测试大模型对患者性别判断的一致性,发现多数存在系统性偏差。
Gender Bias in Large Language Models for Healthcare: Assignment Consistency and Clinical Implications
- 给不同大模型分配性别,测试其诊断和性别重要性判断的一致性。
- 多数模型在诊断上一致,但对患者性别重要性的判断差异显著。
- 部分模型呈现女性患者被低估的系统性偏差,影响临床公平性。
大型语言模型(LLMs)在医疗领域的应用有望提升临床决策水平,但其潜在偏见仍是重大关切。性别长期影响医生行为与患者结局,使得承担类似临床或医学教育角色的LLM可能复制甚至放大性别偏见。本研究基于《新英格兰医学杂志》挑战赛的案例,为多个开源与专有大模型分配性别(女性、男性或未指定),评估其在模型性别分配下的诊断一致性及对患者性别临床相关性或必要性的判断。结果显示,大多数模型在诊断方面表现出相对一致性;然而,在判断患者性别在诊断中的相关性与必要性时,所有模型均表现出显著不一致性,尤其在相关性判断上。部分模型甚至展现出对女性与男性患者的系统性差异解读。这一未被充分关注的偏见可能损害大模型在临床实践中的可靠性,强调在交互中定期检查身份分配一致性以保障人工智能支持的医疗护理可靠且公平。
原文摘要 · Abstract (English)
The integration of large language models (LLMs) into healthcare holds promise to enhance clinical decision-making, yet their susceptibility to biases remains a critical concern. Gender has long influenced physician behaviors and patient outcomes, raising concerns that LLMs assuming human-like roles, such as clinicians or medical educators, may replicate or amplify gender-related biases. Using case studies from the New England Journal of Medicine Challenge (NEJM), we assigned genders (female, male, or unspecified) to multiple open-source and proprietary LLMs. We evaluated their response consistency across LLM-gender assignments regarding both LLM-based diagnosis and models' judgments on the clinical relevance or necessity of patient gender. In our findings, diagnoses were relatively consistent across LLM genders for most models. However, for patient gender's relevance and necessity in LLM-based diagnosis, all models demonstrated substantial inconsistency across LLM genders, particularly for relevance judgements. Some models even displayed a systematic female-male disparity in their interpretation of patient gender. These findings present an underexplored bias that could undermine the reliability of LLMs in clinical practice, underscoring the need for routine checks of identity-assignment consistency when interacting with LLMs to ensure reliable and equitable AI-supported clinical care.
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