ones that can't afford it. A confident-sounding chatbot to answer questions day and night about what's going on with your body is very seductive in a world where access to real healthcare is getting further and further out of reach.

QuantumNoodle• 23 days ago

Your TB stories made me recall my (fond) TB stories. I came from a country that requires tuberculosis vaccines as a school-entry requirement. I have the vaccine and antibodies. Then moved to a country that didn't have this requirement but I had to be tested to make sure I didn't have TB for things like camps, college, etc. The test is something like a vaccine that injects only dead TB cells, if the injection site welts up from anti-bodies then you had to get another whole panel of tests (like X-ray of lungs). Thankfully I've never had it but TB is apparently no joke. Though blasting my chest with radiation is no healthier :p

Anyway, thanks for sharing!

laybak• 23 days ago

AI can hallucinate, but I've been misdiagnosed by humans so many times too...

I've heard this experience from quite a few folks before, but this is my first time hearing about a mandatory 8 months quarantine as a consequence... damn

grumbelbart2• 22 days ago

I had been cured of tuberculosis by them... in 7 days

Just FYI that might suck in the future. Some countries might deny you entry / visa, or at least require expensive additional screening if you had tuberculosis diagnosed in the past. It might be worth to fight this.

geraneum• 24 days ago

There's something incredibly peaceful about being in the hands of an expert you trust. You don't have to worry anymore and can let them guide you through the process. AI can absolutely shatter that feeling in an uncomfortable way

It's always something along the lines of incredibly peaceful, insanely powerful, extremely interesting, also scary and uncomfortable meanwhile feel like magical super powers and science fiction.

I'm telling you... words have lost meaning.

curevalue• 24 days ago

As everyone knows here a large language model using probabilistic next phrase approach will not be able to "diagnose" results from an MRI - at least not with enough confidence. It lacks the patient's history and a snapshot along with very varying datapoints in the training set will lead to "approximate" results. Not what a true doctor with a 360 view of a particular patient's health would be able to diagnose. That 'approximation' will get "better" in time - which only means the results will be replaced by yet another approximation.

light_hue_1• 24 days ago

Go with your report back to your doctor.

A family member has cancer and we treat chatgpt as part of the team (our doctor's words). I ingest everything into it, work with it to make a good report. Then at the next visit we review it.

This gives you the best of both worlds. You get peace of mind and the doctor explains why and how the agent was right or wrong.

Twice now we've caught consequential mistakes (wrong pain medication and incorrect notation of the exact mutation that he has). Which have made a difference to his quality of life and treatment path.

Most of what the doctors have said is in line with the agent but when there have been disagreements they've been very reasonable. Sometimes the doctors have gone with the agent's version sometimes they've explained why that's inappropriate.

thewanderer19832• 24 days ago

I was diagnosed with a rare blood disease called Essential Thrombocythemia (ET) which is part of a group of diseases called myeloproliferative neoplasms. This happened about three years ago. Recently, I decided to get a second opinion and my new specialist changed my diagnosis from ET to Polycythemia Vera (PV). She also highly recommended I quickly go and give blood to lower my haematocrit levels as it put me at a much higher risk of a blood clot. This is standard practice for people with PV but not people with ET. I decided to put the details into google AI in the same way that the original specialist used to diagnose me. Google AI predicted I very likely had PV instead of ET. I also asked Google AI how one could misdiagnose my condition with ET instead of PV and google correctly explained how. My specialist had used my high platelet count and blood test that came back with a JAK2 mutation then after a bone marrow biopsy to incorrectly diagnose me with ET. My high hemoglobin levels should of been checked by my first specialist as an indication of PV not ET. Only the second specialist picked up on this. Google AI took five seconds, and is free. The specialists costs $$$ and took weeks.

throwaway762• 24 days ago

Interesting. I am also diagnosed with ET (from platelet counts, pathology report noting abnormal platelet morphology, and JAK2 mutation from a marrow biopsy). What made you seek a second opinion?

thewanderer19832• 23 days ago

My original specialist wasn't very engaged with my condition. I was getting the same speech every six month visit. On my last meeting she incorrectly stated a condition I wasn't having with bleeding. My wife had a thyroid issue a number of years ago including cancer growth on it. Her first specialist was using older techniques for her treatment. We ended up going to another specialist who's focus of research was her condition. It was worlds better. Given that experience I decided to find another specialist who focused on my condition.

