Evaluating the role of large language models in inflammatory bowel disease patient information

Abstract

This letter evaluates the article by Gravina et al on ChatGPT’s potential in providing medical information for inflammatory bowel disease patients. While promising, it highlights the need for advanced techniques like reasoning + action and retrieval-augmented generation to improve accuracy and reliability. Emphasizing that simple question and answer testing is insufficient, it calls for more nuanced evaluation methods to truly gauge large language models’ capabilities in clinical applications.

Key Words: Crohn’s disease, Ulcerative colitis, Inflammatory bowel disease, Chat generative pre-trained transformer, Large language model, Artificial intelligence

Core Tip: This commentary evaluates the article by Gravina et al on ChatGPT’s potential in providing medical information for inflammatory bowel disease patients. While promising, it highlights the need for advanced techniques like reasoning + action and retrieval-augmented generation to improve accuracy, emphasizing that simple question-and-answer testing is insufficient for evaluating large language models’ true capabilities.

TO THE EDITOR

We are writing to express out thoughts on the recently published article by Gravina et al[1]. Gravina et al[1] assessed the capability of large language models (LLMs) like ChatGPT to provide plausible medical information to patients with inflammatory bowel disease (IBD). Despite identifying several limitations, the authors concluded that there is significant potential in using LLMs for this purpose[1].

One of the key insights from the article is the potential for ChatGPT to offer immediate and accessible information to patients. The authors correctly note that this could be particularly beneficial in providing preliminary guidance and answering common queries that patients may have about their condition. This aligns with the increasing trend of patients seeking health information online before consulting their healthcare providers.

However, the study also underscores significant limitations, such as the potential for outdated or inaccurate information. Given that medical knowledge is continuously evolving, it is crucial for artificial intelligence (AI) tools like ChatGPT to have mechanisms for regular updates to ensure the information provided is current and evidence-based[1]. This is especially important for chronic conditions like IBD, where treatment guidelines and best practices frequently change.

A pertinent question arises: Can LLMs truly perform inference? Current AI-based agents utilizing LLMs operate by either generating answers directly or referring to external tools if the LLM itself cannot provide an answer. These agents determine the necessary information, redefine the questions, call appropriate tools to extract information, analyze the extracted data, and iterate this process as needed to reach a final answer. This pattern, known as reasoning + action, closely mimics human problem-solving by iteratively refining questions and seeking relevant tools rather than merely retrieving similar past solutions[2].

The effectiveness of such an approach often hinges on prompt engineering. Enhanced prompt engineering can significantly improve the accuracy of LLM-generated answers by aligning queries more closely with the model’s trained data and inference capabilities. Therefore, evaluating LLMs based on selected questions often reflects their proficiency in leveraging search tools to produce desired answers. Advanced prompt engineering techniques can potentially yield more accurate responses, indicating that simple question-and-answer testing might not fully capture an LLM’s capabilities[3].

Moreover, the retrieval-augmented generation (RAG) technique enhances traditional LLMs by enabling real-time retrieval of external data not included in the training dataset, thus generating answers that integrate the latest information. This approach helps prevent hallucination and allows the model to utilize a broader knowledge base. However, standardized performance evaluation of these advanced techniques remains challenging due to the limited benchmarks available, making it difficult to assess using only a few representative questions[4].

Another important point raised by the authors is the issue of contextual understanding and empathy, which AI currently lacks. The physician patient relationship is built on trust and understanding, and while AI can provide factual information, it cannot replace the nuanced, empathetic communication that healthcare providers offer. This aspect is particularly vital for managing chronic diseases that significantly impact patients’ quality of life[1].

The authors’ recommendation for further refinement and alignment of AI outputs with reliable medical databases is essential. Such improvements could enhance the accuracy and reliability of AI-generated medical information, making it a more robust tool for both patients and healthcare providers.

Despite these challenges, there is no doubt that LLMs, equipped with sophisticated learning datasets and RAG capabilities, hold promise for clinical application. However, evaluating their potential solely based on simple question-answer accuracy is inadequate. It is essential to consider the advanced techniques and iterative processes that significantly enhance the precision and reliability of LLM-generated medical information.

In conclusion, the article by Gravina et al[1] provides valuable insights into the current capabilities and limitations of AI in gastroenterology. While promising, further refinement and a more nuanced evaluation approach are crucial for realizing the full potential of AI in healthcare. Continued research and development, combined with rigorous validation against established medical standards, will be essential.