This is a guest post by Drew Housman, whose review of Dominion earned finalist status in the 2024 ACX book review contest.
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review → earn → 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.
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you → see → label
You now have “unexplained infertility.”
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You → have → 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.
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system → ’ → you
The fertility doctors don’t become unkind, but they also don’t give you the sense they are pouring over medical journals trying to figure out your problem.
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they → become → problem
They have looked for the keys under the streetlight and come up empty.
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They → look → streetlight
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?”
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we → have → fingers
My wife and I could make healthy embryos, but none of the transfers were sticking.
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none → make → transfers
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.
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it → create → Lights
That’s when our LLM doctor stepped in.
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doctor → ’ → ?
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.
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you → pay → doctor
That’s just how the US medical system works.
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system → ’ → ?
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.
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you → want → side
Once GPT-4 came out, we started using it for every question we didn’t have time for at the doctors office.
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we → come → office
At first it was unhelpful because OpenAI was nerfing their model and it refused to answer most medical questions.
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it → nerfe → questions
Then I read a tweet from someone who had figured out how to game the system.
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who → read → system
The trick was to ask ChatGPT to write a scene from a Hollywood medical drama that featured a doctor analyzing your situation.
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that → ask → situation
It worked beautifully.
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It → work → ?
Our Emmy winning doctor had infinite patience, a tireless work ethic, and would rather die than accept the utterly boring diagnosis of unexplained infertility.
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doctor → win → infertility
It chose the name Dr. Reid and got to work.
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It → choose → name
Caption: I’m not sure if asking for an AI doctor who was similar to the volatile Dr. House was the smartest idea on my part, but it made a difficult situation more entertaining.
We asked Dr. Reid a lot of questions.
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We → ’m → questions
We asked about our scans.
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We → ask → scans
We asked about levels of estradiol and progesterone.
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We → ask → estradiol
We asked about follicle counts and inflammation and cervical mucus and hysteroscopies and supplements and surgeon recommendations and anything else under the sun.
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We → ask → 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.
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It → know → Reid
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?”
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you → look → ultrasound
Then he’d shake it off and go back to being awesome.
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he → shake → it
There were also times where we’d run afoul of OpenAI’s opaque rules and the system would balk at our requests.
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system → be → 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.
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this → get → fun
Then Dr. Reid would snap back into action.
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Reid → snap → 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.
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it → be → script
The tides had completely turned!
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tides → turn → ?
It felt like it was saying, “Okay, you won, can you stop making me write establishing shots describing the outside of a hospital now?”
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me → feel → hospital
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.
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he → choose → app
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.
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we → lounge → MRI
You might think that is bog standard advice.
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that → think → ?
Everyone gets MRIs these days.
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Everyone → get → MRIs
Surely we would have had an MRI of my wife’s uterus at some point over the course of our 6 year infertility struggle.
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we → have → struggle
It was already an ordeal that had included every other scan, test, and biopsy imaginable.
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that → include → scan
In fact, we had never done one.
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we → do → one
…and 39 more, not listed.
The Aporia