The first specialist ( hematologist) was referred from local GP. She is a a hematologist, but she wasn't focused on MPNs.

I recommend joining your local MPN alliance to keep up with what's going on in this field. I also recommend finding a specialist with a focus on MPNs. Looks at their papers or listed focus.

j45• 24 days ago

Imaging is one area where patients will be able to become more educated to ask better questions.

The areas of premature heavy interventions can be a challenge, especially where there might be room for interpretation and the medical professional didn’t share all possible options.

It’s critical to ask all professionals for all possible options and write each down as they write and explain it. No one’s perfect, and not everyone is negligent or malicious.

anon291• 24 days ago

I've found ChatGPT to be much better at medicine than doctors. For example, every winter, I would get itchy toes. I was quite concerned because they could be quite painful. But the symptoms were not obvious and they wouldn't occur often. The toes would swell up and become quite red and uncomfortable. One doctor suggested gout, which was not the right diagnosis, because I have no urea problems. Others suggested a skin cream.

No... I told ChatGPT exactly what I told you and it came up with the answer: Chillblains, which should have been obvious given everything I described, yet general practitioners were clueless and often reached for high intervention approaches

Harmless condition fixed by wearing socks. I brought it up with the same GPs who had misdiagnosed me and none had heard of it.

Of course, I'm cognizant that it could be mistaken, but a hospital fed my diabetic aunt a normal sugar diet while she was in a coma and forgot to give her metformin, so I mean, it's not like humans can't be retarded as well. The difference is no one gets offended when I point out ChatGPT has the capacity to be an idiot. Instead they just fix it.

madrox• 24 days ago

I had shoulder pain about ten years ago. Had an MRI. Found evidence of a tear. Was told I would need surgery and referred to a sports medicine doctor. He looked at my MRI and said the real problem was my shoulder was frozen, and he could do surgery but the PT after is what would actually be what helped me. Two radiologists and two doctors saw my MRI before this moment. Sure enough, with a little PT I got better.

I’ve had several more medical blunders since then, including a doctor telling me my problem is to lose weight 48 hours before going into emergency surgery.

What I have learned is to be weary of any time I feel like I’m in a “funnel.” Once you’re in the funnel, no one is thinking critically about your issue any more. One person said they found X. Next person reads that and assumes Y and recommends Z. And so on until the alpha is multiplied to hell. Lots of treatments that don’t hurt but don’t help and run up insurance.

I have since used AI the last couple years and it has either concurred with my doctors or given me enough ammo to challenge them. If I were the author, I would trust neither but use Claude to ask how to go back to that clinic and challenge the diagnosis.

jongjong• 24 days ago

I don't know which country this is but this sure seems like a country where doctors have an incentive to maximize the amount/cost of treatment.

I've seen the two extremes in different countries; either they have a tendency to maximize the complexity of the medical situation, or they minimize it "Don't worry, it's just stress" - I've been to different doctors in different countries and I see a pattern based on the country and the incentive structure. In some countries, they will send you off to do a scan for the slightest malaise.

I don't think it's about quality/coverage of public healthcare (at least not on its own; I have not seen a clear pattern across this axis). I think the difference is to do with the referral system. In countries where you can't go directly to a specialist and need a referral from a General Practitioner/Physician first (I.e. in order to get a refund), you tend to get more false negatives from the GP which block you from going to the next stage "It's nothing, just stress-related." In countries were you have the option to go directly to a specialist, they tend to be much more trigger-happy in terms of giving you a full workup and GPs/Physicians will more easily refer you to a specialist.

