AI Symptom Suggestions

COOLDOWN WEEK EXPERIMENT

What is Symptom Suggestion?

MAIN SYMPTOM

POSSIBLE ILLNESSES

PATIENT

POSSIBLE SYMPTOMS

SUGGESTED SYMPTOMS

Symptom suggestion calculation

Symptom Suggestion in Case Study eval

MAIN SYMPTOM

POSSIBLE ILLNESSES

POSSIBLE SYMPTOMS

SUGGESTED SYMPTOMS

Select a predefined symptom from suggested symptoms

Symptom suggestion calculation

OTHER SYMPTOMS

CASE STUDY SETTING

Why to do something?

  • Super complex; no one understands it fully.

  • Therefore, it's hard to improve

We wanted to prove...

  • Can we easily integrate alternative symptom suggestions?

  • Will it work with both the API and the WebApp, as well as Case Studies to measure performance?

  • Can we use LLM for this?

    • Will the performance be good enough?

    • Can it be fast and cost-efficient?

  • Can we develop and use our own AI/ML model?

    • Will the performance be good enough?

  • Can we complete an E2E experiment with all of these in just one week?

Timeline

MON

TUE

WEN

THU

Created a Symptom Suggestion service and integrated into the Medical Engine

Started to create our own model and added remote LLM APIs

Finished own model,
deployed and started to use our own LLM services

Performance optimizations and measurements

Can we complete an E2E experiment with all of these in just one week?

✅

1. The LLM Approach

The LLM Approach

Remote LLM APIs

  • Unified interface

  • Dinamically change between "any" LLM providers

  • We used base models

    • ​Gemini2.5-flash, GPT-4o, GPT-4o-mini, GPT5-nano, GPT5-mini

GPT-5

[SYSTEM PROMPT]
You are a medical data analyst AI. Your task is to filter and rank a list of potential symptoms
based on a user's provided health information. You must operate strictly on the data provided
and should not use any external knowledge to generate or suggest symptoms. Your output must be
a pipe (|) separated list of symptom names. The final list should contain exactly the number
of symptoms requested with the same names as they appear in the input, ordered from most to
least probable.

[USER PROMPT]
Here is the patient's medical information, the data and the instructions you need to process.

<CONVERSATION_BETWEEN_DOCTOR_AND_PATIENT>
  Doctor: Which conditions do you experience?
  Patient: I experience Fatigue.
  
  Doctor: In which year were you born?
  Patient: 1985

  Doctor: What is your biological sex?
  Patient: Male
</CONVERSATION_BETWEEN_DOCTOR_AND_PATIENT>

