Exploring the Past — and Future — of Medical Diagnosis and Artificial Intelligence

This perspective summarizes the episode of NEJM AI Grand Rounds in which Dr. Adam Rodman joins cohosts Drs. Arjun Manrai and Andrew Beam for a wide-ranging conversation about the history and future of medical diagnosis.1 Drawing on his experience as a historian of medical epistemology and clinical reasoning — that is, how doctors "know" things about diseases and their patients — Dr. Rodman places our current discussion about the diagnostic abilities of large language models (LLMs) into a century-long context of attempts to build diagnostic artificial intelligence. Dr. Rodman shares his surprise at the diagnostic reasoning abilities of LLMs and his own research on clinical evaluations of the Generative Pre-trained Transformer 4 (GPT-4) model and its ability to change human reasoning. We discuss the implications of these technologies for future medical practice and medical education, with optimism that these technologies might be able to preserve — or really rediscover — the most human elements of medicine.