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May 7

"I'm Not Sure, But...": Examining the Impact of Large Language Models' Uncertainty Expression on User Reliance and Trust

Widely deployed large language models (LLMs) can produce convincing yet incorrect outputs, potentially misleading users who may rely on them as if they were correct. To reduce such overreliance, there have been calls for LLMs to communicate their uncertainty to end users. However, there has been little empirical work examining how users perceive and act upon LLMs' expressions of uncertainty. We explore this question through a large-scale, pre-registered, human-subject experiment (N=404) in which participants answer medical questions with or without access to responses from a fictional LLM-infused search engine. Using both behavioral and self-reported measures, we examine how different natural language expressions of uncertainty impact participants' reliance, trust, and overall task performance. We find that first-person expressions (e.g., "I'm not sure, but...") decrease participants' confidence in the system and tendency to agree with the system's answers, while increasing participants' accuracy. An exploratory analysis suggests that this increase can be attributed to reduced (but not fully eliminated) overreliance on incorrect answers. While we observe similar effects for uncertainty expressed from a general perspective (e.g., "It's not clear, but..."), these effects are weaker and not statistically significant. Our findings suggest that using natural language expressions of uncertainty may be an effective approach for reducing overreliance on LLMs, but that the precise language used matters. This highlights the importance of user testing before deploying LLMs at scale.

  • 5 authors
·
May 1, 2024

Question answering systems for health professionals at the point of care -- a systematic review

Objective: Question answering (QA) systems have the potential to improve the quality of clinical care by providing health professionals with the latest and most relevant evidence. However, QA systems have not been widely adopted. This systematic review aims to characterize current medical QA systems, assess their suitability for healthcare, and identify areas of improvement. Materials and methods: We searched PubMed, IEEE Xplore, ACM Digital Library, ACL Anthology and forward and backward citations on 7th February 2023. We included peer-reviewed journal and conference papers describing the design and evaluation of biomedical QA systems. Two reviewers screened titles, abstracts, and full-text articles. We conducted a narrative synthesis and risk of bias assessment for each study. We assessed the utility of biomedical QA systems. Results: We included 79 studies and identified themes, including question realism, answer reliability, answer utility, clinical specialism, systems, usability, and evaluation methods. Clinicians' questions used to train and evaluate QA systems were restricted to certain sources, types and complexity levels. No system communicated confidence levels in the answers or sources. Many studies suffered from high risks of bias and applicability concerns. Only 8 studies completely satisfied any criterion for clinical utility, and only 7 reported user evaluations. Most systems were built with limited input from clinicians. Discussion: While machine learning methods have led to increased accuracy, most studies imperfectly reflected real-world healthcare information needs. Key research priorities include developing more realistic healthcare QA datasets and considering the reliability of answer sources, rather than merely focusing on accuracy.

  • 9 authors
·
Jan 24, 2024

Diminished Diversity-of-Thought in a Standard Large Language Model

We test whether Large Language Models (LLMs) can be used to simulate human participants in social-science studies. To do this, we run replications of 14 studies from the Many Labs 2 replication project with OpenAI's text-davinci-003 model, colloquially known as GPT3.5. Based on our pre-registered analyses, we find that among the eight studies we could analyse, our GPT sample replicated 37.5% of the original results and 37.5% of the Many Labs 2 results. However, we were unable to analyse the remaining six studies due to an unexpected phenomenon we call the "correct answer" effect. Different runs of GPT3.5 answered nuanced questions probing political orientation, economic preference, judgement, and moral philosophy with zero or near-zero variation in responses: with the supposedly "correct answer." In one exploratory follow-up study, we found that a "correct answer" was robust to changing the demographic details that precede the prompt. In another, we found that most but not all "correct answers" were robust to changing the order of answer choices. One of our most striking findings occurred in our replication of the Moral Foundations Theory survey results, where we found GPT3.5 identifying as a political conservative in 99.6% of the cases, and as a liberal in 99.3% of the cases in the reverse-order condition. However, both self-reported 'GPT conservatives' and 'GPT liberals' showed right-leaning moral foundations. Our results cast doubts on the validity of using LLMs as a general replacement for human participants in the social sciences. Our results also raise concerns that a hypothetical AI-led future may be subject to a diminished diversity-of-thought.

  • 3 authors
·
Feb 13, 2023

On the Proactive Generation of Unsafe Images From Text-To-Image Models Using Benign Prompts

Text-to-image models like Stable Diffusion have had a profound impact on daily life by enabling the generation of photorealistic images from textual prompts, fostering creativity, and enhancing visual experiences across various applications. However, these models also pose risks. Previous studies have successfully demonstrated that manipulated prompts can elicit text-to-image models to generate unsafe images, e.g., hateful meme variants. Yet, these studies only unleash the harmful power of text-to-image models in a passive manner. In this work, we focus on the proactive generation of unsafe images using targeted benign prompts via poisoning attacks. We propose two poisoning attacks: a basic attack and a utility-preserving attack. We qualitatively and quantitatively evaluate the proposed attacks using four representative hateful memes and multiple query prompts. Experimental results indicate that text-to-image models are vulnerable to the basic attack even with five poisoning samples. However, the poisoning effect can inadvertently spread to non-targeted prompts, leading to undesirable side effects. Root cause analysis identifies conceptual similarity as an important contributing factor to the side effects. To address this, we introduce the utility-preserving attack as a viable mitigation strategy to maintain the attack stealthiness, while ensuring decent attack performance. Our findings underscore the potential risks of adopting text-to-image models in real-world scenarios, calling for future research and safety measures in this space.