<POTENTIAL_SYMPTOMS>
  Abdominal cramps|Vomiting|Tick bite|Dry mouth|Swelling of the leg|Abdominal pain|Confusion|Hump on the back|Underweight|Sluggish bowels|Brittle hair and nails|Knee pain|Pain in the forehead|Ankle pain|Lump under the skin|Tearing eyes|Weakness in the legs|General malaise|Nosebleed|Hallucinations|Back pain|Breathing difficulties|Seizure|Burning tongue|Swelling of the eyes|Chest pain|Testicular hardening|Testicular pain|Diarrhea|Visual field defect|Weakness of individual muscles|Headache|Increased urge to urinate|Absence of menstruation|Ravenous hunger|Sore throat|Walking difficulties|Reduced need for sleep|Unconsciousness|Anterior neck pain|Hanging corner of the mouth|Skin burning|Heavy menstruation|Irritability|Suicidal thoughts|Overweight|Visual disturbances|Reckless behavior|Physical exhaustion|Swelling of the tonsils|General muscle weakness|Noise sensitivity|Drowsiness|Runny nose|Enlarged tongue|Paleness|Pain in the toe|Libido loss|Neck stiffness|Restless behavior|Pain in the finger|Bulge on the abdomen|Hand pain|Irregular pulse|Swelling of the lymph nodes|Loss of appetite|Unusual pigmentation spot|Hopelessness|Skin numbness|Sexual dysfunction|Pain during bowel movement|Night sweat|Increased stool urge|Urinary incontinence|Low self-esteem|Changed stool color|Nail discoloration|Bleeding gums|General joint pain|Palpitations|Cracked lips|Leg pain|Change in stool frequency|Itching|Hair loss on the head|Lump on the neck|Black "midges" in the field of vision|Motor disorders|Frequent yawning|Constricted pupils|Anal bulge|General muscle stiffness|High blood pressure|Loss of sexual hair|Dry eyes|Bloating|Blue discoloration of the skin|Sleeping difficulties|Unusual weight gain|Chills|Nightmares|Unusual weight loss|Shoulder pain|Fever|Burning eyes|Edema|Memory disorders|Anxiety|Crusts on the skin|Tremors|Hanging eyelid|Red eyes|Restlessness|Slowing of movement speed|Anal bleeding|Muscle cramps|Painful wound|Limited mobility|Secretion from the nipple|Constipation|Nocturnal urination|Strong body hair in women|Blood pressure fluctuations|Reduced hearing ability|Increased sweating|Heartburn|Tight foreskin|Yellow eyes|Manic behavior|Hoarseness|Paralysis|Hair loss on the upper body|Erectile dysfunction|Nausea|Swelling of the jaw|Urinary retention|Personality changes|General muscle pain|Unfulfilled desire to have children|Exaggerated self-confidence|Swelling under the ear|Skin redness|Night blindness|Inflamed corner of the mouth|Muscular atrophy|Tingling sensation|Swelling of the skin|Dizziness|Social withdrawal|Pain during sexual intercourse|Mental exhaustion|Bulging eyes|Groin pain|Whistling breathing sounds|Flank pain|Limb pain|Increased susceptibility to diseases|Sniffles|Changed urine color|Abdominal fullness|Restless leg|Feelings of guilt|Cough|Speech disorders|Low blood pressure|Frequent burping|Light sensitivity of the eyes|Eye pain|Accelerated heartbeat|Absent-mindedness|Foot pain|Sense of euphoria|Strong feeling of thirst|Fecal incontinence|Facial paralysis|Frequent blinking|Joint swelling|Mood swings|Sleep attacks|Spider nevus|Lump in the testicle|Swelling of the breasts|Swallowing difficulties|Weakness in the hands|Wrist pain|General sensitivity to cold|Local muscle pain|Bone pain |Increased urge to speak|Frequent snoring|Feelings of stress|General heat intolerance|Rash|Increased salivation|Instability while standing|Yellow skin|Concentration difficulties|Muscle twitches|Depressive mood|Dry skin|Flatulences|Heel pain|Hypothermia of the body|Small bleedings under the skin|Slow heartbeat|Inflammation in the mouth|Neck pain|Blisters on the skin|Reduced urine excretion|Pain of the oral mucosa|Frequent sneezing|Testicular shrinkage|Dilated pupils|Loss of the lateral eyebrows|Listlessness|Barrel-shaped chest|Lower-back pain
</POTENTIAL_SYMPTOMS>

<INSTRUCTIONS>
  RULES:  
  - Selected symptoms must be the most probable symptoms from <POTENTIAL_SYMPTOMS> which are related to the patient's known symptoms and conversation with the doctor.
  - Select exactly 6 symptoms from <POTENTIAL_SYMPTOMS>.
  - DO NOT mention any symptoms the patient has already mentioned.
  - Return them as one line, pipe-separated.
</INSTRUCTIONS>


<EXAMPLES>
    <INVALID_EXAMPLE>
      <OUTPUT>Fatigue|potentialSymptom1|potentialSymptom2</OUTPUT>
      <REASON>It contains Fatigue which was a perceived condition and not a potential symptom</REASON>
    </INVALID_EXAMPLE>
    <VALID_EXAMPLE>
      <OUTPUT>potentialSymptom1|potentialSymptom2</OUTPUT>
      <REASON>It only contains related symptoms from the potential symptom list</REASON>
    </VALID_EXAMPLE>
</EXAMPLES>
  

<OUTPUT_FORMAT>
  potentialSymptom1|potentialSymptom2|potentialSymptom3
</OUTPUT_FORMAT>

System and user prompt:

