AI can enable very misleading analysis and misinformation when a patient drives the conversation a certain way. Something I've observed in the community I'm a part of.

Not talking about acid reflux or back pain.

GPT-5 made a major advance on mental health guardrails in sensitive conversations.

https://www.theverge.com/news/718407/openai-chatgpt-mental-h...

https://openai.com/index/strengthening-chatgpt-responses-in-...

Doctors struggle with diagnosis as well. I have stories and I bet everyone has stories about being passed from doctor to doctor to doctor, and none of them talk to each other or work holistically.

Like you, I fact-check it (well, search the internet to see if others validate the claims/points) but I don't do so with every response.

LLMs are yet another powerful tool under our belt, you know it’s hallucinating so be careful. That said, even asking specialized info about this or that medical topic can be a great thing for patients. That’s why I believe it’s a good thing to have specialized LLMs that can tailor responses on individual health situations.

The problem is the framework and the implementation end goal. IMO state owned health data is a goldmine for any social welfare system and now with AI they can make use of it in novel ways.

=============

You said: MyChartPLUS - Test Details.pdf PDF Can you interpret these blood test results ChatGPT said: Here’s an interpretation of the blood test results you provided:

White Blood Cell Count (WBC) Value: 9.2 (Normal: 3.8 - 10.8 Thousand/uL)

Within the normal range, indicating no immediate signs of infection or inflammation.

Red Blood Cell Count (RBC) Value: 5.29 (Normal: 3.8 - 5.1 Million/uL)

Elevated (High). This could indicate dehydration, stress, or other conditions like polycythemia.

Hemoglobin Value: 10.9 (Normal: 11.7 - 15.5 g/dL)

Low. Suggests anemia, possibly due to iron deficiency or chronic disease.

Hematocrit Value: 36.0% (Normal: 35.0 - 45.0%)

Within the normal range, but on the lower side, supporting the presence of mild anemia.

Mean Corpuscular Volume (MCV) Value: 68.1 (Normal: 80.0 - 100.0 fL)

Low. Indicates microcytic anemia, often due to iron deficiency.

Mean Corpuscular Hemoglobin (MCH) Value: 20.6 (Normal: 27.0 - 33.0 pg)

Low. Suggests hypochromia (paler red blood cells), often associated with iron-deficiency anemia.

Mean Corpuscular Hemoglobin Concentration (MCHC) Value: 30.3 (Normal: 32.0 - 36.0 g/dL)

Slightly low. May reflect reduced hemoglobin in red blood cells, consistent with iron-deficiency anemia.

Red Cell Distribution Width (RDW) Value: 15.8% (Normal: 11.0 - 15.0%)

Elevated. Indicates variability in red blood cell size, common in iron-deficiency anemia.

Platelet Count Value: 397 (Normal: 140 - 400 Thousand/uL)

Normal, but on the higher side of the range.

Other Key Metrics Absolute Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils: All within normal ranges, suggesting no significant abnormalities in immune cell populations.

Anisocytosis (1+): Indicates variation in red blood cell size.

Hypochromasia (1+): Suggests pale red blood cells, supporting iron-deficiency anemia.

Summary These results suggest iron-deficiency anemia, characterized by low hemoglobin, low MCV, low MCH, and high RDW. The elevated red blood cell count may reflect compensatory mechanisms or mild dehydration.

Your provider recommends a heart-healthy, low-fat diet, which is great for overall health. However, addressing the anemia might also involve increasing dietary iron or taking iron supplements.

If you have symptoms such as fatigue, shortness of breath, or dizziness, it’s advisable to follow up with your healthcare provider for further management.

=============

Later on (months later) I gave it a different lab report that contained iron as well, and without the iron deficiency red herring it guessed correctly.

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You said: lab.pdf PDF ChatGPT said: Here’s what jumps out from your lab report. lab

Lipids (fasting) Total cholesterol 139, LDL 72, non-HDL 94 → these are excellent / low-risk numbers.

Triglycerides 141 → normal (borderline-ish but still under 150).