And I feel like the attitude extends to the specialists themselves. I suppose making people go to a GP first creates a kind of efficiency and predictability which alleviates pressure to exaggerate the severity of the situation.

throwawayffffas2• 24 days ago

Fucking doctor google bullshit, they want medical treatment but don't want medical advice...

parsabg• 24 days ago

We provide a second opinion service with certified human radiologists, if anyone's interested: https://expert.med

coffeecoders• 24 days ago

I need this but for dentists.

beacon2942• 24 days ago

I put a MRI of my body part into Gemini 2.5 Pro (for fun) and it said it was my brain. These models don't necessarily have that data.

GuestFAUniverse• 24 days ago

German doctors are very prone to quackery. Including their nurses.

I've overheard a nurse at a university hospital argue with patient who used tape on himself about the color of the tape. She was worried he might use the "wrong color". Again: at a university hospital, where they teach MDs. Half of them recommend homeopathic remedies

In short: quaks.

skeptrune• 24 days ago

the more awesome thing to me is that you can run the MRI through an ensemble of LLMs and check to see if they converge among each other

_carbyau_• 24 days ago

This seems less a demonstration of competence than of accessibility.

Often we only get 10-15 minutes with the one health professional that makes a determination and sets the path of your life for some time.

As opposed to being able to spend hours with an LLM that in many ways feels more sympathetic and helpful - even though it's competence is in question.

So here we are:

1. with doctors processing patients every 10 minutes like a machine.

2. and machine's processing, for a patient, at any hour like a human.

hmokiguess• 24 days ago

Nice, I have Claude, now I just need an MRI (which in some countries is sort of a hard requirement still unfortunately, long queues)

themantalope6• 24 days ago

Radiologist. I don’t read MR shoulder exams in my day to day practice, but from the few pictures shown , I can’t conclusively disagree with the original report.

These models are generally terrible at reading medical images. The amount of public training data on the internet compared to the number of scans a radiologist reads in training is minuscule. There’s obviously a ton of medical images in general but very few, and even fewer along with a report are available on the internet publicly for download.

There are vision language models coming out of research labs that are excellent in describing and localizing findings. Still at the level of a 1st or 2nd year radiology resident, but as we all say - this is the worst the models will ever be.

billynomates• 24 days ago

Anecdotally, I've had Claude (Sonnet and Opus latest) consistently misread numbers from screenshots of my macro tracking app. Makes me skeptical of claims about its usefulness for anything requiring accurate image interpretation, let alone MRI analysis.

deaux3• 24 days ago

Absolutely. It's very unfortunate that this post used the worst example possible of using LLMs for medical purposes.

General-purpose LLMs are _fantastic_ at medical diagnosis that do not involve imaging. I am completely convinced that given enough information and time, frontier models already outperform >90% of doctors on initial diagnosis of internal issues and suggesting medical tests to further reject or confirm the most likely theories. To the point where I'm eagerly waiting for the first hospital in the world that's willing to be open and honest about using them for that first step, and then proceeding from there. I'll be on a flight there as soon as one arrives.

At the same time, they're worse than useless at anything involving medical imaging. Asking them to interpret them is worse than trying to interpret them yourself as a layman. And you surely wouldn't interpret them yourself.

throwaway20374• 23 days ago

    > General-purpose LLMs are _fantastic_ at medical diagnosis that do not involve imaging.

Can you share the reasons that you believe this?

    > At the same time, they're worse than useless at anything involving medical imaging.

What is special about medical imaging that makes AI/LLMs specifically bad?

themantalope6• 17 days ago

Not to mention shoulder MRs can be hard to read. Findings can be subtle and have to be interpreted in context with the exam, symptoms etc.

yfontana• 24 days ago

Yeah, medical computer vision is a (fascinating) field with a lot of ongoing research. SOTA models are highly specialized, and are only getting good enough to be used by actual doctors and patients. Using a general purpose LLM to do this is similar to giving a credit card to Openclaw and telling it to make you rich through the stock market & cryptos.

themantalope6• 17 days ago

Somewhat. During residency I developed models for detecting liver tumors in MRI imaging. Like you said, highly specialized and a lot of manual work developing the dataset.

