Evaluating Locally Run Large Language Models (Gemma 2, Mistral Nemo, and Llama 3) for Outpatient Otorhinolaryngology Care: Retrospective Study

Background: Large language models (LLMs) have great potential to improve and make the work of clinicians more efficient. Previous studies have mainly focused on web-based services, such as ChatGPT, often with simulated cases. For the processing of personalized patient data, web-based services have major data protection concerns. Ensuring compliance with data protection and medical device regulations therefore remains a critical challenge for adopting LLMs in clinical settings. Objective: This retrospective single-center study aimed to evaluate locally run LLMs (Gemma 2, Mistral Nemo, and Llama 3) in providing diagnosis and treatment recommendation for real-world outpatient cases in otorhinolaryngology (ORL). Methods: Outpatient cases (n=30) from regular consultation hours and the emergency service at a university hospital ORL outpatient department were randomly selected. Documentation by ORL doctors, including anamnesis and examination results, was passed to the locally run LLMs (Gemma 2, Mistral Nemo, and Llama 3), which were asked to provide diagnostic and treatment strategies. Recommendations of the LLMs and the treating ORL doctors were rated by 3 experienced ORL consultants on a 6-point Likert scale for medical adequacy, conciseness, coherence, and comprehensibility. Moreover, consultants were asked whether the answers pose a risk to the patient's safety. A modified Turing test was performed to distinguish responses generated by LLMs from those of doctors. Finally, the potential influence of the information generated by the LLMs on the raters' own diagnosis and treatment opinions was evaluated. Results: Over all categories, ORL doctors achieved superior (P<.0005) ratings compared to locally run LLMs (Llama 3, Mistral Nemo, and Gemma 2). ORL doctors' responses were considered hazardous for patients in only 1% of the ratings, whereas recommendations by Llama 3, Gemma 2, and Mistral Nemo were considered hazardous in 54%, 47%, and 32% of cases, respectively. According to the raters, the LLM's information rarely influenced their judgment, with Mistral Nemo, Gemma 2, and Llama 3 achieving 1%, 3%, and 4% of the ratings, respectively. Conclusions: Although locally run LLM models still underperform compared with their web-based counterparts, they achieved respectable results on outpatient treatment in this study. Nevertheless, the retrospective and single-center nature of the study, along with the clinicians' documentation style, may have introduced bias in favor of human recommendations. In the future, locally run LLMs will help address data protection concerns; however, further refinement and prospective validation are still needed to meet strict medical device requirements. As locally run LLMs continue to evolve, they are likely to become comparably powerful to web-based LLMs and become established as useful tools to support doctors in clinical practice.

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