Can ChatGPT-4 evaluate whether a differential diagnosis list contains the correct diagnosis as accurately as a physician?

Objectives: The potential of artificial intelligence (AI) chatbots, particularly the fourth-generation chat generative pretrained transformer (ChatGPT-4), in assisting with medical diagnosis is an emerging research area. While there has been significant emphasis on creating lists of differential diagnoses, it is not yet clear how well AI chatbots can evaluate whether the final diagnosis is included in these lists. This short communication aimed to assess the accuracy of ChatGPT-4 in evaluating lists of differential diagnosis compared to medical professionals' assessments. Methods: We used ChatGPT-4 to evaluate whether the final diagnosis was included in the top 10 differential diagnosis lists created by physicians, ChatGPT-3, and ChatGPT-4, using clinical vignettes. Eighty-two clinical vignettes were used, comprising 52 complex case reports published by the authors from the department and 30 mock cases of common diseases created by physicians from the same department. We compared the agreement between ChatGPT-4 and the physicians on whether the final diagnosis was included in the top 10 differential diagnosis lists using the kappa coefficient. Results: Three sets of differential diagnoses were evaluated for each of the 82 cases, resulting in a total of 246 lists. The agreement rate between ChatGPT-4 and physicians was 236 out of 246 (95.9 %), with a kappa coefficient of 0.86, indicating very good agreement. Conclusions: ChatGPT-4 demonstrated very good agreement with physicians in evaluating whether the final diagnosis should be included in the differential diagnosis lists.