Towards Explainable Conversational AI for Early Diagnosis with Large Language Models

Abstract

Healthcare systems around the world are grappling with issues such as inefficient diagnostics, rising costs, and limited access to specialists. These challenges often contribute to delays in treatment and poorer health outcomes. Most existing AI and deep learning based health assessment systems offer limited interactivity and transparency, reducing their usefulness for user-centered health support. This research introduces a conversational chatbot powered by a Large Language Model (LLM), using GPT-4o, Retrieval-Augmented Generation, and explainable AI techniques. The chatbot engages users in a dynamic conversation to extract and normalize symptoms while identifying and ranking potential health conditions through similarity matching and adaptive questioning. Using Chain-of-Thought prompting, the system also provides more transparent explanations of its reasoning process. When evaluated against traditional machine learning models, including Naive Bayes, Logistic Regression, SVM, Random Forest, and KNN using both TF-IDF and CountVectorizer feature extraction, the proposed LLM-based system achieved a Top-1 accuracy of 90% and a Top-3 accuracy of 100%. The system was additionally evaluated through a cross-sectional expert evaluation involving 17 physicians across all 14 conditions, with the results indicating generally favorable assessments of conversational quality, early diagnostic plausibility, and safety-related criteria. These findings demonstrate the potential of explainable conversational AI as a health and well-being support tool for early symptom assessment. However, the proposed system is not intended for clinical diagnosis or clinical decision-making, and further validation would be required before any use in healthcare practice.