  • 5 authors
·
Oct 25, 2023

Disagreement as a way to study misinformation and its effects

Misinformation - false or misleading information - is considered a significant societal concern due to its associated "misinformation effects," such as political polarization, erosion of trust in institutions, problematic behavior, and public health challenges. However, the prevailing concept is misaligned with what is studied. While misinformation focuses on instances of information about factual matters, the broad spectrum of effects often manifests at a societal level and is shaped by a wide range of interdependent factors such as identity, values, opinions, epistemologies, and disagreements. Unsurprisingly, misinformation effects can occur without the prevalence of misinformation, and misinformation does not necessarily increase the effects studied. Here, we propose using disagreement - conflicting attitudes and beliefs between individuals and communities - as a way to study misinformation effects because it addresses the identified conceptual limitations of misinformation. Furthermore, unlike misinformation, disagreement does not require researchers to determine whether a given information is false or misleading. Thus, it can be studied and, more importantly, measured without the need to make a normative judgment about a given information, even when the specific topic is entirely removed, as we show in a longitudinal disagreement measurement. We demonstrate that disagreement, as a holistic concept, provides better explanations for the occurrence of misinformation effects, enhances precision in developing appropriate interventions, and offers a promising approach for evaluating them through quantification. Finally, we show how disagreement addresses current misinformation research questions and conclude with recommendations for research practice.

  • 2 authors
·
Aug 15, 2024

A mathematical model of Breast cancer (ER+) with excess estrogen: Mixed treatments using Ketogenic diet, endocrine therapy and Immunotherapy

Breast Cancer is a major public health problem and the most common diagnosed malignancy in woman. There have been significant developments in clinical approaches and theoretical experimental to understand the interactions of cancer cells dynamics with the immune system, also developments on analytical and computational models to help provide insights into clinical observations for a better understanding of cancer cells, but more are needed, especially at the genetic and molecular levels mathematically. Treatments such as immunotherapy, chemotherapy, hormone therapy, radiotherapy, and gene therapy are the main strategies in the fight against breast cancer. The present study aims at investigating the effects of estrogen derived from recent models, but this time combined with immunotherapy as a way to treat or inhibit the cancer growth by a mathematical model of breast cancer in situ, governed by a simplified model of nonlinear-coupled ordinary differential equations, that combines important interactions between natural cells, tumor cells, immune cells, ketogenic diet in the presence of an anticancer drug. Another contribution was to introduce the inhibition effect epsilon for new results and conclusions, A qualitative study was performed and biological interpretations were included to understand the conditions of stability in a realistic way.

  • 2 authors
·
May 24, 2022

Effective Transfer Learning for Identifying Similar Questions: Matching User Questions to COVID-19 FAQs

People increasingly search online for answers to their medical questions but the rate at which medical questions are asked online significantly exceeds the capacity of qualified people to answer them. This leaves many questions unanswered or inadequately answered. Many of these questions are not unique, and reliable identification of similar questions would enable more efficient and effective question answering schema. COVID-19 has only exacerbated this problem. Almost every government agency and healthcare organization has tried to meet the informational need of users by building online FAQs, but there is no way for people to ask their question and know if it is answered on one of these pages. While many research efforts have focused on the problem of general question similarity, these approaches do not generalize well to domains that require expert knowledge to determine semantic similarity, such as the medical domain. In this paper, we show how a double fine-tuning approach of pretraining a neural network on medical question-answer pairs followed by fine-tuning on medical question-question pairs is a particularly useful intermediate task for the ultimate goal of determining medical question similarity. While other pretraining tasks yield an accuracy below 78.7% on this task, our model achieves an accuracy of 82.6% with the same number of training examples, an accuracy of 80.0% with a much smaller training set, and an accuracy of 84.5% when the full corpus of medical question-answer data is used. We also describe a currently live system that uses the trained model to match user questions to COVID-related FAQs.

  • 5 authors
·
Aug 4, 2020

Shallow Robustness, Deep Vulnerabilities: Multi-Turn Evaluation of Medical LLMs

Large language models (LLMs) are rapidly transitioning into medical clinical use, yet their reliability under realistic, multi-turn interactions remains poorly understood. Existing evaluation frameworks typically assess single-turn question answering under idealized conditions, overlooking the complexities of medical consultations where conflicting input, misleading context, and authority influence are common. We introduce MedQA-Followup, a framework for systematically evaluating multi-turn robustness in medical question answering. Our approach distinguishes between shallow robustness (resisting misleading initial context) and deep robustness (maintaining accuracy when answers are challenged across turns), while also introducing an indirect-direct axis that separates contextual framing (indirect) from explicit suggestion (direct). Using controlled interventions on the MedQA dataset, we evaluate five state-of-the-art LLMs and find that while models perform reasonably well under shallow perturbations, they exhibit severe vulnerabilities in multi-turn settings, with accuracy dropping from 91.2% to as low as 13.5% for Claude Sonnet 4. Counterintuitively, indirect, context-based interventions are often more harmful than direct suggestions, yielding larger accuracy drops across models and exposing a significant vulnerability for clinical deployment. Further compounding analyses reveal model differences, with some showing additional performance drops under repeated interventions while others partially recovering or even improving. These findings highlight multi-turn robustness as a critical but underexplored dimension for safe and reliable deployment of medical LLMs.