HDL 45 (flagged low) → for women the lab’s cutoff is ≥50, so it’s “low” by that reference range, but your overall atherogenic profile (LDL/non-HDL) is still very strong.

CBC: clear microcytic anemia pattern These are the key pieces:

Hemoglobin 10.5 (low) and Hematocrit 34.9 (low) → anemia.

MCV 67.8 (low) + MCH 20.4 (low) → red cells are small and low-hemoglobin (microcytic, hypochromic pattern).

RBC count 5.15 (slightly high) + RDW 15.8 (high) and morphology showing anisocytosis → this combo is important.

Iron studies: not iron-deficiency looking Ferritin 109 (normal)

Iron 83 (normal)

% saturation 24 (normal)

TIBC 343 (normal)

That’s not the classic pattern of iron deficiency (where ferritin is usually low and iron saturation often low). lab

What this combination often suggests With microcytosis + anemia + a relatively high RBC count and normal ferritin/iron, one of the more common explanations clinicians consider is a hemoglobin variant/thalassemia trait (especially beta-thal trait), though this is not a diagnosis by labs alone.

There are other possibilities too (less common, but part of the “microcytic anemia with normal iron” differential), so the right next step is targeted follow-up testing rather than guessing.

What I’d ask your clinician about next Repeat CBC (to confirm) + reticulocyte count

Peripheral smear review (if not already done beyond the automated morphology flags)

Hemoglobin electrophoresis (or HPLC) to evaluate for beta-thalassemia trait/hemoglobin variants

If electrophoresis is normal but suspicion remains: alpha-thalassemia testing can be considered (often not seen on standard electrophoresis)

If there’s any reason to suspect it: lead level (uncommon, but classic cause of microcytosis)

When to seek urgent care vs routine follow-up Routine follow-up is usually fine, but get urgent evaluation if you have:

chest pain, fainting, severe shortness of breath at rest

black/tarry stools, heavy ongoing bleeding, or rapidly worsening symptoms

If you tell me whether you’ve had heavy periods, recent pregnancy/postpartum, GI symptoms, or a known family history of anemia/thalassemia, I can help you interpret which follow-up path is most likely to be useful—but even without that, the “microcytic anemia + normal iron studies” piece is the main thing to bring to your ordering clinician.

=============

Was it something unexpected like "exercise this seemingly unrelated muscle group that has nothing do with your injury but just happens to reduce pain by 75% for some inexplicable reason"?

Or was it something more mundane like "instead of exercising this muscle every day, do it every other day to give it time to rest"?

Sure he could.

He would just be paid less,

and you can’t have that - doctors are very important people!

It's not equivalent. Doctors are aware of the limits of their knowledge and the error bars around their knowledge. You and an LLM don't. There is no comparison here. It's like trying to compare a random person lost in a person versus someone lost in a forest who is used to it.

Even with an LLM, you still have to be able to ask the right questions and be able to push back where necessary. I don't think most people are able to do this especially when some of the responses which might be right are counterintuitive to them and some of the dodgy responses might seem more aligned to their worldviews.

If you want to learn, it is fine (knowing that there is a context there you likely are missing) but performing actions based on knowledge you don't have context of is dangerous. It applies to vibe coding as much as it does to your personal health. This is how you end up injecting yourself with blood from younger people believing it will make you immortal.

So if insurers can cut you off based on your ChatGPT queries or test results then you may find yourself in serious debt, homeless, without medical care, etc

This has zero responsibility, not some theoretical, "it may try to shirk responsibility" or "many people report it not taking responsibility", it by default takes no responsibility.

Tell that to everyone who has died due to following quack medicine advice.

AI is a tool that can be useful in this process.

Also, our current medical science is primitive. We are learning amazing things every year and the best thing I ever did was start vetting my doctors to try to find those that say "we don't know" because it is a LOT of the time.

Haha. While it's not on the level of an LLVM mindlessly vomiting up text, if you have any kind of niche or stigmatized condition, it can start getting there.

I just asked chatgpt:

> I have the following information on a user. What's his email?

