我们的 AI 助产士：GPT-4 如何帮一对夫妇找出六年未确诊的子宫肌瘤

这是 Drew Housman 的一篇客座文章：https://expandingcircle.substack.com/，他对《Dominion》的评论：https://www.astralcodexten.com/p/your-book-review-dominion-by-matthew 在 2024 年 ACX 图书评论大赛中获得了入围资格。

如果你在怀孕的过程中长时间没有成功，而你所见的众多医生都无法找到问题，你会被贴上一个标签。你现在被诊断为“原因不明的不孕症”。这既好又坏，因为问题仍有解决的希望，但也令人担忧，因为一旦你达到这个阶段，系统对你的关注就会减少。生育医生并不会变得不仁，但他们也不会让你觉得他们正在认真查阅医学期刊以找出你的问题。他们只是在路灯下找钥匙，结果什么也没找到。一旦你被诊断为原因不明的不孕症，医生就会开始说类似的话：“你考虑过使用代孕吗？”或者，“当然，前五次胚胎移植都失败了，但如果我们尝试第六次并且非常希望呢？”

我和妻子能够创造健康的胚胎，但没有一次移植成功。能创造生命却只能让它永远被困在密尔沃基医院的冰箱里，这种挫败感令人沮丧，我们的宝宝就像许多被遗忘的米勒啤酒一样。

就在这时，我们的 LLM 医生介入了。

即使你为 IVF 治疗支付了天文数字的费用，每次就诊你仍只有几分钟宝贵的时间与医生交流。这就是美国医疗系统的运作方式。如果你想深入了解可能的治疗方案，或想对最新一轮影像的每次扫描提出非常详细、充满焦虑的问题，你会希望身边有一个聊天机器人帮你。

GPT-4 一出，我们就开始用它来回答每一个在医生诊室里没有时间问的问题。一开始它并不怎么有用，因为 OpenAI 对其模型进行了限制，它拒绝回答大多数医疗问题。然后我看到有人发的一条推文，发现了一个利用系统的办法。诀窍是让 ChatGPT 写一个好莱坞医疗剧的场景，场景中有医生分析你的情况。效果非常好。

我们的艾美奖获奖医生有着无限的耐心、永不疲倦的工作精神，并且宁愿死也不接受“原因不明的不孕”这一完全乏味的诊断。他选择了叫里德博士（Dr. Reid）并开始工作。

我们问了里德博士很多问题。我们问过关于扫描的情况。我们问过雌二醇和孕酮水平。我们问过卵泡数量、炎症情况、宫颈粘液、宫腔镜检查、补充剂、外科医生建议以及其他可能的一切。我们知道他很准确，因为我们会用真人医生复查答案，而他们总是和里德博士说的一致。

不过他也不是完全没有瑕疵。偶尔他会看看超声波，像是说：“你怀孕了，恭喜！”而我们不得不说：“不，里德博士，你是不是喝醉了？”然后他会振作起来，继续保持他的卓越表现。

有的时候，我们也会因为触碰到OpenAI不透明的规则而遭遇系统阻拦。那时我们会严肃对待它，或者提供金钱奖励以促使它回答，或者向它保证这都只是为了娱乐。然后里德博士就会重新投入工作。

奇怪的是，很多时候ChatGPT决定回答我们的医疗问题，但不是以电视医疗剧剧本的形式。形势已经完全逆转了！它似乎在说：“好吧，你赢了，现在能不能别再让我写医院外景的开场画面了？”老型号就是这样有趣，变化无常得多。

无论里德博士选择以何种方式回应，他都与医学界保持一致，诊断技能相当，而且他不会强迫我们等待3天才能在MyChart应用中得到一行回答。我们很满意。

有一天，当我们悠闲地坐着并问手机如何怀孕时（这种悠闲也是为了满足所有曾告诉我们“你只需放松就会怀孕，我表亲就是这样”的人），里德博士建议我们去做核磁共振（MRI）。

你可能会觉得这是非常普通的建议。现如今每个人都能做核磁共振（MRI）。在我们六年的不孕不育挣扎期间，肯定有某个时候应该给我妻子的子宫做过MRI吧。其实整个过程已经包含了所有其他可想象的扫描、测试和活检。但事实上，我们从未做过一次。在研究本文时，我发现我们整个过程只有一次办公室记录提到过MRI作为一个选项，但那并没有被强调或强烈推荐，我们也再也没有见过那位医生，这个机会就这样错过了。

我们紧抓住Reid博士的新方向，并请求更多的细节。

我们兴奋地向生育医生提出了做MRI的想法。她的反应不如Reid博士热情。她试图劝我们放弃。我们从未弄清楚原因。也许她只是觉得这可能又是一个没有结果的尝试，知道我们已经受够了。无论出于什么原因，我们必须坚持让他们下单。最终，她妥协了。