There are now open source open weight “foundation models” coming out of labs that are transformer or mamba based architectures. These will accelerate development.

odiroot2• 24 days ago

I can see how your thesis is valid.

Like OP, I also had a shoulder MRI, and asked two AIs for opinion (awaiting a follow up appointment to discuss the results).

They both insinuated much more serious problem than it was (as judged by an orthopaedic doctor).

throwaway20374• 23 days ago

No trolling here: Do you feel threatened by the advance of AI/LLMs with respect to your field? I would. I am a computer programmer, and it absolutely feels threatening.

zoul• 23 days ago

As a programmer, I don’t feel threatened by the technology itself, but I do feel threatened by the second-degree effects such as what the technology does to our field, especially in the wrong hands.

themantalope6• 17 days ago

I mostly do interventional radiology, which is more similar to a surgical specialty than a diagnostic radiology practice. We do a lot of procedures , see patients in our clinic, have a service that rounds on and follows up on patients etc. I don’t think AI will affect my job much in the next 10-20 years. Advancements in AI and robotics could potentially offload some of our work, but most of what’s out there is underwhelming, but we all know that can change fast.

Even for diagnostic, I’m not totally convinced AI is going to cause a lot of issues. From a medical-legal perspective I doubt AI companies are willing to take on the risk of misdiagnosis . When that happens, human rads will start to get phased out.

In the interim, I think the next 10 years could be a golden period for diagnostic rads. Rads will still be the ones doing the work and signing reports, but people who learn how to use the right combination of tools will become very productive and can make a great living. Eventually payers will re-align but early adopters who figure it out will have a leg up.

Maro2• 23 days ago

I don't have insider information, but: if one of the AI companies really wants their models to become really good at this and publicly available datasets are scarce, they can probably just buy anonymized X-ray/MRI scans paired with the human doctor's diagnosis, and train on them. I don't know what the legal story is around this, but AI companies have near infinite money, so I'm sure they can buy their way around regulations (eg. by buying them from a less regulated country).

themantalope6• 17 days ago

That’s a good question.

My understanding is that medical images are part of a patients record (so they must be available for the patient or other docs at the request of the patient) but whoever has collected the images does have some form of ownership. I’m not a lawyer and I have a cursory understanding of this. I believe it would be possible for an AI company to lease or get access to the data through a transaction but I suspect that it hasn’t happened (or happened publicly) due to fear of backlash.

For example I know that some companies like Tempus had access to imaging that corresponded to tumors which had been biopsies for sequencing and they were developing models in house.

neves• 24 days ago

A coworker just spend a weekend with AI analysing his image data. No problem detected. The official diagnosis came later: he had a serious degenerative problem.

These models don't have curated image exams in their training data. Your can't trust them.

FredF---• 24 days ago

Thank you for sharing. I'm about to get my MRI scan on my right shoulder tomorrow. Now I'm wondering what I'm going to do even if the result shows benign. Certainly, I would double check the result if it's concerning, should I also check a comforting result in case the truth is less comforting?

KronisLV2• 24 days ago

So I'm left in a state of limbo where I either try my luck with another doctor or wait and see if my shoulder gets better with the rehab I'm doing.

Get a second opinion from another doctor. If that’s inconclusive, see three.

BIackSwan• 24 days ago

Although it does not handle MRI files yet. I opensourced an AI workflow that helps in figuring out issues with my family.

https://karankurani.github.io/OpenCareLoop/

It has helped me personally solve longer chronic problems in my family that doctors just dont have the time to go into indepth due to their (understandable) lack of time.

Its in alpha and AI hallucinates. Use with care. Feedback welcome.

An AI agent for personalized healthcare is inevitable. The cases such as the one posted are all solvable with time. AI has hallucinated and continues to hallucinate but the value we get in the space of coding can be extended to other domains.