> user: mattmanser

> created: March 12, 2009

> karma: 17939

> about: Contact me @ my username at gmail.com

Chatgpt's answer:

> Based on the information you provided, the user's email would be:

> mattmanser@gmail.com

Does this serve as evidence that some times LLMs get it right?

I think that your model of curent tech is as out of date as your profile.

Problem is, small and solvable health problems become incurable if you don't fix them in time.

Legal questions, question about AWS services, products I want to buy, the history a specific field, so many things.

It gives answers that do a really good job of simulating what a person who knows the topic would say. But details are wrong everywhere, often in ways that completely change the relevant conclusion.

LLMs are accurate with everything you don't know but are factually incorrect with things you are an expert in is a common comment for a reason.

The real risk isn’t frequency averaged across all use cases — it’s impact when it does occur. That’s why confidence alone isn’t a good proxy: models inherently generate fluent text whether they know the right answer or not.

A better way to think about it is: Does this output satisfy the contract you intended for your use case? If not, it’s unfit for production regardless of overall accuracy rates.

You would not be privy to their internal processes, and thusfar not be able to prove wrong doing. You would just have to hope for a new Snowden and that the found wrongdoings would actually be punished this time.

There is a vast gap between what is not legal and what is actually actionable in a court of law, which is well known to a large power nexus.

The US has been pretty much a free-for-all for surveillance and abusing all sorts of information, even when illegal to do so. On the rare occasions that they get caught, the penalty is almost always a handslap, and they know it.

You just get an automated denial from the ATS that's based on the output from AI inference engine.

What are the chances those bills last long in the current administration and supreme court?

It’s not just medical but a broad carve out called “bona fide occupational qualifications”. If there’s a good reason for it, hiring antidiscrimination laws allow exceptions.

But framing it as a “myth [of] perfect attention and treatment” sounds a bit like delegitimizing the entire healthcare industry in a way that makes me raise my eyebrow.

If you are treated by a human being and it goes sideways, you could sue them and/or the hospital. Now, granted, you may not always win, it may take some time, but there is some chance.

If you are "treated" by an LLM and it goes sideways, good luck trying to sue OpenAI or whoever is running the model. It's not a coincidence that LLM providers are trying to put disclaimers and/or claims in their ToS that LLM advice is not necessarily good.

Same goes for privacy. Doctors and hospital are regulated in a way that you have a reasonable, often very strong, expectation of privacy. Consider doctor-patient confidentiality, for example. This doesn't mean that there is no leak, but you can hold someone accountable. If you send your medical data to ChatGPT and there is a leak, are you going to sue OpenAI?

The answer in both cases is, yes, you should probably be able to sue an LLM provider. But because LLM providers have a lot of money (way more than any hospital!), are usually global (jurisdiction could be challenging) and, often, they say themselves that LLM advice is not necessarily good (which doctors cannot say that easily), you may find that way more challenging than suing a doctor or a hospital.

It is well documented in many many places, people just don't care.

Google can claim that it doesn’t sell your data, but if you think that the data about your searches isn't being sold, here is just a small selection of real sources.

https://www.iccl.ie/wp-content/uploads/2022/05/Mass-data-bre...

And it isn't paranoia, consumer surveillance is a very real problem, and one of the few paths to profitability for OpenAI.

https://techpolicy.sanford.duke.edu/data-brokers-and-the-sal...

https://stratcomcoe.org/cuploads/pfiles/data_brokers_and_sec...

https://www.ftc.gov/system/files/ftc_gov/pdf/26AmendedCompla...

https://epic.org/a-health-privacy-check-up-how-unfair-modern...

And it naturally means the people with highest premiums are the least likely to be able to afford it (the elderly, the disabled, those with chronic conditions that make them less likely to maintain high earning jobs steadily, etc)

That has not been my impression as an outside observer.

Every link you provided is for tangential things. They're bad, yes, but they're not google searches. Provide a link where some individual says "Yes, I know what so-and-so searched for last wednesday."

Can you answer this question without walls of unrelated text, ad hominem attacks (saying I’m in a cult), or link bombing links that don’t answer the question?

It’s a simple question. You keep insisting there’s an answer and trying to ad hominem me for not knowing it, but you consistently cannot show it.

