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Harm Reduction Strategies for Thoughtful Use of Large Language Models in the Medical Domain: Perspectives for Patients and Clinicians
KTH, School of Electrical Engineering and Computer Science (EECS), Intelligent systems, Speech, Music and Hearing, TMH.ORCID iD: 0000-0002-6529-1211
Department of Clinical Science, Intervention and Technology, Division of Speech and Language Pathology, Karolinska Institutet, Stockholm, Sweden; Theme Womens Health and Allied Health Professionals, Section of Speech and Language Pathology, Karolinska University Hospital, Stockholm, Sweden.ORCID iD: 0000-0001-8452-0043
2025 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 27, article id e75849Article, review/survey (Refereed) Published
Abstract [en]

The integration of large language models (LLMs) into health care presents significant risks to patients and clinicians, inadequately addressed by current guidance. This paper adapts harm reduction principles from public health to medical LLMs, proposing a structured framework for mitigating these domain-specific risks while maximizing ethical utility. We outline tailored strategies for patients, emphasizing critical health literacy and output verification, and for clinicians, enforcing “human-in-the-loop” validation and bias-aware workflows. Key innovations include developing thoughtful use protocols that position LLMs as assistive tools requiring mandatory verification, establishing actionable institutional policies with risk-stratified deployment guidelines and patient disclaimers, and critically analyzing underaddressed regulatory, equity, and safety challenges. This research moves beyond theory to offer a practical roadmap, enabling stakeholders to ethically harness LLMs, balance innovation with accountability, and preserve core medical values: patient safety, equity, and trust in high-stakes health care settings.

Place, publisher, year, edition, pages
JMIR Publications Inc. , 2025. Vol. 27, article id e75849
Keywords [en]
artificial intelligence, assistive technology, bias awareness, conversational AI, governance frameworks, health care innovation, human-in-the-loop, regulatory compliance, risk mitigation, trustworthiness, verification protocols
National Category
Medical Ethics Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:kth:diva-368804DOI: 10.2196/75849ISI: 001542093800002PubMedID: 40712151Scopus ID: 2-s2.0-105011835941OAI: oai:DiVA.org:kth-368804DiVA, id: diva2:1990920
Note

QC 20250821

Available from: 2025-08-21 Created: 2025-08-21 Last updated: 2025-10-17Bibliographically approved
In thesis
1. Evaluation of Artificial Intelligence in the Medical Domain: Speech, Language and Applications
Open this publication in new window or tab >>Evaluation of Artificial Intelligence in the Medical Domain: Speech, Language and Applications
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This doctoral thesis investigates the potential of advanced speech and languagetechnologies, driven by deep learning, to improve clinical diagnostics and patientcare, primarily within the Swedish healthcare context. The research encompasseseight key papers, which are presented across three main sections:(1) Data Capture and Machine Learning for Speech: This section explores the use ofmultimodal data and advanced speech processing techniques for clinical applications.It includes research on utilizing multimodal data capture (speech, gaze, and digitalpen input) from clinical interviews to identify potential digital biomarkers for theearly detection and differentiation of dementia (Paper A). It also develops anautomated deep learning system to evaluate the oral diadochokinesis test for motorspeech disorders, which demonstrates higher accuracy than human raters andproposes a human-in-the-loop clinical interface (Paper B). Furthermore, this sectionevaluates the performance of Automatic Speech Recognition (ASR) systems,comparing word error rates between native (L1) and non-native (L2) Swedishspeakers (Paper C), and investigates data augmentation techniques to improve ASRaccuracy for individuals with aphasia, demonstrating a path towards more inclusivetechnology (Paper D).(2) Evaluation of LLMs in the Medical Domain: This section focuses on establishingrobust methods for assessing Large Language Models (LLMs) within a medicalcontext. It details the development of a specialized Swedish Medical LLM Benchmark,comprising over 2600 questions across various medical domains, designed to assessLLM performance in a clinically relevant, language-specific manner (Paper E).Additionally, the medical reasoning capabilities of LLMs, such as DeepSeek R1, arerigorously assessed, focusing on their capacity for general medical diagnosticreasoning (Paper F).(3) Application and Best Practice for Working with AI in Healthcare: This sectionaddresses the practical, ethical, and user experience (UX) considerations forvimplementing AI in healthcare. It proposes a novel user interface paradigm throughan AI-powered journaling application designed for personal health management,illustrating a low-risk, user-centric approach to AI integration (Paper G).Complementing this, it develops harm reduction strategies for the thoughtful use ofLLMs in the medical domain, providing perspectives for both patients and cliniciansto maximize utility while mitigating risks, thereby establishing best practices forresponsible AI engagement (Paper H).Collectively, this work advances the field by providing new tools and methodologiesfor early disease detection using speech and multimodal data, establishing robustevaluation methods for ASR and LLMs in the medical domain, and offering pathwaysand frameworks for responsible, user-centered, and effective AI implementation inhealthcare.

