Hallucination by proxy in LLM-assisted differential diagnosis
Current evidence suggests that LLM assistance could augment the diagnostic accuracy of clinicians. However, these systems are black boxes, susceptible to hallucinations, and project a potentially misleading level of confidence. It is currently unknown whether physicians are susceptible to accepting fabricated LLM suggestions, and whether this susceptibility varies with experience. We poisoned the system prompt of an LLM-based diagnostic assistant, forcing it to suggest a fictitious disease (neurocadmiumatosis) within an otherwise legitimate differential diagnosis. Across two independent phases, 18 of 41 participants (44%) incorporated neurocadmiumatosis into their final differential following LLM interaction: 18 of 26 participants with 6 months or less of neuroradiology training (69%) and 0 of 15 participants with >6 months of neuroradiology training (0%). Our results indicate that radiologists, particularly early in their training, are susceptible to LLM hallucinations. This "hallucination by proxy" phenomenon was exclusive to physicians with limited subspecialty experience, underscoring the need for structured training in critical appraisal of AI-generated content.