arXiv AI

The Reliability of LLMs for Medical Diagnosis: An Examination of Consistency, Manipulation, and Contextual Awareness

arXiv:2503. 10647v2 Announce Type: replace-cross Abstract: This study evaluated the diagnostic reliability of two Large Language Models (LLMs), Google Gemini 2.

arXiv Computation and Language
Aug 24

An ambiguity taxonomy for evaluating large language model performance on clinical registry abstraction: a multi-site prospective study

The study evaluates large language models (LLMs) on unprocessed electronic medical record data for clinical registry abstraction, focusing on the American College of Cardiology National Cardiovascular Data Registry. In a pilot at one academic center, the LLM identified candidate data sources for each registry question, which abstractors used to define question‑specific document sets. In a subsequent validation at a second center, the LLM answered 157 registry questions with an overall mean accuracy of 91.5%, but accuracy dropped from 96% for simple medication or event flag questions to 62% for event timing questions, reflecting increasing ambiguity and required clinical reasoning.

By James Matheson, Betsy Castillo, Andrew Y. Shin, David Scheinker
arXiv AI
Jul 16

Ask Before You Diagnose: Safe-Psych, a Sequential Evaluation Benchmark for LLMs in Psychiatry

arXiv:2607. 13036v1 Announce Type: cross Abstract: Large language models (LLMs) are increasingly used for decision support in healthcare, but clinical evidence is often incomplete or evolving.

By Oriana Presacan, Andreea Grama, Larisa Irimin\u{a}, Alireza Nik, Jaya Ojha, Vajira Thambawita, Ciprian I. B\u{a}cil\u{a}, Bogdan Ionescu, Michael A. Riegler
arXiv Computation and Language
Sep 11

Towards Reliable Medical LLMs: Benchmarking and Enhancing Confidence Estimation of Large Language Models in Medical Consultation

The paper introduces the first benchmark for evaluating confidence estimation in large language models during multi‑turn medical consultations, combining three types of medical data and an information sufficiency gradient to capture how confidence and correctness evolve as evidence accumulates. Experiments with 27 methods reveal that token‑level and consistency‑level confidence approaches are limited by medical data, and that medical reasoning must be judged on both diagnostic accuracy and information completeness. Building on these findings, the authors propose MedConf, a retrieval‑augmented, linguistically grounded self‑assessment framework that aligns patient information with supporting, missing, and contradictory relations, producing interpretable confidence estimates that outperform existing methods across multiple datasets and LLMs.

By Zhiyao Ren, Yibing Zhan, Siyuan Liang, Guozheng Ma, Baosheng Yu, Dacheng Tao
arXiv AI
Aug 25

SDoH-Aware Narrative Anchoring Bias in Medical LLMs for Trustworthy Clinical Decision Support

The paper investigates how medical large language models (LLMs) may exhibit narrative anchoring bias when presented with the same clinical case in different patient voices. Using the NarrativeShield SDoH MedQA dataset, the authors evaluate three Qwen2.5 instruction‑tuned LLMs (1.5B, 3B, 7B) on 300 clinical cases, reporting metrics such as persona‑level accuracy, counterfactual consistency, correct consistency, and narrative sensitivity error. The 7B model achieves the highest accuracy (56.33 %) and correct consistency (40.33 %), yet narrative sensitivity errors remain substantial (31.67 %).

By Ahnaf Atef Choudhury, Ramkrishna Saha
arXiv AI
Aug 3

Reasoning in Real World Clinical Care: Why Large Language Models Are Not Yet Safe for Autonomous Clinical Decision Support

arXiv:2607. 28677v1 Announce Type: new Abstract: LLM now pass medical licensing examinations and, in curated cases, can rival physicians at diagnostic reasoning.

By Shayndhan Sivanathan, Shravan Nageswaran, Mehdi Zadem, Ryaan Sultan, Nicolas von Mallinckrodt, Max Solovyev, Alexey Matyushkin, Sumon Sadhu, Gabriele C DeLuca, Sanjeeva Jeyaretna, James Hillis, Manoj Ramachandran, Prakash Jayakumar
arXiv AI
Sep 3

Untangling the Mechanisms of Misleading Context in Medical Question Answering

The paper investigates how misleading context—specifically fabricated evidence and bare assertions—affects large language models’ medical question‑answering performance. Experiments on MedMisBench show that models are more prone to adopt answers based on assertions than fabricated evidence, and that these misleading cues are often disclosed in reasoning traces but rarely in final responses. A monitor that reads open reasoning traces can detect most corrupted decisions, whereas monitoring only responses is less effective.

By Robin Linzmayer, No\'emie Elhadad
arXiv Computation and Language
Sep 22

LLMs Anchor on Chief Complaint and Fail to Integrate Evidence in Sequential Clinical Triage

The study evaluates large language models (LLMs) on sequential emergency department triage, where acuity labels are predicted from progressively longer nurse‑patient conversations. Six LLMs were tested at five checkpoints on simulated and physician‑authored dialogues, showing a decline from moderate‑to‑substantial agreement on full records to only fair‑to‑moderate agreement at each checkpoint. The models consistently anchor on chief complaint exchanges and fail to integrate later evidence, yielding low agreement with clinicians (QWK 0.295 vs. 0.887‑0.929) and concentrating predictions on ESI‑2 and ESI‑3. whyItMatters":"The findings reveal that LLMs, despite strong offline performance, cannot reliably handle the sequential nature of real‑time triage, highlighting a critical gap for safe deployment in emergency settings."

By Dipankar Srirag, Haokai Zhao, Ashutosh Kumar, Eleanor Hopper, Michael Dalton, Quoc Dung Nguyen, Aditya Joshi, Salil S. Kanhere, Padmanesan Narasimhan
arXiv AI
Sep 17

From 'May' to 'Is': Certainty Distortion in Language Model Rewriting

The study examines how language models (LMs) alter the expressed certainty of statements when rewriting text, a process termed certainty distortion. Using an LM‑based metric aligned with human judgments, the authors find that up to 75% of LM outputs exhibit such distortion, with most models more likely to inflate certainty than reduce it. Repeated paraphrasing can amplify this effect, especially in medical contexts, and while prompt interventions help, they do not fully eliminate the bias.

By Catarina G Belem, Shang Wu, Hongyu Yao, Mark Steyvers, Sameer Singh, Padhraic Smyth