Comparison of Diagnostic and Triage Accuracy of Ada Health and WebMD Symptom Checkers, ChatGPT, and Physicians for Patients in an Emergency Department: Clinical Data Analysis Study
Bibliographic record
Abstract
BACKGROUND: Diagnosis is a core component of effective health care, but misdiagnosis is common and can put patients at risk. Diagnostic decision support systems can play a role in improving diagnosis by physicians and other health care workers. Symptom checkers (SCs) have been designed to improve diagnosis and triage (ie, which level of care to seek) by patients. OBJECTIVE: The aim of this study was to evaluate the performance of the new large language model ChatGPT (versions 3.5 and 4.0), the widely used WebMD SC, and an SC developed by Ada Health in the diagnosis and triage of patients with urgent or emergent clinical problems compared with the final emergency department (ED) diagnoses and physician reviews. METHODS: We used previously collected, deidentified, self-report data from 40 patients presenting to an ED for care who used the Ada SC to record their symptoms prior to seeing the ED physician. Deidentified data were entered into ChatGPT versions 3.5 and 4.0 and WebMD by a research assistant blinded to diagnoses and triage. Diagnoses from all 4 systems were compared with the previously abstracted final diagnoses in the ED as well as with diagnoses and triage recommendations from three independent board-certified ED physicians who had blindly reviewed the self-report clinical data from Ada. Diagnostic accuracy was calculated as the proportion of the diagnoses from ChatGPT, Ada SC, WebMD SC, and the independent physicians that matched at least one ED diagnosis (stratified as top 1 or top 3). Triage accuracy was calculated as the number of recommendations from ChatGPT, WebMD, or Ada that agreed with at least 2 of the independent physicians or were rated "unsafe" or "too cautious." RESULTS: Overall, 30 and 37 cases had sufficient data for diagnostic and triage analysis, respectively. The rate of top-1 diagnosis matches for Ada, ChatGPT 3.5, ChatGPT 4.0, and WebMD was 9 (30%), 12 (40%), 10 (33%), and 12 (40%), respectively, with a mean rate of 47% for the physicians. The rate of top-3 diagnostic matches for Ada, ChatGPT 3.5, ChatGPT 4.0, and WebMD was 19 (63%), 19 (63%), 15 (50%), and 17 (57%), respectively, with a mean rate of 69% for physicians. The distribution of triage results for Ada was 62% (n=23) agree, 14% unsafe (n=5), and 24% (n=9) too cautious; that for ChatGPT 3.5 was 59% (n=22) agree, 41% (n=15) unsafe, and 0% (n=0) too cautious; that for ChatGPT 4.0 was 76% (n=28) agree, 22% (n=8) unsafe, and 3% (n=1) too cautious; and that for WebMD was 70% (n=26) agree, 19% (n=7) unsafe, and 11% (n=4) too cautious. The unsafe triage rate for ChatGPT 3.5 (41%) was significantly higher (P=.009) than that of Ada (14%). CONCLUSIONS: ChatGPT 3.5 had high diagnostic accuracy but a high unsafe triage rate. ChatGPT 4.0 had the poorest diagnostic accuracy, but a lower unsafe triage rate and the highest triage agreement with the physicians. The Ada and WebMD SCs performed better overall than ChatGPT. Unsupervised patient use of ChatGPT for diagnosis and triage is not recommended without improvements to triage accuracy and extensive clinical evaluation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.046 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".