AI从医生助手变主导,全程独立完成临床诊断
Reverse Physician-AI Relationship: Full-process Clinical Diagnosis Driven by a Large Language Model
- AI担任诊断主控,从模糊主诉出发自主推进全流程
- 在罕见病与复杂病例中准确率显著优于现有模型
- 可大幅减轻医生负担,适合高负荷医疗场景使用
真实世界的全流程临床诊断始于模糊的主诉,当前人工智能(尤其是大语言模型)主要作为医生辅助工具,仅能在特定环节回答具体问题,无法从初始症状出发驱动完整诊断流程,仍高度依赖医生。为此,我们提出颠覆性范式:将AI置于主导地位,医生作为其助手。由此构建的DxDirector-7B模型具备深度推理能力,可独立完成全流程诊断,并建立误诊责任划分机制。在罕见病、复杂病及真实病例上的评估显示,该模型诊断准确率显著优于先进医疗LLM和通用大模型,同时大幅降低医生工作量。多科室细粒度分析验证其有效性,专家评估认为其具备替代专科医生的潜力。这标志着AI从辅助角色转向主导角色,开启高效精准诊断新纪元。
原文摘要 · Abstract (English)
Full-process clinical diagnosis in the real world encompasses the entire diagnostic workflow that begins with only an ambiguous chief complaint. While artificial intelligence (AI), particularly large language models (LLMs), is transforming clinical diagnosis, its role remains largely as an assistant to physicians. This AI-assisted working pattern makes AI can only answer specific medical questions at certain parts within the diagnostic process, but lack the ability to drive the entire diagnostic process starting from an ambiguous complaint, which still relies heavily on human physicians. This gap limits AI's ability to fully reduce physicians' workload and enhance diagnostic efficiency. To address this, we propose a paradigm shift that reverses the relationship between physicians and AI: repositioning AI as the primary director, with physicians serving as its assistants. So we present DxDirector-7B, an LLM endowed with advanced deep thinking capabilities, enabling it to drive the full-process diagnosis with minimal physician involvement. Furthermore, DxDirector-7B establishes a robust accountability framework for misdiagnoses, delineating responsibility between AI and human physicians. In evaluations across rare, complex, and real-world cases under full-process diagnosis setting, DxDirector-7B not only achieves significant superior diagnostic accuracy but also substantially reduces physician workload than state-of-the-art medical LLMs as well as general-purpose LLMs. Fine-grained analyses across multiple clinical departments and tasks validate its efficacy, with expert evaluations indicating its potential to serve as a viable substitute for medical specialists. These findings mark a new era where AI, traditionally a physicians' assistant, now drives the entire diagnostic process to drastically reduce physicians' workload, indicating an efficient and accurate diagnostic solution.
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