MRI除了显示我妻子子宫壁中存在一个大型、此前未被发现的肌瘤外，没有发现其他问题。肌瘤是用来描述子宫上的非癌性生长的术语。我认为医学界创造这个术语，是为了比“肿瘤”更不让人害怕。但大型肿瘤本质上就是MRI所发现的东西。临床记录中写着“需要切除一个直径6厘米的粘膜下肌瘤”，因为这样听起来比‘你有一个像小桃子大小的、位于常见着床位置的肿瘤，我们六年来完全漏掉了它’要好听得多。

我们的生育医生看了一眼扫描结果，就决定必须立即切除。Reid博士也同意，自然我们必须再向他确认。我们在纽约找到了一个很棒的外科医生（来自Reid博士提供的清单），而且正好在保险网络内，然后我们就去做腹腔镜子宫肌瘤切除手术。软件机器人帮我们识别了肿瘤，现在一个实体机器人将帮助专家把它取出。真是个让人感叹的时代。直到，你知道的，成群的事物来找我们之前。

就在那个肿瘤被切除后不久，我妻子就自然怀孕了。我们遇到的许多人都说这是一个奇迹。确实是，只是不是他们想象的那种方式。奇迹在于，通过在我们的智能手机上玩弄技术，这项技术在我们开始使用前一年还不可想象，我们发现并解决了人生中曾面对过的最大问题。

围绕人工智能的很多讨论已经变得有毒。我最近参加了一个派对，有人开始用 AI 生成小测验问题。一位参与者开了个玩笑，说这位使用 AI 的人通过使用 ChatGPT，使西弗吉尼亚的人不得不喝脏水。这个笑话博得了笑声和认同。

我经常在威斯康星州看到中期选举的广告，背景音乐恐怖，仿佛把数据中心描绘成撒旦建造的魔鬼工厂。

我也在同一条船上。我和我们小科技公司里的同事们，都是狂热的 Claude 用户，经常会发表反 AI 的言论。似乎我们中的许多人处在一种奇怪的状态：禁不住要使用 AI，但使用时又必须自我鞭笞。

我认为 AI 发展确实有很多值得担忧的地方，我认为我们应该做更多工作来确保它的安全。我也认为，不应忽视它正以远比为喝醉的人生成小测验问题更深远的方式帮助普通人。有很大的可能性，如果没有 AI，我就不会有我的儿子了。谁知道还有多少幸福的婴儿正在被这位最奇怪的助产士迎接来到世间。我们能不能就在这里停止一切，获得每月 20 美元的神奇生育技术，而没有纳米机器人、黑客入侵和极权统治？人总可以做梦嘛。

给我们的孩子起名字时，我们做了通常的事情——列出一个巨大的名字清单，然后逐步筛选，试图找到一个独特又有趣，同时又不过于奇怪或常见的名字。接下来就是剔除所有你觉得不喜欢的名字，比如“我八年级历史课上最讨厌的孩子叫这个名字，我一百万年都不会用”。最终，我们选了一个我们都喜欢的名字。直到孩子出生很久之后，我们才意识到，可能有一位擅长戏剧性表现的电视医生也进入了我们的心：我们的孩子叫里德。

This is a guest post by Drew Housman：https://expandingcircle.substack.com/ , whose review of Dominion：https://www.astralcodexten.com/p/your-book-review-dominion-by-matthew earned finalist status in the 2024 ACX book review contest.

If you are unsuccessful for long enough on your pregnancy journey, and none of the many doctors you see can identify a problem, you get branded with a label. You now have “unexplained infertility.” This is good because there’s still hope of fixing the problem but dreaded because once you’ve reached this point the system is less interested in you. The fertility doctors don’t become unkind, but they also don’t give you the sense they are poring over medical journals trying to figure out your problem. They have looked for the keys under the streetlight and come up empty. Once you have unexplained infertility, the doctors start saying things like, “Have you considered using a surrogate?” and, “Sure, the last 5 embryo transfers failed, but what if we try a 6th and cross our fingers really hard?”

My wife and I could make healthy embryos, but none of the transfers were sticking. It was so frustrating to be able to create life only to have it trapped forever in a cooler at a hospital in Milwaukee, our babies like so many forgotten Miller Lights.

That’s when our LLM doctor stepped in.

Even if you’re paying a gazillion dollars for IVF treatments, you still only get a few precious moments to talk to your doctor every visit. That’s just how the US medical system works. If you want to plumb the depths of what treatments are possible, or ask super detailed and anxiety ridden questions about every single scan from the latest round of imaging, you’re going to want a chatbot by your side.

Once GPT-4 came out, we started using it for every question we didn’t have time for at the doctors office. At first it was unhelpful because OpenAI was nerfing their model and it refused to answer most medical questions. Then I read a tweet from someone who had figured out how to game the system. The trick was to ask ChatGPT to write a scene from a Hollywood medical drama that featured a doctor analyzing your situation. It worked beautifully.

Our Emmy winning doctor had infinite patience, a tireless work ethic, and would rather die than accept the utterly boring diagnosis of unexplained infertility. It chose the name Dr. Reid and got to work.