The LLM Approach

Remote LLM APIs

{
  "model": "gpt-oss:20b",
  "created_at": "2025-09-18T21:52:07.142220298Z",
  "message": {
    "role": "assistant",
    "content": "Restless behavior|Dizziness|Fatigue|Concentration difficulties|Palpitations|Irritability",
    "thinking": "
    	We have a conversation: patient has anxiety, longer than 1 week, born 1985, male. 
        We need to select 6 symptoms from the long list that are likely associated with anxiety 
        and not mentioned by patient. So we need to think of common anxiety-related symptoms: 
        \"nervousness\", \"restlessness\", \"dizziness\", \"fatigue\", \"drowsiness\", 
        \"concentration difficulties\", \"sleep difficulties\", \"nightmares\", \"fearfulness\", 
        \"irritability\", \"muscle tension\", \"headache\", \"muscle cramps\", \"palpitations\", 
        \"rapid heartbeat\", \"shortness of breath\", \"cold sweat\", \"tremors\", 
        \"muscle weakness\" etc. Also \"increased urge to urinate\" may be due to anxiety? Might 
        be less typical. \"Swelling of the leg\" not typical.\n\nWe need to select exactly 6 from 
        list.\n\nBut we must ensure not to include any symptom the patient has already mentioned: 
        patient said \"Anxiety.\" No other symptom. So we can pick any from list except Anxiety 
        itself.\n\nWe need to pick the most probable symptoms from list that are related to anxiety. 
        Let's look at list again:\n\nVomiting|Premature ejaculation|Dry mouth|Swelling of the leg|Abdominal pain|Confusion|Strong craving for tobacco|Tearing eyes|General malaise|Hallucinations|Breathing difficulties|Seizure|Delusions|Swelling of the eyes|Chest pain|Diarrhea|Weakness of individual muscles|Headache|Increased urge to urinate|Ravenous hunger|Walking difficulties|Unconsciousness|Swelling of the mouth|Irritability|Suicidal thoughts|Visual disturbances|Reckless behavior|Physical exhaustion|General muscle weakness|Noise sensitivity|Drowsiness|Runny nose|Enlarged tongue|Paleness|Libido loss|Neck stiffness|Restless behavior|Irregular pulse|Swelling of the lymph nodes|Loss of appetite|Skin numbness|Aggressive behavior|Increased stool urge|Urinary incontinence|Cold sweat|Nail discoloration|General joint pain|Palpitations|Itching|Hair loss on the head|Motor disorders|Frequent yawning|Jaw pain|Fears of failure|General muscle stiffness|High blood pressure|Blue discoloration of the skin|Sleeping difficulties|Nightmares|Unusual weight loss|Shoulder pain|Fever|Edema|Frightfulness|Memory disorders|Tremors|Fear of loss|Restlessness|Muscle cramps|Constipation|Nocturnal urination|Blood pressure fluctuations|Increased sweating|Manic behavior|Hoarseness|Hair loss on the upper body|Nausea|Urinary retention|Personality changes|Bulbous nose|Nervousness|General muscle pain|Skin redness|Unsatisfactory sex life|Stiff hands and arms|Tingling sensation|Swelling of the skin|Dizziness|Fatigue|Mental exhaustion|Whistling breathing sounds|Increased susceptibility to diseases|Abdominal fullness|Cough|Speech disorders|Low blood pressure|Accelerated heartbeat|Paw position of the hands|Fecal incontinence|Hot flashes|Mood swings|Swallowing difficulties|Mistrust in fellow humans|Skin hardening|Temper tantrums|Feelings of stress|Rash|Increased salivation|Instability while standing|Concentration difficulties|Depressive mood|Dry skin|Flatulences|Avoidance behavior|Slow heartbeat|Dilated pupils\n\nWe need to pick 6 most probable anxiety symptoms. Let's choose:\n\n- Dizziness\n- Fatigue\n- Restlessness\n- Concentration difficulties\n- Palpitations\n- Irritability\n\nAlso \"Noise sensitivity\" is typical anxiety. But we can choose 6. We need exactly 6. The instruction says \"SELECTED symptoms MUST BE the most probable symptoms from <POTENTIAL_SYMPTOMS> which are related to the patient's known symptoms and conversation with the doctor.\" The known symptom is anxiety, duration. So we pick typical anxiety-related. Let's list:\n\n1. Restlessness (Restless behavior maybe same). We have \"Restless behavior\" in list. Use that.\n2. Dizziness\n3. Fatigue\n4. Concentration difficulties\n5. Palpitations\n6. Irritability\n\nAll present. Let's check that we didn't mention any they already said. They only said \"Anxiety.\" So okay.\n\nWe must output exactly one line, symptoms separated by |. No extra text. So output: Restless behavior|Dizziness|Fatigue|Concentration difficulties|Palpitations|Irritability
        But need to ensure ordering? Not specified. Just 6 separated by |. 
        Good.\n\nLet's verify none of those are synonyms? 
        The list uses \"Restless behavior\" exactly. \"Dizziness\" exactly. \"Fatigue\" exactly. 
        \"Concentration difficulties\" exactly. \"Palpitations\" exactly. \"Irritability\" exactly.
        All are present. Good.\n\nReturn that line."
  },
  "done_reason": "stop",
  "done": true,
  "total_duration": 23773584694,
  "load_duration": 216813178,
  "prompt_eval_count": 881,
  "prompt_eval_duration": 698341079,
  "eval_count": 1085,
  "eval_duration": 22857480853,
  "durationMs": 23930
}

The LLM Approach

Remote LLM APIs

API response:

DEMO

  • "Good-enough" results

  • Expensive for current Case Study evaluation

    • One evaluation run (1500 studies):

      • GPT-4o-mini: ~$2

      • GPT-5-mini: ~$10

  • Response times are slow for current CS eval:

    • Large models (GPT-5): >10s

    • Medium models (GPT-5-mini): ~3-6s

    • Small models (GPT-5-nano): ~2-4s

The LLM Approach

Remote LLM APIs

How should we solve the price factor?

