Adam Rodman
@adamrodmanmd.bsky.social
Physician, educator, historian, author, podcaster, researcher at Beth Israel Deaconess Medical Center and Harvard Medical School, host of histmed podcast Bedside Rounds, associate editor at NEJM AI, studies 🤖+🧠. 🖖🚲
As I'm writing this, I realize I'm probably not making anyone feel better😀
TL;DR: I largely agree with your premise, but it's going to take longer, and have much more slow and incremental change (and then fast and epistemic change) than the tech bros think
TL;DR: I largely agree with your premise, but it's going to take longer, and have much more slow and incremental change (and then fast and epistemic change) than the tech bros think
October 30, 2025 at 12:03 PM
As I'm writing this, I realize I'm probably not making anyone feel better😀
TL;DR: I largely agree with your premise, but it's going to take longer, and have much more slow and incremental change (and then fast and epistemic change) than the tech bros think
TL;DR: I largely agree with your premise, but it's going to take longer, and have much more slow and incremental change (and then fast and epistemic change) than the tech bros think
... since most of the proposed regulatory systems rely on tech that doesn't really exist yet.
October 30, 2025 at 12:02 PM
... since most of the proposed regulatory systems rely on tech that doesn't really exist yet.
There's also the regulatory angle. I think that SaMD absolutists are delusional (and probably not talking to anyone in the government), but companies are going to need some sort of regulatory structure in order to make investments in this space. That's a problem (right now) too...
October 30, 2025 at 12:01 PM
There's also the regulatory angle. I think that SaMD absolutists are delusional (and probably not talking to anyone in the government), but companies are going to need some sort of regulatory structure in order to make investments in this space. That's a problem (right now) too...
... but I see no signs that OE is doing that, and I don't think that's happening in the short term (which, I mean, is like 5 years)
October 30, 2025 at 12:00 PM
... but I see no signs that OE is doing that, and I don't think that's happening in the short term (which, I mean, is like 5 years)
I think it's much more likely that OE wants to become the indispensable tool for doctors, and leverage the massive amount of data that they collect on us.
I also think that means that eventually, an OE API might become part of an evidence retrieval agent for a semi-autonomous HITL->HOTL system...
I also think that means that eventually, an OE API might become part of an evidence retrieval agent for a semi-autonomous HITL->HOTL system...
October 30, 2025 at 11:59 AM
I think it's much more likely that OE wants to become the indispensable tool for doctors, and leverage the massive amount of data that they collect on us.
I also think that means that eventually, an OE API might become part of an evidence retrieval agent for a semi-autonomous HITL->HOTL system...
I also think that means that eventually, an OE API might become part of an evidence retrieval agent for a semi-autonomous HITL->HOTL system...
But that's the *easy* part. Building out workflows, developing and testing oversight systems, and then deploying and iterating -- that is a MUCH larger challenge. If OE wants to do that, they've made no signs in their hiring, or any acquisitions.
October 30, 2025 at 11:58 AM
But that's the *easy* part. Building out workflows, developing and testing oversight systems, and then deploying and iterating -- that is a MUCH larger challenge. If OE wants to do that, they've made no signs in their hiring, or any acquisitions.
... for many tasks at least.
OE has built an industry standard for an incredibly important part of that (knowledge retrieval), and their moat is now their content agreements, as well as the RL from all of their users.
OE has built an industry standard for an incredibly important part of that (knowledge retrieval), and their moat is now their content agreements, as well as the RL from all of their users.
October 30, 2025 at 11:57 AM
... for many tasks at least.
OE has built an industry standard for an incredibly important part of that (knowledge retrieval), and their moat is now their content agreements, as well as the RL from all of their users.
OE has built an industry standard for an incredibly important part of that (knowledge retrieval), and their moat is now their content agreements, as well as the RL from all of their users.
Maybe I can make you feel better (in the short run at least).
Replacing doctors (or rather creating agentic workflows that allow for moving from HITL to HOTL) is both an immense technological and oversight system challenge (though I believe that it's fully doable).
Replacing doctors (or rather creating agentic workflows that allow for moving from HITL to HOTL) is both an immense technological and oversight system challenge (though I believe that it's fully doable).
October 30, 2025 at 11:55 AM
Maybe I can make you feel better (in the short run at least).
Replacing doctors (or rather creating agentic workflows that allow for moving from HITL to HOTL) is both an immense technological and oversight system challenge (though I believe that it's fully doable).
Replacing doctors (or rather creating agentic workflows that allow for moving from HITL to HOTL) is both an immense technological and oversight system challenge (though I believe that it's fully doable).
All of these studies have limitations of course -- but the evidence suggests that LLMs can absolutely collect information in meaningful ways directly from patients at least within certain confines (especially telehealth-style urgent care).
October 17, 2025 at 6:40 PM
All of these studies have limitations of course -- but the evidence suggests that LLMs can absolutely collect information in meaningful ways directly from patients at least within certain confines (especially telehealth-style urgent care).