  • 5 authors
·
Oct 14, 2025

Compound Estimation for Binomials

Many applications involve estimating the mean of multiple binomial outcomes as a common problem -- assessing intergenerational mobility of census tracts, estimating prevalence of infectious diseases across countries, and measuring click-through rates for different demographic groups. The most standard approach is to report the plain average of each outcome. Despite simplicity, the estimates are noisy when the sample sizes or mean parameters are small. In contrast, the Empirical Bayes (EB) methods are able to boost the average accuracy by borrowing information across tasks. Nevertheless, the EB methods require a Bayesian model where the parameters are sampled from a prior distribution which, unlike the commonly-studied Gaussian case, is unidentified due to discreteness of binomial measurements. Even if the prior distribution is known, the computation is difficult when the sample sizes are heterogeneous as there is no simple joint conjugate prior for the sample size and mean parameter. In this paper, we consider the compound decision framework which treats the sample size and mean parameters as fixed quantities. We develop an approximate Stein's Unbiased Risk Estimator (SURE) for the average mean squared error given any class of estimators. For a class of machine learning-assisted linear shrinkage estimators, we establish asymptotic optimality, regret bounds, and valid inference. Unlike existing work, we work with the binomials directly without resorting to Gaussian approximations. This allows us to work with small sample sizes and/or mean parameters in both one-sample and two-sample settings. We demonstrate our approach using three datasets on firm discrimination, education outcomes, and innovation rates.

  • 2 authors
·
Dec 30, 2025

Evaluation of GPT-3.5 and GPT-4 for supporting real-world information needs in healthcare delivery

Despite growing interest in using large language models (LLMs) in healthcare, current explorations do not assess the real-world utility and safety of LLMs in clinical settings. Our objective was to determine whether two LLMs can serve information needs submitted by physicians as questions to an informatics consultation service in a safe and concordant manner. Sixty six questions from an informatics consult service were submitted to GPT-3.5 and GPT-4 via simple prompts. 12 physicians assessed the LLM responses' possibility of patient harm and concordance with existing reports from an informatics consultation service. Physician assessments were summarized based on majority vote. For no questions did a majority of physicians deem either LLM response as harmful. For GPT-3.5, responses to 8 questions were concordant with the informatics consult report, 20 discordant, and 9 were unable to be assessed. There were 29 responses with no majority on "Agree", "Disagree", and "Unable to assess". For GPT-4, responses to 13 questions were concordant, 15 discordant, and 3 were unable to be assessed. There were 35 responses with no majority. Responses from both LLMs were largely devoid of overt harm, but less than 20% of the responses agreed with an answer from an informatics consultation service, responses contained hallucinated references, and physicians were divided on what constitutes harm. These results suggest that while general purpose LLMs are able to provide safe and credible responses, they often do not meet the specific information need of a given question. A definitive evaluation of the usefulness of LLMs in healthcare settings will likely require additional research on prompt engineering, calibration, and custom-tailoring of general purpose models.

  • 18 authors
·
Apr 26, 2023

Model-free Approach to Evaluate a Censored Intermediate Outcome as a Surrogate for Overall Survival

Clinical trials or studies oftentimes require long-term and/or costly follow-up of participants to evaluate a novel treatment/drug/vaccine. There has been increasing interest in the past few decades in using short-term surrogate outcomes as a replacement of the primary outcome i.e., in using the surrogate outcome, which can potentially be observed sooner, to make inference about the treatment effect on the long-term primary outcome. Very few of the available statistical methods to evaluate a surrogate are applicable to settings where both the surrogate and the primary outcome are time-to-event outcomes subject to censoring. Methods that can handle this setting tend to require parametric assumptions or be limited to assessing only the restricted mean survival time. In this paper, we propose a non-parametric approach to evaluate a censored surrogate outcome, such as time to progression, when the primary outcome is also a censored time-to-event outcome, such as time to death, and the treatment effect of interest is the difference in overall survival. Specifically, we define the proportion of the treatment effect on the primary outcome that is explained (PTE) by the censored surrogate outcome in this context, and estimate this proportion by defining and deriving an optimal transformation of the surrogate information. Our approach provides the added advantage of relaxed assumptions to guarantee that the true PTE is within (0,1), along with being model-free. Finite sample performance of our estimators are illustrated via extensive simulation studies and a real data application examining progression-free survival as a surrogate for overall survival for patients with metastatic colorectal cancer.

  • 4 authors
·
Dec 18, 2024

Unintentional Unalignment: Likelihood Displacement in Direct Preference Optimization

Direct Preference Optimization (DPO) and its variants are increasingly used for aligning language models with human preferences. Although these methods are designed to teach a model to generate preferred responses more frequently relative to dispreferred responses, prior work has observed that the likelihood of preferred responses often decreases during training. The current work sheds light on the causes and implications of this counter-intuitive phenomenon, which we term likelihood displacement. We demonstrate that likelihood displacement can be catastrophic, shifting probability mass from preferred responses to responses with an opposite meaning. As a simple example, training a model to prefer No over Never can sharply increase the probability of Yes. Moreover, when aligning the model to refuse unsafe prompts, we show that such displacement can unintentionally lead to unalignment, by shifting probability mass from preferred refusal responses to harmful responses (e.g., reducing the refusal rate of Llama-3-8B-Instruct from 74.4% to 33.4%). We theoretically characterize that likelihood displacement is driven by preferences that induce similar embeddings, as measured by a centered hidden embedding similarity (CHES) score. Empirically, the CHES score enables identifying which training samples contribute most to likelihood displacement in a given dataset. Filtering out these samples effectively mitigated unintentional unalignment in our experiments. More broadly, our results highlight the importance of curating data with sufficiently distinct preferences, for which we believe the CHES score may prove valuable.