AidenVennis• 24 days ago

Personally I do this as well now with a lot of stuff. I've recently had a lot of issues with my knee, which was operated on about 20 years ago because of a torn cruciate ligament, and now it was acting up again. The specialized doctor did a x-ray (which I thought was pointless because I was sure it was not bones related). Long story short, my left knee is 20 years older then me because of increased knee wear and tear. I don't have a doubt the doctor is right, but I did doubt I memorized everything correctly, and later on I had some more low effort questions I didn't want to bother them with like what movements should I prevent and specifically what training I should be doing at the gym.

Thankfully I got a pretty detailed report that I couldn't read because of all the medical terms. I've fed this to Claude and asked for a human readable conclusion and it repeated pretty much everything the doctor told me, which was great, I now have a readable report for future reference. Secondly I asked it questions about what movements I should and shouldn't do, and it eventually I made a gym plan to improve stability and prevent any more wear and tear in my knee. Lastly I validated this with the assigned physiotherapist, and the plan I created with Claude was perfect!

I probably won't ever use AI as a second opinion, but I would definitely use it to ask numerous silly questions that would help me in day to day life.

i4i• 24 days ago

"A 2026 Finnish study published in JAMA Internal Medicine that used magnetic resonance imaging (MRI) scans to look at patients’ shoulders found that 99% of Finnish adults over 40 have at least one rotator cuff abnormality." https://brainlenses.substack.com/p/abnormality

Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging https://jamanetwork.com/journals/jamainternalmedicine/fullar...

shiandow3• 24 days ago

I read the article, I read the AI's verdict, I read the comments here, and I still don't know if OP does or does not have a tear in their tendon!

The AI doesn't present evidence I can understand, it doesn't even present a plausible explanation why someone could conclude it is a tear.

The main things that made OP suspicious are the possibly unnecessary shockwave therapy. Which seems harmless. And using a homeopathic gel that I would classify as more of a herbal medicine because it contains several ingredients I know people use for shoulder pain, and some even in concentrations that might even have an effect.

If this is the best rebuttal AI can come up with I would trust the diagnosis. But then OP never trusted the diagnosis and now they have several they cannot.

misja111• 24 days ago

As someone who has had shoulder issues for the last 25 years or so, including partial tendon tears, I can tell you that even if your tendon would have been damaged, the treatment would have been strange. With moderately damaged tendons, you want:

1. stop any inflammation, by taking NSAIDs for a few days

2. detect and correct any behavioral patterns that could have caused the presumed overwear of the tendon

2. start physiotherapy to strengthen those muscles that can take over the load from the damaged tendon

These are not quick fixes, because quick fixes don't exist here. Stuff like shockwave treatment, massages etc will only lessen the problems for a few hours at most, after which they will come back.

deaux3• 24 days ago

Frustrating post. This gives rightful ammunition to the calls of "LLMs need to be avoided for anything medical". Even though the issue is that they're asking it to interpret images. They need to be avoided for that, but that doesn't say much about their medical accuracy outside of image interpretation.

It would already be a huge benefit to 90% of people worldwide if the very first part of most hospital visits would be outsourced to frontier-level LLMs. Yet this kind of misuse just gives the medical industry a stick to beat that idea into the ground.

Oh well, I'm sure there will be at least a few countries that will indeed embrace frontier models for initial diagnostic medical purposes. Maybe medical tourism destinations. But it's unfortunate for those who can't afford the trip.

stefs• 24 days ago

My hope is that in a couple of model generations, we'll trust AI to review MRIs the way we trust it to proofread our emails.

the doctors may have financial motives to suggest unnecessary treatments. but i fear, by the time we'll have models powerful enough we'd be _theoretically_ able to trust their expertise, the financial motives will have shifted to the model creators.

ltbarcly3• 24 days ago

I had Claude interpret a photo of the heart monitor when I was in the ER last year. It said I was about to die. I was fine.

