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Hager, P.* ; Jungmann, F.* ; Holland, R.* ; Bhagat, K.* ; Hubrecht, I.* ; Knauer, M.* ; Vielhauer, J.* ; Makowski, M.* ; Braren, R.* ; Kaissis, G. ; Rueckert, D.*

Evaluation and mitigation of the limitations of large language models in clinical decision-making.

Nat. Med., DOI: 10.1038/s41591-024-03097-1 (2024)
Publ. Version/Full Text DOI PMC
Open Access Gold (Paid Option)
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Clinical decision-making is one of the most impactful parts of a physician's responsibilities and stands to benefit greatly from artificial intelligence solutions and large language models (LLMs) in particular. However, while LLMs have achieved excellent performance on medical licensing exams, these tests fail to assess many skills necessary for deployment in a realistic clinical decision-making environment, including gathering information, adhering to guidelines, and integrating into clinical workflows. Here we have created a curated dataset based on the Medical Information Mart for Intensive Care database spanning 2,400 real patient cases and four common abdominal pathologies as well as a framework to simulate a realistic clinical setting. We show that current state-of-the-art LLMs do not accurately diagnose patients across all pathologies (performing significantly worse than physicians), follow neither diagnostic nor treatment guidelines, and cannot interpret laboratory results, thus posing a serious risk to the health of patients. Furthermore, we move beyond diagnostic accuracy and demonstrate that they cannot be easily integrated into existing workflows because they often fail to follow instructions and are sensitive to both the quantity and order of information. Overall, our analysis reveals that LLMs are currently not ready for autonomous clinical decision-making while providing a dataset and framework to guide future studies.
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Publication type Article: Journal article
Document type Scientific Article
Corresponding Author
ISSN (print) / ISBN 1078-8956
e-ISSN 1546-170X
Journal Nature medicine
Publisher Nature Publishing Group
Publishing Place New York, NY
Non-patent literature Publications
Reviewing status Peer reviewed
Institute(s) Institute for Machine Learning in Biomed Imaging (IML)