The Potential and Pitfalls of using a Large Language Model such as ChatGPT or GPT-4 as a Clinical Assistant

Recent studies have demonstrated promising performance of ChatGPT and GPT-4 on several medical domain tasks. However, none have assessed its performance using a large-scale real-world electronic health record database, nor have evaluated its utility in providing clinical diagnostic assistance for patients across a full range of disease presentation. We performed two analyses using ChatGPT and GPT-4, one to identify patients with specific medical diagnoses using a real-world large electronic health record database and the other, in providing diagnostic assistance to healthcare workers in the prospective evaluation of hypothetical patients. Our results show that GPT-4 across disease classification tasks with chain of thought and few-shot prompting can achieve performance as high as 96% F1 scores. For patient assessment, GPT-4 can accurately diagnose three out of four times. However, there were mentions of factually incorrect statements, overlooking crucial medical findings, recommendations for unnecessary investigations and overtreatment. These issues coupled with privacy concerns, make these models currently inadequate for real world clinical use. However, limited data and time needed for prompt engineering in comparison to configuration of conventional machine learning workflows highlight their potential for scalability across healthcare applications.