Large Language Models in Belgian Primary Care: Clinical Applications, Ethical Challenges, and Epistemological Reflections

Background: Large language models (LLMs) are increasingly integrated into healthcare,
with potential applications spanning clinical documentation, patient communication, de-
cision support, and biomedical research. Their use, however, raises significant challenges
in terms of ethics, epistemology, and health system organization.
Objective: This narrative review critically examines the opportunities and limitations
of LLMs in medicine, with a particular focus on their implications for Belgian primary
care and family medicine.
Methods: We conducted a structured narrative review of the recent literature (2023–2025)
on LLMs in healthcare, complemented by clinical case illustrations and analysis of the
Belgian information system. The review emphasizes practical applications, ethical issues,
and epistemological reflections relevant to clinicians and policymakers.
Results: LLMs can enhance efficiency in clinical documentation, support patient-centered
communication across languages, and facilitate evidence retrieval and research through
standardized terminologies such as the Human Phenotype Ontology. However, their inte-
gration into Belgian healthcare is hindered by fragmented information systems and rigid
data governance. Ethical concerns include reliability, bias, confidentiality, transparency,
patient trust, and environmental impact. Epistemological biases in scientific production
and the invisibilization of field knowledge further limit the reliability of LLM outputs. Im-
portantly, LLMs cannot substitute for the therapeutic relationship, which remains central
to care.
Conclusion: LLMs represent promising auxiliary tools in Belgian and international
medicine, capable of reducing administrative burden and supporting clinical practice and
research. Their safe and effective integration requires ethical oversight, systemic reform
of fragmented health information structures, and renewed attention to the physician–
patient relationship. For Belgian primary care, these technologies should be adopted with
caution, transparency, and critical vigilance to ensure they serve patients and reinforce,
rather than undermine, the human dimension of medicine.