arXiv AI By Bharath Kumar Bolla, Chaitali Deb Purkayastha, Vishnu Surya Reddy Nandi

Right Answer, Wrong Reason: Accuracy, Consistency, and Consensus Are Misleading Indicators of LLM Faithfulness in Clinical Decision Support

Read the original on arXiv AI →

The paper introduces three interpretable metrics—Explanation Stability Index (ESI), Causal Faithfulness Score (CFS), and Perturbation Stability Score (PSS)—to assess the faithfulness of large language models (LLMs) in clinical decision support. Evaluating six LLMs on 150 MedQA-USMLE questions, the study finds that only 23.3% of cited clinical concepts are causally necessary, and that correct answers often have lower CFS than incorrect ones, with answer consistency negatively predicting faithfulness. These findings suggest that accuracy, consistency, and consensus are incomplete safety signals for clinical decision-making support.

Machine-generated by The Flow from the publisher's headline and feed description — not written or checked by a human. The full article lives at arXiv AI.

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
Sep 12

Can LLMs Follow Medical Expert Logic? A Benchmark for Hierarchical Logical Consistency in Risk-of-Bias Assessment

LogiMed‑RoB is a new benchmark that tests large language models (LLMs) on hierarchical logical consistency in medical risk‑of‑bias assessments, using 860 randomized controlled trials and 14,820 queries based on Cochrane Risk of Bias 2.0 expert logic. The benchmark evaluates models across four dimensions—Atomic Consistency, Domain Consistency, Aggregation Consistency, and Evidential Faithfulness—revealing a catastrophic error‑compounding effect where high atomic accuracy does not translate to end‑to‑end consistency. Experiments on ten state‑of‑the‑art LLMs show that even top models can fail to deduce correct outcomes in a significant portion of cases, highlighting a gap between evidence retrieval and reasoning. whyItMatters":"The study shows that high outcome accuracy can mask critical reasoning flaws, emphasizing the need for white‑box logical verification before deploying LLMs in clinical settings."

By Jiayu Huang, Zichen Tang, Qianhui Ling, Zemin Kuang, Haihong E
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