Human–AI collectives most accurately diagnose clinical vignettes
Bibliographic record
Abstract
AI systems, particularly large language models (LLMs), are increasingly being employed in high-stakes decisions that impact both individuals and society at large, often without adequate safeguards to ensure safety, quality, and equity. Yet LLMs hallucinate, lack common sense, and are biased-shortcomings that may reflect LLMs' inherent limitations and thus may not be remedied by more sophisticated architectures, more data, or more human feedback. Relying solely on LLMs for complex, high-stakes decisions is therefore problematic. Here, we present a hybrid collective intelligence system that mitigates these risks by leveraging the complementary strengths of human experience and the vast information processed by LLMs. We apply our method to open-ended medical diagnostics, combining 40,762 differential diagnoses made by physicians with the diagnoses of five state-of-the art LLMs across 2,133 text-based medical case vignettes. We show that hybrid collectives of physicians and LLMs outperform both single physicians and physician collectives, as well as single LLMs and LLM ensembles. This result holds across a range of medical specialties and professional experience and can be attributed to humans' and LLMs' complementary contributions that lead to different kinds of errors. Our approach highlights the potential for collective human and machine intelligence to improve accuracy in complex, open-ended domains like medical diagnostics.
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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 | 0.050 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
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".