petercooper• 24 days ago

I'm pro-AI, but when I can't even give Claude a photo of my fingers clearly on four different piano keys and get an accurate result of which keys I'm pressing, I'm bearish on its visual analyses. (With that said, I imagine it's been trained on more photos of MRI scans than people playing piano, so I could see how it might provide interesting ideas for a radiologist to consider.)

voidUpdate2• 23 days ago

How do LLMs get information from images? Do they have to run essentially the opposite of an image generation model, taking an image and converting it into a description? I'm just concerned that the description wouldn't be able to encapsulate the information needed to differentiate exactly what is wrong with a shoulder. The image -> text model would need to know what it should actually report back to the LLM about the image, so that it doesn't just say "this is an MRI of a shoulder" or similar. It would be like a layperson describing a bridge, and asking an engineer if the bridge is safe based on that description

weird-eye-issue• 23 days ago

No, it does not work like that, it actually can process the image itself there is not an intermediate image to text step

voidUpdate2• 23 days ago

How does a Large Language Model process images then?

Mr-Frog• 23 days ago

older vision LLMs chopped up images into patches which were projected into the same embedding token space as words. Newer ones use an encoder to more efficiently project an image into token space. Then it runs through the same attention layers as the text component.

niceworkbuddy• 23 days ago

This is like someone not knowing software development at all doing a code review.

manicennui• 23 days ago

If you see an orthopedic surgeon (the much more common name for this type of doctor in the US) about almost anything you will almost certainly end up with an MRI (good chance your insurance won't cover this fully) and some kind of recommended intervention.

1970-01-01• 23 days ago

Seems like we've forgotten something already? LLMs are bad with the butterfly effect by their very nature. An extremely slight phrasing change can absolutely trigger a deterministic output decision that is out of touch with reality. Tuning only helps if there is training from a previous input. As far as I know (casual research), there still isn't a great solution to this, only marketing hype.

jedimastert• 23 days ago

I'm seeing surprisingly few comments about OP getting homeopathic treatment

dsign• 23 days ago

There's something incredibly peaceful about being in the hands of an expert you trust. You don't have to worry anymore and can let them guide you through the process.
AI can absolutely shatter that feeling in an uncomfortable way...

As a mental experiment, think how things would look like if the AIs were right more often than doctors. Then living longer and being healthier would imply living with a lot of "technical medical worries" that you don't longer get to outsource to a black-boxy human wearing whites. I know some people who are already ridding that train.

steele• 23 days ago

I wonder what this article would have concluded if the author considered how many individuals of the HN readership were professional radiologists.

Volsk1• 23 days ago

I thought this was an interesting experiment and I repeated it with my own DICOM. Results are terrible. Claude has complete opposite diagnosis on my ACL, mensci and cartilage.

Claude: Primary finding: Complete ACL tear with the classic pivot-shift bone bruise signature (posterior lateral femoral condyle + anterior lateral tibial plateau edema) and large hemarthrosis. PCL, MCL, LCL, menisci, and cartilage all intact.

Radiologist: English translation of findings & conclusion: Mild joint effusion. No Baker's cyst. Post-ACL reconstruction with minor cyst formation in both the femoral and tibial bone tunnels. The ACL graft shows heterogeneous signal but no complete or recurrent rupture. PCL and collateral ligaments intact. The lateral meniscus appears abnormal, likely from prior partial meniscectomy, with significant cartilage loss (partly Grade 4) at the posterior lateral compartment, osteophyte formation, and reactive bone marrow edema. The medial meniscus shows diffuse signal change from prior repair but no recurrent tear (specifically no recurrent bucket-handle tear). Mild chondropathy with focal cartilage loss on the lateral side of the medial femoral condyle. Cyclops lesion present. No definite loose bodies.