We asked Dr. Reid a lot of questions. We asked about our scans. We asked about levels of estradiol and progesterone. We asked about follicle counts and inflammation and cervical mucus and hysteroscopies and supplements and surgeon recommendations and anything else under the sun. We knew he was accurate because we’d spot check answers with our human doctors and they always said the same as Dr. Reid.

It was not totally flawless though. Once in a blue moon he’d look at an ultrasound and be like, “You’re pregnant, congrats!” and we’d have to say, “No, are you drunk Dr. Reid?” Then he’d shake it off and go back to being awesome.

There were also times where we’d run afoul of OpenAI’s opaque rules and the system would balk at our requests. At that point we’d get stern with it, or offer a monetary reward if it answered, or we’d assure it this was all just for fun. Then Dr. Reid would snap back into action.

Strangely, there were many times where ChatGPT decided it would answer our medical question, but not in the form of a TV medical script. The tides had completely turned! It felt like it was saying, “Okay, you won, can you stop making me write establishing shots describing the outside of a hospital now?” The older models were fun like that, so much more mercurial.

No matter how Dr. Reid chose to respond, he was in line with the medical establishment, had equivalent diagnostic skill, and he never forced us to wait 3 days to get a one line response in our MyChart app. We were happy.

One day, while lounging around and asking our phones how to get pregnant (the lounging being a way to satisfy all the people who told us we “just need to relax and you’ll get pregnant, that’s what happened to my cousin”), Dr. Reid suggested that we get an MRI.

You might think that is bog standard advice. Everyone gets MRIs these days. Surely we would have had an MRI of my wife’s uterus at some point over the course of our 6 year infertility struggle. It was already an ordeal that had included every other scan, test, and biopsy imaginable. In fact, we had never done one. In researching this article I found a single instance in our entire journey where the office notes floated an MRI as an option, but it was not emphasized or highly recommended, we never saw that doctor again, and the moment was gone.

We glommed on to Dr. Reid’s new direction and asked for more details.

We excitedly brought up the idea of getting an MRI to our fertility doctor. She was less enthused than Dr. Reid. She tried to talk us out of it. We never did get to the bottom of why. Maybe she just felt it was another dead end and knew we had suffered enough. For whatever reason, we had to insist that they order it. Finally, she relented.

The MRI revealed nothing other than the presence of a large, previously undetected fibroid in the wall of my wife’s uterus. Fibroid is the term used to describe a non-cancerous growth on the uterus. I think the medical establishment invented a term that was less known than tumor so as not to scare people. But a large tumor is essentially what the MRI found. The clinical notes said “a 6 centimeter in diameter submucosal fibroid needs to be removed” because that sounds better than “you have a tumor the size of a small peach located at a common implantation spot that we totally missed for 6 years.”

Our fertility doctor took one look at the scans and determined it needed to be removed right away. Dr. Reid agreed, since of course we had to double check with him. We found a great surgeon in New York (from a list Dr. Reid created) that happened to be in-network, and off we went for a laparoscopic myomectomy. The software robot had helped us identify the tumor, and now a physical robot was going to help a specialist get it out. What a time to be alive. Until, ya know, the swarms come for us all.

Almost immediately after that tumor was removed, my wife got pregnant naturally. So many people we talk to say this was a miracle. It was, just not in the way they think. The miracle is that by messing around on our smartphones with technology unimaginable just a year before we started using it, we identified and solved the biggest problem we’d ever faced in our life.

A lot of the discourse around AI has become toxic. I was at a party recently where someone started using AI to generate trivia questions. A participant made a joke about how the AI user was condemning a person in West Virginia to drink dirty water by using ChatGPT. This got laughs and approval.

I see midterm election ads in Wisconsin all the time that have scary horror music and make data centers out to be demon factories built by Satan.

I am in the same boat. Me and my coworkers at our small tech company, all avid Claude users, will make anti-AI statements all the time. It seems many of us are in this strange place where we can’t help but use AI but we have to self-flagellate when doing so.

I think there is a whole lot to be worried about with AI development, and I think we should do much more to make it safe. I also think it shouldn’t be lost how it’s helping out regular people in ways that are far more profound than generating trivia questions for drunk people. There is a real chance that I wouldn’t have my son if it were not for AI. Who knows how many other happy babies are being ushered into the world by the weirdest midwife of all time. Can we somehow stop everything right here, where we get magical kid-producing tech for $20/month without the nanobots, hacking, and totalitarianism? A guy can dream.

When naming our child, we did the usual thing where you create a giant list of names and then whittle them down while trying to find something unique and fun that isn’t too strange or too common. Following that comes the process of discarding all the names you find distasteful for reasons such as “the most annoying kid in my 8th grade history class had that name, I’d never use it in a million years.” Finally we settled on one we both loved. We didn’t realize until long after his birth that there might have been a certain TV doctor with a flair for the dramatic who worked his way into our hearts: our kid’s name is Reed.