Enhancing Diagnostic Accuracy through Multi-Agent Conversations: Using Large Language Models to Mitigate Cognitive Bias

Background: Cognitive biases in clinical decision-making significantly contribute to errors in diagnosis and suboptimal patient outcomes. Addressing these biases presents a formidable challenge in the medical field. This study explores the role of large language models (LLMs) in mitigating these biases through the utilization of a multi-agent framework. We simulate the clinical decision-making processes through multi-agent conversation and evaluate its efficacy in improving diagnostic accuracy. Methods: A total of 16 published and unpublished case reports where cognitive biases have resulted in misdiagnoses were identified from the literature. In the multi-agent system, we leveraged GPT-4 Turbo to facilitate interactions among four simulated agents to replicate clinical team dynamics. Each agent has a distinct role: 1) To make the initial and final diagnosis after considering the discussions, 2) The devil's advocate and correct confirmation and anchoring bias, 3) The tutor and facilitator of the discussion to reduce premature closure bias, and 4) To record and summarize the findings. A total of 80 simulations were evaluated for the accuracy of initial diagnosis, top differential diagnosis and final two differential diagnoses. Findings: In a total of 80 responses evaluating both initial and final diagnoses, the initial diagnosis had an accuracy of 0% (0/80), but following multi-agent discussions, the accuracy for the top differential diagnosis increased to 71.3% (57/80), and for the final two differential diagnoses, to 80.0% (64/80). The system demonstrated an ability to reevaluate and correct misconceptions, even in scenarios with misleading initial investigations. Interpretation: The LLM-driven multi-agent conversation system shows promise in enhancing diagnostic accuracy in diagnostically challenging medical scenarios.