Maro2• 23 days ago

Recently I was at the doctor for a very minor sports injury ("tennis leg"). The doctor — who was in his 50s — was explaining the degrees of the injury to me, and quoted ChatGPT as the source, along the lines of "ChatGPT usually says you have to rest for.." I thought it's quite funny, but after thinking about it, it's really no surprise that doctors also use AIs to look things up / clean up their diagnosis.

order-matters• 23 days ago

the more I think about what intelligence really is and what it is about humans that AIs seem unable to replicate, the closer I come to the conclusion that personality is a huge component of intelligence. Certain problem spaces have a structure such that personality differences are stripped away, like in math problems for example, but more and more I am genuinely starting to believe that personality drives intelligence.

There is an undeniable mechanical / logical / objective component to intelligence that acts as the machine to get answers, but I am becoming ever increasingly convinced that you cannot actually separate this machine from personality and still perform at the highest level it is capable of. Communication has its own intelligence limits, and I do not think the marketing angle of "putting intelligence on a meter for you to buy" is going to be an actual real application of intelligence. Not without also outsourcing your personality or being satisfied with a flanderized impersonator of yourself as part of the intelligence

it may seem like this sort of thing should be ignorable for analyzing an MRI, that it's an objective conclusion. But medicine is not really as black and white as it seems. Doctors often have different opinions and they are credible. scans are not oracles, interpretation is involved, as well as a measurement of faith in what the patients body is able to do on its own and what it cant. hard to describe in a simple comment, but the point is that medical diagnosis are not exaclty something that can be packaged into perfect products for consumption to turn into the 1 and only treatment that's best for you

shadowtree• 23 days ago

Word of caution, I used Claude to read my MRI images too.

Looked legit.

Until I really dug in, and found that all it did was read the embedded annotations.

DICOM is a container format after all.

kensai• 23 days ago

As a neurologist I read often imaging findings myself. However, one ability of the radiologists I appreciate is their ability to discern through artifacts by years of experience. I am not convinced the current AI crop can reach this level of discerning yet. But I am pretty sure they will reach us and surpass us there as well.

For the moment, I would prefer the final opinion always to be from a human (the human-in-the-loop approach in medicine). Best course of action is to run these LLM assessments and bring them to the next appointment and challenge constructively the doctor.

pmarreck• 23 days ago

The text on this is unreadable on my machine because the background immediately goes to white.

nums3• 23 days ago

Here's an example that illustrates a shortcoming about how medicine has historically been practiced and how it might change with the advent of AI.

A person very familiar with me was having an interaction at a review board level at Stanford. They had this rare illness that they were treating and someone had the "bright idea" of suggesting of saying ... "hey, why don't we look at the ten other times we treated this exact illness and see what worked!" Everyone was delighted with this novel idea (discussion circa 2021). My person was a bit disgusted as this is simple feedback loop style improvement and WTF! they should be doing this all the time to get probabilistic style suggestions for many treatments. I know it happens within certain healthcare systems (e.g., Kaiser had full EMR back in early 2000s and saw right away that VIOXX was killing people. So, they stop prescribing it. citation: Kaiser panel member paraphrase at a healthcare conference in 2010). If you just observe the healthcare system, you can see that the healthcare systems and most EMRs don't typically capture the feedback loop (i.e, when's the last time a doctor followed up and said "did you feel better after the last treatment?" or measures the result.) AI itself can't solve this as it doesn't have access to the data feedback loop. However, maybe AI's within the EMR will help "suggest" evidence based treatments. I could go on and on, but as a math guy, I've often been shocked at the non-evidence based assertions some doctors make. My conclusion is that if you're not "in the fairway", they are typically just guessing.

harhargange• 23 days ago

I was building a pc and the ai was hellbent on saying either the cpu pins are bent or motherboard is faulty. Both giving me a panic attack. The solution came from updating bios which i had done so ai ruled it out. But the shop owner did the bios update again and it worked

rurban• 22 days ago

If you ever get a MRI!

I'd like to have one for my broken shoulder, but they decided the x-ray is good enough before my shoulder OP. At least I got a date for my shoulder OP one year after the accident. Everything's perfect in Germany.

zftnb666• 21 days ago

Trusting Claude Code with my MRI before I trust it with my production database. Priorities.

I used Claude Code to get a second opinion on my MRI

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