ChatGPT- versus human-generated answers to frequently asked questions about diabetes: a Turing test-inspired survey among employees of a Danish diabetes center
Authors: Hulman Adam , Dollerup Ole Lindgård , Mortensen Jesper Friis , Fenech Matthew , Norman Kasper , Støvring Henrik , Hansen Troels Krarup 
Published: February 2023

SummaryBackgroundLarge language models have received enormous attention recently with some studies demonstrating their potential clinical value, despite not being trained specifically for this domain. We aimed to investigate whether ChatGPT, a language model optimized for dialogue, can answer frequently asked questions about diabetes.MethodsWe conducted a closed e-survey among employees of a large Danish diabetes center. The study design was inspired by the Turing test and non-inferiority trials. Our survey included ten questions with two answers each. One of these was written by a human expert, while the other was generated by ChatGPT. Participants had the task to identify the ChatGPT-generated answer. Data was analyzed at the question-level using logistic regression with robust variance estimation with clustering at participant level. In secondary analyses, we investigated the effect of participant characteristics on the outcome. A 55% non-inferiority margin was pre-defined based on precision simulations and had been published as part of the study protocol before data collection began.FindingsAmong 311 invited individuals, 183 participated in the survey (59% response rate). 64% had heard of ChatGPT before, and 19% had tried it. Overall, participants could identify ChatGPT-generated answers 59.5% (95% CI: 57.0, 62.0) of the time. Among participant characteristics, previous ChatGPT use had the strongest association with the outcome (odds ratio: 1.52 (1.16, 2.00), p=0.003). Previous users answered 67.4% (61.7, 72.7) of the questions correctly, versus non-users’ 57.6% (54.9, 60.3).InterpretationParticipants could distinguish between ChatGPT-generated and human-written answers somewhat better than flipping a fair coin. However, our results suggest a stronger predictive value of linguistic features rather than the actual content. Rigorously planned studies are needed to elucidate the risks and benefits of integrating such technologies in routine clinical practice.Research in contextEvidence before this studyChatGPT (OpenAI, San Francisco, CA) was released on 30th of November, 2022. A PubMed search for ‘ChatGPT’ conducted on 5th of February, 2023, returned 21 results. All of these were either editorials, commentaries or investigated educational perspectives of the technology. We also searched medRxiv, which returned seven preprints on the topic. Two studies investigated ChatGPT ‘s performance on the United States Medical Licensing Exam and reported that it passed some components of the exam. Other studies investigated ChatGPT ‘s ability to answer questions in specific medical specialties, including ophthalmology, genetics, musculoskeletal disorders, with encouraging results, but often expressing the need for further specialization. We identified one study where participants had to distinguish between chatbot- and human-generated answers to patient-healthcare provider interactions extracted from electronic health records. Chatbot-generated responses were identified 65% of the time, suggesting that they were weakly distinguishable from human-generated answers.Added value of this studyOur study is among the first ones to assess the capabilities of ChatGPT from the patients’ perspective instead of focusing on retrieval of scientific knowledge. We did so in a rigorously designed study inspired by the Turing test and non-inferiority trials. Among all participants, 64% had heard of ChatGPT before, and 19% had tried it. These proportions were even higher among men (87% and 48%). Overall, participants could identify ChatGPT-generated answers (versus human) 60% of the time. We found that individuals who had previously used ChatGPT could distinguish ChatGPT-generated answers from human answers more often, while having contact with patients was not as strong a discriminator. This may suggest a stronger predictive value of linguistic features rather than the actual content.Implications of all available evidenceAfter ChatGPT, a general-purpose large language model optimized for dialogue, demonstrated its capabilities to the general public, an enormous interest arose in how large language models can support medical research and clinical tasks. Despite not being specifically trained for this, ChatGPT not only has clinical knowledge, but also encodes information about disease management and practical aspects relevant to patients’ everyday lives. Large language models optimized for healthcare use are warranted, but rigorously planned studies are needed to elucidate the risks and benefits of integrating such technologies in patient care.