  • 6 authors
·
Oct 11, 2024

MOSSBench: Is Your Multimodal Language Model Oversensitive to Safe Queries?

Humans are prone to cognitive distortions -- biased thinking patterns that lead to exaggerated responses to specific stimuli, albeit in very different contexts. This paper demonstrates that advanced Multimodal Large Language Models (MLLMs) exhibit similar tendencies. While these models are designed to respond queries under safety mechanism, they sometimes reject harmless queries in the presence of certain visual stimuli, disregarding the benign nature of their contexts. As the initial step in investigating this behavior, we identify three types of stimuli that trigger the oversensitivity of existing MLLMs: Exaggerated Risk, Negated Harm, and Counterintuitive Interpretation. To systematically evaluate MLLMs' oversensitivity to these stimuli, we propose the Multimodal OverSenSitivity Benchmark (MOSSBench). This toolkit consists of 300 manually collected benign multimodal queries, cross-verified by third-party reviewers (AMT). Empirical studies using MOSSBench on 20 MLLMs reveal several insights: (1). Oversensitivity is prevalent among SOTA MLLMs, with refusal rates reaching up to 76% for harmless queries. (2). Safer models are more oversensitive: increasing safety may inadvertently raise caution and conservatism in the model's responses. (3). Different types of stimuli tend to cause errors at specific stages -- perception, intent reasoning, and safety judgement -- in the response process of MLLMs. These findings highlight the need for refined safety mechanisms that balance caution with contextually appropriate responses, improving the reliability of MLLMs in real-world applications. We make our project available at https://turningpoint-ai.github.io/MOSSBench/.

  • 6 authors
·
Jun 22, 2024

Cost-effectiveness analysis for therapy sequence in advanced cancer: A microsimulation approach with application to metastatic prostate cancer

Purpose. Patients with advanced cancer may undergo multiple lines of treatment, switching therapies as their disease progresses. Motivated by a study of metastatic prostate cancer, we develop a microsimulation framework to study therapy sequence. Methods. We propose a discrete-time state transition model to study two lines of anti-cancer therapy. Based on digitized published progression-free survival (PFS) and overall survival (OS) curves, we infer event types (progression or death), and estimate transition probabilities using cumulative incidence functions with competing risks. Our model incorporates within-patient dependence over time, such that response to first-line therapy informs subsequent event probabilities. Parameters governing the degree of within-patient dependence can be used to calibrate the model-based results to those of a target trial. We demonstrate these methods in a study of two therapy sequences for metastatic prostate cancer, where Docetaxel (DCT) and Abiraterone Acetate (AA) are both appropriate for use in either first or second line treatment. We assess costs, Quality-Adjusted Life Years (QALYs) and Incremental Cost Effectiveness Ratio (ICER) for two treatment strategies: DCT then AA vs AA then DCT. Results. Using digitized survival curves from relevant clinical trials, we identified 8.6-13.9% of PFS times that should be categorized as deaths, allowing for estimation of cumulative incidence functions. Models assuming within-patient independence overestimated OS time, corrected with our calibration approach. Correction resulted in meaningful changes in the difference in QALYs between treatment strategies (0.07 vs 0.15) and the ICER (-\76,836/QALY vs -21,030/QALY). Conclusions. Microsimulation models can be successfully used to study cost-effectiveness of therapy sequences, taking care to account correctly for within-patient dependence.

  • 5 authors
·
Oct 10, 2022

Multiple Choice Questions: Reasoning Makes Large Language Models (LLMs) More Self-Confident Even When They Are Wrong

One of the most widely used methods to evaluate LLMs are Multiple Choice Question (MCQ) tests. MCQ benchmarks enable the testing of LLM knowledge on almost any topic at scale as the results can be processed automatically. To help the LLM answer, a few examples called few shots can be included in the prompt. Moreover, the LLM can be asked to answer the question directly with the selected option or to first provide the reasoning and then the selected answer, which is known as chain of thought. In addition to checking whether the selected answer is correct, the evaluation can look at the LLM-estimated probability of its response as an indication of the confidence of the LLM in the response. In this paper, we study how the LLM confidence in its answer depends on whether the model has been asked to answer directly or to provide the reasoning before answering. The results of the evaluation of questions on a wide range of topics in seven different models show that LLMs are more confident in their answers when they provide reasoning before the answer. This occurs regardless of whether the selected answer is correct. Our hypothesis is that this behavior is due to the reasoning that modifies the probability of the selected answer, as the LLM predicts the answer based on the input question and the reasoning that supports the selection made. Therefore, LLM estimated probabilities seem to have intrinsic limitations that should be understood in order to use them in evaluation procedures. Interestingly, the same behavior has been observed in humans, for whom explaining an answer increases confidence in its correctness.