Similarly, the K health studies again show LLMs (though the K-health system uses multiple types of tech) are capable of collecting patient histories (in urgent care)
October 17, 2025 at 6:38 PM
Similarly, the K health studies again show LLMs (though the K-health system uses multiple types of tech) are capable of collecting patient histories (in urgent care)
LLMs work well at eliciting information (from patient actors, compared to a blinded human, via a chat interface). The study the OP is referring to is CRAFT-MD, which uses MedQA questions and two LLMs role-playing a human and a patient.
Clinical trial data coming soon.
Clinical trial data coming soon.
October 17, 2025 at 6:37 PM
LLMs work well at eliciting information (from patient actors, compared to a blinded human, via a chat interface). The study the OP is referring to is CRAFT-MD, which uses MedQA questions and two LLMs role-playing a human and a patient.
Clinical trial data coming soon.
Clinical trial data coming soon.
I don't think being anti-AI is the solution -- just to be thoughtful about it. EG, me and my resident made a neurological diagnosis (we are not neurologists) by using GPT-5 to help guide us on the bedside neurological exam. Lord knows I'm not usually breaking out Hoffman's sign
October 17, 2025 at 2:21 PM
I don't think being anti-AI is the solution -- just to be thoughtful about it. EG, me and my resident made a neurological diagnosis (we are not neurologists) by using GPT-5 to help guide us on the bedside neurological exam. Lord knows I'm not usually breaking out Hoffman's sign
So maybe 15 years from now none of this will matter (though I'm skeptical) -- but in the meantime, I think I stand by what I told Dhruv in that story, if we (meaning educators) don't figure out how to train the next gen in this environment, we're all screwed.
October 17, 2025 at 1:19 PM
So maybe 15 years from now none of this will matter (though I'm skeptical) -- but in the meantime, I think I stand by what I told Dhruv in that story, if we (meaning educators) don't figure out how to train the next gen in this environment, we're all screwed.
(plus, it's not like there's going to be an "AI doctor" -- there will have to be brand new workflows, safety systems, and regulatory environments)
October 17, 2025 at 1:18 PM
(plus, it's not like there's going to be an "AI doctor" -- there will have to be brand new workflows, safety systems, and regulatory environments)
in the near future (reward systems favor classification, though of course we all know that for many important diagnoses we never get anything close to a definitive answer).
But management reasoning at a physician level is probably beyond that these systems can reasonably do
But management reasoning at a physician level is probably beyond that these systems can reasonably do
October 17, 2025 at 1:17 PM
in the near future (reward systems favor classification, though of course we all know that for many important diagnoses we never get anything close to a definitive answer).
But management reasoning at a physician level is probably beyond that these systems can reasonably do
But management reasoning at a physician level is probably beyond that these systems can reasonably do
This probably WOULDN'T matter too much if this current generation of tech would uniformly outperform doctors.
But it won't. I'm actually much more optimistic than @ericstrong.bsky.social that diagnostic reasoning will largely be done better than LLMs for a variety of diagnoses (not just esoterica)
But it won't. I'm actually much more optimistic than @ericstrong.bsky.social that diagnostic reasoning will largely be done better than LLMs for a variety of diagnoses (not just esoterica)
October 17, 2025 at 1:17 PM
This probably WOULDN'T matter too much if this current generation of tech would uniformly outperform doctors.
But it won't. I'm actually much more optimistic than @ericstrong.bsky.social that diagnostic reasoning will largely be done better than LLMs for a variety of diagnoses (not just esoterica)
But it won't. I'm actually much more optimistic than @ericstrong.bsky.social that diagnostic reasoning will largely be done better than LLMs for a variety of diagnoses (not just esoterica)
We don't have a LOT of evidence yet about what overreliance on the tools does to our diagnostic (and management) reasoning abilities, but there's plenty of reason from other domains (and our psychological understanding of learning) that it degrades them.
October 17, 2025 at 1:15 PM
We don't have a LOT of evidence yet about what overreliance on the tools does to our diagnostic (and management) reasoning abilities, but there's plenty of reason from other domains (and our psychological understanding of learning) that it degrades them.
My biggest concern about this technology in the short (and, well, medium)-term is what is does to US, especially the current generation of doctors in training. Even the difference between my third year and first-year residents is pretty stark in their use of AI tools (especially Open Evidence)
October 17, 2025 at 1:14 PM
My biggest concern about this technology in the short (and, well, medium)-term is what is does to US, especially the current generation of doctors in training. Even the difference between my third year and first-year residents is pretty stark in their use of AI tools (especially Open Evidence)
I think another big difference in the ICU is that line volume is also much less than it was in the past. So also fewer opportunities.
September 25, 2025 at 12:54 AM
I think another big difference in the ICU is that line volume is also much less than it was in the past. So also fewer opportunities.
I was going to say, as one of our proceduralist hospitalists, this problem stretches back to the 2010s or even 2000s. Back when I was an intern (2013), we were gnashing out teeth about it.
September 24, 2025 at 7:26 PM
I was going to say, as one of our proceduralist hospitalists, this problem stretches back to the 2010s or even 2000s. Back when I was an intern (2013), we were gnashing out teeth about it.
Congrats! They're lucky to have you!
June 4, 2025 at 2:20 PM
Congrats! They're lucky to have you!