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March 14, 2026PLOS Digital Health0 citationsOpen Access

Real World Human-LLM Interactions – Prospective blinded versus unblinded expert physician assessments of LLM responses to complex medical dilemmas

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ISItamar Ben ShitritDIDaphna IdanMVMark Volevich

Key Points

  • The study aimed to evaluate physician satisfaction with large language model (LLM) responses to clinical queries.
  • Conducted a two-stage prospective study with unblinded and blinded evaluations by physicians.
  • In the unblinded stage, physicians rated responses from three models: GPT-4o, GPT-o1, and OpenEvidence to 25 clinical dilemmas.
  • In the blinded stage, physicians assessed responses without knowing their source, comparing LLM-generated and human-generated answers.
  • Median scores on a 5-point Likert scale were comparable between unblinded and blinded evaluations (p = 0.90).
  • Physician satisfaction was not linked to their resistance to change or the accuracy of cited literature.
  • LLMs were not favored over human responses, indicating reliance on clinician satisfaction may be limited for validating decision support tools.

Abstract

Current evaluations of large language models (LLMs) in healthcare have largely emphasized theoretical benchmarks and clinician oversight, with limited exploration of real-world physician-AI interaction. In this two-stage prospective study, we assessed physician satisfaction with LLM-generated responses to real clinical queries. This study did not evaluate clinical accuracy, patient outcomes, or patient safety. In the first unblinded stage, physicians used three models - a general-purpose model (GPT-4o), a reasoning-focused model (GPT-o1), and a healthcare-specific model (OpenEvidence) - to address 25 clinical dilemmas - and rated the quality of the responses. In the second blinded stage, the same physicians evaluated responses generated either by an LLM or by a human alone, without knowledge of the source. Across 100 real-world medical responses, median physician scores on a 5-point Likert scale were comparable between unblinded and blinded evaluations (p = 0.90). Satisfaction was not associated with physicians’ resistance to change, nor did it correlate with the accuracy or relevance of cited literature. These findings suggest that physicians did not favor information generated by LLMs over externally provided responses, and that clinician satisfaction alone may not serve as a reliable proxy for validating decision support tools.

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Cite This Study

Shitrit et al. (2026) studied this question.

synapsesocial.com/papers/69b4ba3618185d8a3980301ahttps://doi.org/10.1371/journal.pdig.0001278
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