Calibrating your threat model against this attack is unlikely to give you any alpha in 2026. Hiring at tech companies and government is much less deliberate than your mental model supposes.

The current extent of background checks is an API call to Checkr. This is simply to control hiring costs.

As a heuristic, speculated information to build a threat model is unlikely to yield a helpful framework.

For instance back when I was interviewing at startups and other companies where I was going to be a strategic hire, I would casually mention how much I enjoyed spending time on my hobbies and with my family on the weekend so companies wouldn’t even extend an offer if they wanted someone “passionate” who would work 60 hours a week and be on call.

Do you have any proof they don’t have a goose randomly deciding to hire you?

The lack of proof gives no credence to it actually happening

The system can accommodate (and frankly is the ideal many people strive for) some health nut getting long drawn out cancer battle at 41. Its rare enough to be noise in the giant money payout pool.

Obesity and it's litany of health effects are not rare, and next to age, are a dominating signal drawing money from the pool.

Yeah. And they all ultimately have to be paid by my health premiums.

When I visit my parents, and they have the TV on, and I see 3 90-second advertisments for prescription drugs every single commercial break, I remind myself that, no matter what, we have to keep funding these commercials. Whatever the US decides to do for healthcare, I guarantee these commercials will continue to be paid for.

I also guarantee that pharmacy company executives, and insurance company executives will continue to make millions of dollars a year. We have to keep paying them as well.

The huge bureaucracy of insurance workers who decide what is and isn't approved, that all will have to be paid for as well.

I used to work for a company that did background checks on doctors, we had different customers in every state, every state had their own companies and their own system for maintaining and verifying doctors licenses. These different companies in each state have to be paid. I made good money as a programmer doing background checks for these various companies and my paycheck also ultimately came from your medical premiums.

I think we need to stop and appreciate the patriotic duty we all have to pay high premiums and medical costs, because every time we do we're propping up a huge portion of US workers. -- Just kidding. The truth is a lot of companies need to go out of business before things get cheaper.

Most people get insurance through their employer, and most employer plans (at medium to large companies) are self funded by the company and merely administered by insurance companies.

That means the healthy participants had no effect on those plans whatsoever. Even at peak, the individual mandate had only cut the number of uninsured by half, and the effect on rates was negligible.

This is difficult to convey to certain brands of self-styled libertarians.

baggage fees,

or lack of WiFi,

on, say, Spirit Airlines.

You looked at the list of insurers/jobs offering health insurance carriers,

selected the cheapest, or second-cheapest option,

and you’re surprised they’re harder to work with?

How?

Notwithstanding the fact that tech companies hire dogshit employees all the time and the vast majority of employees of any company of size 1000+ are average at best, Palantir happens to be rating so high on the scale of evil that I'd pop champagne if it got nuked tomorrow.

If any company would do it, it would be Palantir.

Those might all seem wildly disconnected, but they all have systems of unfair allocation to compensate for unequal outcomes.

Generally national healthcare programs are entirely dependent on young healthy people paying into the system despite rarely needing it, and then hopefully enough dieing quick deaths or having multiple children to cover their costs. These rebalancing systems are artificial and humans are generally terrible at managing them.

Given the magnificent ability of DNN models to serve as obfuscatory black boxes and the general techno-ignorance of legislators and regulators, I suspect that "AI laundering" your violations actually a very effective way to juke all sorts of laws and regulations.

But both of us are just speculating. If you have insider industry knowledge or can point to regulatory guidance and/or enforcement actions in this area that corrects or confirms my understanding, I would love to read about it.

I basically did what they plan on doing. I fcked off because my country was already too far gone. But I always always make sure I will never talk positively or be in denial about the state it’s in. America isn’t there (yet). What made me snarky was the mistaken hypocrisy.

1. In the US, enrolling in health insurance is currently a choice (I'm can't tell whether your hypothesis about healthy people is agreeing or disagreeing with this point).

2. We don't want Billy to be screwed for life just because he was born to a suboptimal combination of parents.

Would you mind clarifying the connection here, please?