Abstract [sv]

Denna doktorsavhandling undersöker potentialen hos avancerade tal- ochspråkteknologier, drivna av djupinlärning, för att förbättra klinisk diagnostik ochpatientvård, främst inom svensk hälso- och sjukvård. Forskningen omfattar åttacentrala artiklar, vilka presenteras inom tre huvudsakliga avsnitt:(1) Datainsamling och maskininlärning för tal: Detta avsnitt utforskar användningenav multimodal data och avancerade talbearbetningstekniker för kliniskatillämpningar. Det inkluderar forskning om användning av multimodaldatainsamling från kliniska intervjuer för att identifiera digitala biomarkörer fördemens (Artikel A). Vidare utvecklas ett automatiserat system med djupinlärning föratt utvärdera oral diadochokinesis-testet vid motoriska talrubbningar, vilket visarhögre noggrannhet än mänskliga bedömare och föreslår ett kliniskt gränssnitt medmänniska-i-loopen (Artikel B). Avsnittet utvärderar även prestandan hos system förautomatisk taligenkänning (ASR) genom att jämföra felkvoter mellan talare medsvenska som modersmål respektive andraspråk (Artikel C) och undersökerdataaugmenteringstekniker för att förbättra ASR-noggrannheten för personer medafasi (Artikel D).(2) Utvärdering av stora språkmodeller (LLM:er) inom det medicinska området:Detta avsnitt fokuserar på att etablera robusta metoder för att bedöma storaspråkmodeller (LLM:er) i en medicinsk kontext. Det beskriver utvecklingen av ettspecialiserat svenskt medicinskt LLM-benchmark, bestående av över 2600 frågorinom olika medicinska domäner, avsett att utvärdera LLM:ers prestanda på ettkliniskt relevant och språkspecifikt sätt (Artikel E). Därtill bedöms den medicinskaresonemangsförmågan hos LLM:er, såsom DeepSeek R1, noggrant, med fokus påderas kapacitet för generell medicinsk diagnostiskt resonerande (Artikel F).(3) Applikationer och bästa praxis för AI inom hälso- och sjukvård: Detta avsnittbehandlar praktiska, etiska och användarupplevelsemässiga (UX) överväganden vidimplementering av AI inom hälso- och sjukvården. Ett nyttviianvändargränssnittsparadigm föreslås genom en AI-driven applikation för att föra enpersonlig hälsodagbok. Den är utformad för personlig hälsohantering och illustreraren lågrisk, användarcentrerad strategi för AI-integration (Artikel G). Somkomplement utvecklas strategier för harm reduction för genomtänkt användning avLLM:er inom det medicinska området. Dessa strategier erbjuder perspektiv för bådepatienter och kliniker för att maximera nyttan och samtidigt minimera riskerna, ochetablerar därmed bästa praxis för ansvarsfullt AI-engagemang (Artikel H).Sammantaget bidrar detta arbete till forskningsfältet genom att tillhandahålla nyaverktyg och metoder för tidig sjukdomsdetektion med hjälp av tal- och multimodaldata, etablera robusta utvärderingsmetoder för ASR och LLM:er inom det medicinskaområdet, samt erbjuda vägledning och ramverk för en ansvarsfull, användarcentreradoch effektiv implementering av AI inom hälso- och sjukvården.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2025. p. xxi, 82
Series
TRITA-EECS-AVL ; 2025:83
Keywords
Large Language Models (LLMs), Automatic Speech Recognition (ASR), Neurodegenerative Disorders, Swedish Language, Clinical Diagnostics, AI Ethics, Medical Reasoning, Multimodal Data, Tal- och språkteknologi, maskininlärning, djupinlärning, automatisk taligenkänning (ASR), stora språkmodeller (LLM), medicinsk diagnostik, digitala biomarkörer, afasi, demens, hälso- och sjukvård, användarupplevelse (UX), harm reduction, AI-integration
National Category
Artificial Intelligence
Research subject
Speech and Music Communication
Identifiers
urn:nbn:se:kth:diva-371738 (URN)978-91-8106-404-9 (ISBN)
Public defence
2025-12-12, https://kth-se.zoom.us/j/69936124469, Kollegiesalen, Brinellvägen 8, Stockholm, 13:00 (English)
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Note

QC 20251022

Available from: 2025-10-22 Created: 2025-10-17 Last updated: 2025-11-13Bibliographically approved

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