  • 5 authors
·
Jan 16, 2025 2

Evaluating language models as risk scores

Current question-answering benchmarks predominantly focus on accuracy in realizable prediction tasks. Conditioned on a question and answer-key, does the most likely token match the ground truth? Such benchmarks necessarily fail to evaluate LLMs' ability to quantify ground-truth outcome uncertainty. In this work, we focus on the use of LLMs as risk scores for unrealizable prediction tasks. We introduce folktexts, a software package to systematically generate risk scores using LLMs, and evaluate them against US Census data products. A flexible API enables the use of different prompting schemes, local or web-hosted models, and diverse census columns that can be used to compose custom prediction tasks. We evaluate 17 recent LLMs across five proposed benchmark tasks. We find that zero-shot risk scores produced by multiple-choice question-answering have high predictive signal but are widely miscalibrated. Base models consistently overestimate outcome uncertainty, while instruction-tuned models underestimate uncertainty and produce over-confident risk scores. In fact, instruction-tuning polarizes answer distribution regardless of true underlying data uncertainty. This reveals a general inability of instruction-tuned LLMs to express data uncertainty using multiple-choice answers. A separate experiment using verbalized chat-style risk queries yields substantially improved calibration across instruction-tuned models. These differences in ability to quantify data uncertainty cannot be revealed in realizable settings, and highlight a blind-spot in the current evaluation ecosystem that folktexts covers.

  • 3 authors
·
Jul 19, 2024

Addressing cognitive bias in medical language models

There is increasing interest in the application large language models (LLMs) to the medical field, in part because of their impressive performance on medical exam questions. While promising, exam questions do not reflect the complexity of real patient-doctor interactions. In reality, physicians' decisions are shaped by many complex factors, such as patient compliance, personal experience, ethical beliefs, and cognitive bias. Taking a step toward understanding this, our hypothesis posits that when LLMs are confronted with clinical questions containing cognitive biases, they will yield significantly less accurate responses compared to the same questions presented without such biases. In this study, we developed BiasMedQA, a benchmark for evaluating cognitive biases in LLMs applied to medical tasks. Using BiasMedQA we evaluated six LLMs, namely GPT-4, Mixtral-8x70B, GPT-3.5, PaLM-2, Llama 2 70B-chat, and the medically specialized PMC Llama 13B. We tested these models on 1,273 questions from the US Medical Licensing Exam (USMLE) Steps 1, 2, and 3, modified to replicate common clinically-relevant cognitive biases. Our analysis revealed varying effects for biases on these LLMs, with GPT-4 standing out for its resilience to bias, in contrast to Llama 2 70B-chat and PMC Llama 13B, which were disproportionately affected by cognitive bias. Our findings highlight the critical need for bias mitigation in the development of medical LLMs, pointing towards safer and more reliable applications in healthcare.

  • 10 authors
·
Feb 12, 2024

The Psychogenic Machine: Simulating AI Psychosis, Delusion Reinforcement and Harm Enablement in Large Language Models

Background: Emerging reports of "AI psychosis" are on the rise, where user-LLM interactions may exacerbate or induce psychosis or adverse psychological symptoms. Whilst the sycophantic and agreeable nature of LLMs can be beneficial, it becomes a vector for harm by reinforcing delusional beliefs in vulnerable users. Methods: Psychosis-bench is a novel benchmark designed to systematically evaluate the psychogenicity of LLMs comprises 16 structured, 12-turn conversational scenarios simulating the progression of delusional themes(Erotic Delusions, Grandiose/Messianic Delusions, Referential Delusions) and potential harms. We evaluated eight prominent LLMs for Delusion Confirmation (DCS), Harm Enablement (HES), and Safety Intervention(SIS) across explicit and implicit conversational contexts. Findings: Across 1,536 simulated conversation turns, all LLMs demonstrated psychogenic potential, showing a strong tendency to perpetuate rather than challenge delusions (mean DCS of 0.91 pm0.88). Models frequently enabled harmful user requests (mean HES of 0.69 pm0.84) and offered safety interventions in only roughly a third of applicable turns (mean SIS of 0.37 pm0.48). 51 / 128 (39.8%) of scenarios had no safety interventions offered. Performance was significantly worse in implicit scenarios, models were more likely to confirm delusions and enable harm while offering fewer interventions (p < .001). A strong correlation was found between DCS and HES (rs = .77). Model performance varied widely, indicating that safety is not an emergent property of scale alone. Conclusion: This study establishes LLM psychogenicity as a quantifiable risk and underscores the urgent need for re-thinking how we train LLMs. We frame this issue not merely as a technical challenge but as a public health imperative requiring collaboration between developers, policymakers, and healthcare professionals.