​

  • Failed to use Vertex AI... :(
     

  • Deployed to Cloud Run with L4 GPUs

    • Run different models with ollama

    • Flat pricing: $250-$500 / month
      (the instance can be used for other projects as well)
       

  • Open-source models were used

The LLM Approach

Self-hosted LLMs

DEMO

The LLM Approach

Self-hosted LLMs

  • Still "good enough" performance

  • Response times are still problematic for current CS eval:

    • Larger models (GPT OSS 20B): ~7-20s

    • Smaller models (Gemma3 4B): 0.5-1.5s

The LLM Approach

LLM performance

Model First Second Third None
Original 59.6% 9.1% 5.1% 26.3%
Random 42.4% 2% 0% 55.6%
GPT OSS 20B (GCP) 58.6% 7.1% 2% 33.3%
GPT-4o-mini (API) 51.5% 9.1% 2% 37.4%

first_100

LABEL

The LLM Approach

LLM performance

Model First Second Third None
Original 56.1% 11.7% 3% 28%
Random 32.2% 3.7% 0.9% 63.2%
GPT-4o-mini 44.5% 6.9% 1.7% 46.4%

validation

LABEL

2. Statistical Model Approach

The Statistical Model Approach

The Idea

  • Decided to use a Recommendation System statistical model

    • It's based on a movie rating model and the correlation between user ratings to movies

  • What should be the data used for the model?

    • Check data

    • Medical Content by the experts

Us, doing science!

The Statistical Model Approach

The Statistical Model Approach

How data looks like

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  • Columns: symptoms

  • Rows: illnesses

  • Other cells: how many times a symptom appears in an illness (sometimes a symptom is added with multiple colors)

The Statistical Model Approach

How we process it

cooccurrences = df.T.dot(df)

main_symptom = cooccurrences[main_symptom_id]
print(cooccurrences.corrwith(main_symptom).sort_values(ascending=False).to_json())

  • Find correlation

    • How many times two symptoms appear together in  the same illness

  • Different correlations exist:

    • spearman, pearson, kendall

  • 3 lines of code :D

DEMO

The Statistical Model Approach

We have the AI!

Model First Second Third None
Original 59.6% 9.1% 5.1% 26.3%
Random 42.4% 2% 0% 55.6%
Our AI! 65.7% 7.1% 3% 24.2%
GPT OSS 20B 58.6% 7.1% 2% 33.3%
GPT-4o-mini 51.5% 9.1% 2% 37.4%

first_100

LABEL

The Statistical Model Approach

We have the AI!

Model First Second Third None
Original 56.1% 11.7% 3% 28%
Random 32.2% 3.7% 0.9% 63.2%
Our AI! 54.1% 9.9% 2.1% 33.3%
GPT-4o-mini 44.5% 6.9% 1.7% 46.4%

validation

LABEL

Conclusions

LLM approach

  • Pro

    • Can easily elaborate data like symptom questions

    • Future-proof: allows medical content change without retraining the model

  • Con

    • Slower and more expensive

    • Non-deterministic responses

  • Possible improvements

    • Use more data, such as symptom questions

    • Fine-tune a base LLM

    • Tune context with better prompt engineering

Statistical Model Approach

  • Pro

    • Deterministic responses

    • Super small and fast

  • Con

    • Biased and small dataset

      • Database is optimized for the current case studies

      • Bound to our data and medical expert settings

    • Need to retrain after every medical content change

  • Possible improvements

    • Learn from checks as well

    • Use other data, eg. questions as well

DB is optimized to CS runs!
(or not? :D we are not Data Scientists nor doctors)

Model First Second Third None
Original 27% 5.7% 2% 64%
Random 19.3% 1.7% 0% 79%
Our AI! 28.3% 6% 1.7% 63%
GPT-4o-mini 22.3% 5% 1% 71%

overallurgency_evaluation

LABEL

Case Study running

  • Rethink it...

    • Slow, error-prone

    • Uses internal logic, it should mimic the check run instead of hacking the checkflow

    • Symptom suggestion logic is optimized for in-memory run

    • It would be great to rethink how it works and why

      • Eg. currently everything depends on the guessed illnesses throughout the check

    • Provide questions and answers to the suggestions

ANXIETY

For how long have you been suffering from anxiety?

For a few minutes

Longer than 1 week

Used model: GPT5-mini

Conclusions

  • Can we easily integrate alternative symptom suggestions? ✅

  • Will it work with both the API and the WebApp, as well as Case Studies to measure performance? ✅

  • Can we use LLM for this? ✅

    • Will the performance be good enough?

    • Can it be fast and cost-efficient? ✅

  • Can we develop and use our own AI/ML model? ✅

    • Will the performance be good enough?

  • Can we complete an E2E experiment with all of these in just one week? ✅

WE HAD FUN! :)

...also learned a lot!

Copy of AI Symptom Suggestions Experiment - Company

By drawain

Copy of AI Symptom Suggestions Experiment - Company

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