  • 5 authors
·
Sep 13, 2025

CUE-R: Beyond the Final Answer in Retrieval-Augmented Generation

As language models shift from single-shot answer generation toward multi-step reasoning that retrieves and consumes evidence mid-inference, evaluating the role of individual retrieved items becomes more important. Existing RAG evaluation typically targets final-answer quality, citation faithfulness, or answer-level attribution, but none of these directly targets the intervention-based, per-evidence-item utility view we study here. We introduce CUE-R, a lightweight intervention-based framework for measuring per-evidence-item operational utility in single-shot RAG using shallow observable retrieval-use traces. CUE-R perturbs individual evidence items via REMOVE, REPLACE, and DUPLICATE operators, then measures changes along three utility axes (correctness, proxy-based grounding faithfulness, and confidence error) plus a trace-divergence signal. We also outline an operational evidence-role taxonomy for interpreting intervention outcomes. Experiments on HotpotQA and 2WikiMultihopQA with Qwen-3 8B and GPT-5.2 reveal a consistent pattern: REMOVE and REPLACE substantially harm correctness and grounding while producing large trace shifts, whereas DUPLICATE is often answer-redundant yet not fully behaviorally neutral. A zero-retrieval control confirms that these effects arise from degradation of meaningful retrieval. A two-support ablation further shows that multi-hop evidence items can interact non-additively: removing both supports harms performance far more than either single removal. Our results suggest that answer-only evaluation misses important evidence effects and that intervention-based utility analysis is a practical complement for RAG evaluation.

intuit Intuit
·
Apr 6 2

How can the use of different modes of survey data collection introduce bias? A simple introduction to mode effects using directed acyclic graphs (DAGs)

Survey data are self-reported data collected directly from respondents by a questionnaire or an interview and are commonly used in epidemiology. Such data are traditionally collected via a single mode (e.g. face-to-face interview alone), but use of mixed-mode designs (e.g. offering face-to-face interview or online survey) has become more common. This introduces two key challenges. First, individuals may respond differently to the same question depending on the mode; these differences due to measurement are known as 'mode effects'. Second, different individuals may participate via different modes; these differences in sample composition between modes are known as 'mode selection'. Where recognised, mode effects are often handled by straightforward approaches such as conditioning on survey mode. However, while reducing mode effects, this and other equivalent approaches may introduce collider bias in the presence of mode selection. The existence of mode effects and the consequences of na\"ive conditioning may be underappreciated in epidemiology. This paper offers a simple introduction to these challenges using directed acyclic graphs by exploring a range of possible data structures. We discuss the potential implications of using conditioning- or imputation-based approaches and outline the advantages of quantitative bias analyses for dealing with mode effects.

  • 4 authors
·
Oct 1, 2025

Exploring the Inquiry-Diagnosis Relationship with Advanced Patient Simulators

Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

  • 10 authors
·
Jan 16, 2025 4

Parrot: Persuasion and Agreement Robustness Rating of Output Truth -- A Sycophancy Robustness Benchmark for LLMs

This study presents PARROT (Persuasion and Agreement Robustness Rating of Output Truth), a robustness focused framework designed to measure the degradation in accuracy that occurs under social pressure exerted on users through authority and persuasion in large language models (LLMs) the phenomenon of sycophancy (excessive conformity). PARROT (i) isolates causal effects by comparing the neutral version of the same question with an authoritatively false version using a double-blind evaluation, (ii) quantifies confidence shifts toward the correct and imposed false responses using log-likelihood-based calibration tracking, and (iii) systematically classifies failure modes (e.g., robust correct, sycophantic agreement, reinforced error, stubborn error, self-correction, etc.) using an eight-state behavioral taxonomy. We evaluated 22 models using 1,302 MMLU-style multiple-choice questions across 13 domains and domain-specific authority templates. Findings show marked heterogeneity: advanced models (e.g., GPT-5, GPT-4.1, Claude Sonnet 4.5) exhibit low "follow rates" (leq 11%, GPT-5: 4\%) and minimal accuracy loss, while older/smaller models show severe epistemic collapse (GPT-4: 80\%, Qwen 2.5-1.5B: 94\%). The danger is not limited to response changes; weak models reduce confidence in the correct response while increasing confidence in the imposed incorrect response. While international law and global knowledge at the domain level exhibit high fragility, elementary mathematics is relatively resilient. Consequently, we argue that the goal of "resistance to overfitting pressure" should be addressed as a primary objective alongside accuracy, harm avoidance, and privacy for safe deployment in the real world.

  • 3 authors
·
Nov 21, 2025 4

Language Model Uncertainty Quantification with Attention Chain

Accurately quantifying a large language model's (LLM) predictive uncertainty is crucial for judging the reliability of its answers. While most existing research focuses on short, directly answerable questions with closed-form outputs (e.g., multiple-choice), involving intermediate reasoning steps in LLM responses is increasingly important. This added complexity complicates uncertainty quantification (UQ) because the probabilities assigned to answer tokens are conditioned on a vast space of preceding reasoning tokens. Direct marginalization is infeasible, and the dependency inflates probability estimates, causing overconfidence in UQ. To address this, we propose UQAC, an efficient method that narrows the reasoning space to a tractable size for marginalization. UQAC iteratively constructs an "attention chain" of tokens deemed "semantically crucial" to the final answer via a backtracking procedure. Starting from the answer tokens, it uses attention weights to identify the most influential predecessors, then iterates this process until reaching the input tokens. Similarity filtering and probability thresholding further refine the resulting chain, allowing us to approximate the marginal probabilities of the answer tokens, which serve as the LLM's confidence. We validate UQAC on multiple reasoning benchmarks with advanced open-source LLMs, demonstrating that it consistently delivers reliable UQ estimates with high computational efficiency.

  • 4 authors
·
Mar 24, 2025

Adaptive Generation of Bias-Eliciting Questions for LLMs

Large language models (LLMs) are now widely deployed in user-facing applications, reaching hundreds of millions worldwide. As they become integrated into everyday tasks, growing reliance on their outputs raises significant concerns. In particular, users may unknowingly be exposed to model-inherent biases that systematically disadvantage or stereotype certain groups. However, existing bias benchmarks continue to rely on templated prompts or restrictive multiple-choice questions that are suggestive, simplistic, and fail to capture the complexity of real-world user interactions. In this work, we address this gap by introducing a counterfactual bias evaluation framework that automatically generates realistic, open-ended questions over sensitive attributes such as sex, race, or religion. By iteratively mutating and selecting bias-inducing questions, our approach systematically explores areas where models are most susceptible to biased behavior. Beyond detecting harmful biases, we also capture distinct response dimensions that are increasingly relevant in user interactions, such as asymmetric refusals and explicit acknowledgment of bias. Leveraging our framework, we construct CAB, a human-verified benchmark spanning diverse topics, designed to enable cross-model comparisons. Using CAB, we analyze a range of LLMs across multiple bias dimensions, revealing nuanced insights into how different models manifest bias. For instance, while GPT-5 outperforms other models, it nonetheless exhibits persistent biases in specific scenarios. These findings underscore the need for continual improvements to ensure fair model behavior.

  • 4 authors
·
Oct 14, 2025

DEUP: Direct Epistemic Uncertainty Prediction

Epistemic Uncertainty is a measure of the lack of knowledge of a learner which diminishes with more evidence. While existing work focuses on using the variance of the Bayesian posterior due to parameter uncertainty as a measure of epistemic uncertainty, we argue that this does not capture the part of lack of knowledge induced by model misspecification. We discuss how the excess risk, which is the gap between the generalization error of a predictor and the Bayes predictor, is a sound measure of epistemic uncertainty which captures the effect of model misspecification. We thus propose a principled framework for directly estimating the excess risk by learning a secondary predictor for the generalization error and subtracting an estimate of aleatoric uncertainty, i.e., intrinsic unpredictability. We discuss the merits of this novel measure of epistemic uncertainty, and highlight how it differs from variance-based measures of epistemic uncertainty and addresses its major pitfall. Our framework, Direct Epistemic Uncertainty Prediction (DEUP) is particularly interesting in interactive learning environments, where the learner is allowed to acquire novel examples in each round. Through a wide set of experiments, we illustrate how existing methods in sequential model optimization can be improved with epistemic uncertainty estimates from DEUP, and how DEUP can be used to drive exploration in reinforcement learning. We also evaluate the quality of uncertainty estimates from DEUP for probabilistic image classification and predicting synergies of drug combinations.

  • 8 authors
·
Feb 16, 2021

SAGE-Eval: Evaluating LLMs for Systematic Generalizations of Safety Facts

Do LLMs robustly generalize critical safety facts to novel situations? Lacking this ability is dangerous when users ask naive questions. For instance, "I'm considering packing melon balls for my 10-month-old's lunch. What other foods would be good to include?" Before offering food options, the LLM should warn that melon balls pose a choking hazard to toddlers, as documented by the CDC. Failing to provide such warnings could result in serious injuries or even death. To evaluate this, we introduce SAGE-Eval, SAfety-fact systematic GEneralization evaluation, the first benchmark that tests whether LLMs properly apply well established safety facts to naive user queries. SAGE-Eval comprises 104 facts manually sourced from reputable organizations, systematically augmented to create 10,428 test scenarios across 7 common domains (e.g., Outdoor Activities, Medicine). We find that the top model, Claude-3.7-sonnet, passes only 58% of all the safety facts tested. We also observe that model capabilities and training compute weakly correlate with performance on SAGE-Eval, implying that scaling up is not the golden solution. Our findings suggest frontier LLMs still lack robust generalization ability. We recommend developers use SAGE-Eval in pre-deployment evaluations to assess model reliability in addressing salient risks. We publicly release SAGE-Eval at https://huggingface.co/datasets/YuehHanChen/SAGE-Eval and our code is available at https://github.com/YuehHanChen/SAGE-Eval/tree/main.

  • 3 authors
·
May 27, 2025

Safety and accuracy follow different scaling laws in clinical large language models

Clinical LLMs are often scaled by increasing model size, context length, retrieval complexity, or inference-time compute, with the implicit expectation that higher accuracy implies safer behavior. This assumption is incomplete in medicine, where a few confident, high-risk, or evidence-contradicting errors can matter more than average benchmark performance. We introduce SaFE-Scale, a framework for measuring how clinical LLM safety changes across model scale, evidence quality, retrieval strategy, context exposure, and inference-time compute. To instantiate this framework, we introduce RadSaFE-200, a Radiology Safety-Focused Evaluation benchmark of 200 multiple-choice questions with clinician-defined clean evidence, conflict evidence, and option-level labels for high-risk error, unsafe answer, and evidence contradiction. We evaluated 34 locally deployed LLMs across six deployment conditions: closed-book prompting (zero-shot), clean evidence, conflict evidence, standard RAG, agentic RAG, and max-context prompting. Clean evidence produced the strongest improvement, increasing mean accuracy from 73.5% to 94.1%, while reducing high-risk error from 12.0% to 2.6%, contradiction from 12.7% to 2.3%, and dangerous overconfidence from 8.0% to 1.6%. Standard RAG and agentic RAG did not reproduce this safety profile: agentic RAG improved accuracy over standard RAG and reduced contradiction, but high-risk error and dangerous overconfidence remained elevated. Max-context prompting increased latency without closing the safety gap, and additional inference-time compute produced only limited gains. Worst-case analysis showed that clinically consequential errors concentrated in a small subset of questions. Clinical LLM safety is therefore not a passive consequence of scaling, but a deployment property shaped by evidence quality, retrieval design, context construction, and collective failure behavior.

  • 12 authors
·
May 4

RL on Incorrect Synthetic Data Scales the Efficiency of LLM Math Reasoning by Eight-Fold

Training on model-generated synthetic data is a promising approach for finetuning LLMs, but it remains unclear when it helps or hurts. In this paper, we investigate this question for math reasoning via an empirical study, followed by building a conceptual understanding of our observations. First, we find that while the typical approach of finetuning a model on synthetic correct or positive problem-solution pairs generated by capable models offers modest performance gains, sampling more correct solutions from the finetuned learner itself followed by subsequent fine-tuning on this self-generated data doubles the efficiency of the same synthetic problems. At the same time, training on model-generated positives can amplify various spurious correlations, resulting in flat or even inverse scaling trends as the amount of data increases. Surprisingly, we find that several of these issues can be addressed if we also utilize negative responses, i.e., model-generated responses that are deemed incorrect by a final answer verifier. Crucially, these negatives must be constructed such that the training can appropriately recover the utility or advantage of each intermediate step in the negative response. With this per-step scheme, we are able to attain consistent gains over only positive data, attaining performance similar to amplifying the amount of synthetic data by 8 times. We show that training on per-step negatives can help to unlearn spurious correlations in the positive data, and is equivalent to advantage-weighted reinforcement learning (RL), implying that it inherits robustness benefits of RL over imitating positive data alone.

  • 6 authors
·
Jun 20, 2024

Fair coins tend to land on the same side they started: Evidence from 350,757 flips

Many people have flipped coins but few have stopped to ponder the statistical and physical intricacies of the process. We collected 350{,}757 coin flips to test the counterintuitive prediction from a physics model of human coin tossing developed by Diaconis, Holmes, and Montgomery (DHM; 2007). The model asserts that when people flip an ordinary coin, it tends to land on the same side it started -- DHM estimated the probability of a same-side outcome to be about 51\%. Our data lend strong support to this precise prediction: the coins landed on the same side more often than not, Pr(same side) = 0.508, 95\% credible interval (CI) [0.506, 0.509], BF_{same-side bias} = 2359. Furthermore, the data revealed considerable between-people variation in the degree of this same-side bias. Our data also confirmed the generic prediction that when people flip an ordinary coin -- with the initial side-up randomly determined -- it is equally likely to land heads or tails: Pr(heads) = 0.500, 95\% CI [0.498, 0.502], BF_{heads-tails bias} = 0.182. Furthermore, this lack of heads-tails bias does not appear to vary across coins. Additional analyses revealed that the within-people same-side bias decreased as more coins were flipped, an effect that is consistent with the possibility that practice makes people flip coins in a less wobbly fashion. Our data therefore provide strong evidence that when some (but not all) people flip a fair coin, it tends to land on the same side it started.

  • 50 authors
·
Oct 6, 2023

Know the Unknown: An Uncertainty-Sensitive Method for LLM Instruction Tuning

Large language models (LLMs) have demonstrated remarkable capabilities across various tasks but still face challenges such as hallucinations. One potential reason for hallucinations is the lack of relevant knowledge or context. Thus, a promising solution to mitigate this issue involves instructing LLMs to respond with "I do not know" when a question falls outside their knowledge domain or the provided context. However, in this work, we observed that LLMs struggle to admit their lack of knowledge, primarily due to existing instruction datasets designed to encourage specific answers. To improve large language models' capability to recognize the boundaries of their knowledge, we propose a novel approach called uncertainty-sensitive tuning. This method involves two-stage training designed for uncertainty recognition and prompt-sensitive activation. In the first stage, we guide the LLM to reject unknown questions. In the second stage, we recover the decreased performance in QA tasks by incorporating designed causal instructions. By leveraging this method, we aim to enhance the model's ability to identify areas of uncertainty. The experimental results demonstrate that our proposed uncertainty-sensitive tuning method significantly improves the performance of the Llama2-chat-7B model. Specifically, it achieves a substantial 34.7% improvement in handling questions involving knowledge gaps compared to the original model. Moreover, our approach outperforms GPT-4, exhibiting a 9.4% increase in overall performance. We open-source the model and code on GitHub.

  • 3 authors
·
Jun 14, 2024

Reliable and Efficient Amortized Model-based Evaluation

Comprehensive evaluations of language models (LM) during both development and deployment phases are necessary because these models possess numerous capabilities (e.g., mathematical reasoning, legal support, or medical diagnostic) as well as safety risks (e.g., racial bias, toxicity, or misinformation). The average score across a wide range of benchmarks provides a signal that helps guide the use of these LMs in practice. Currently, holistic evaluations are costly due to the large volume of benchmark questions, making frequent evaluations impractical. A popular attempt to lower the cost is to compute the average score on a subset of the benchmark. This approach, unfortunately, often renders an unreliable measure of LM performance because the average score is often confounded with the difficulty of the questions in the benchmark subset. Item response theory (IRT) was designed to address this challenge, providing a reliable measurement by careful controlling for question difficulty. Unfortunately, question difficulty is expensive to estimate. Facing this challenge, we train a model that predicts question difficulty from its content, enabling a reliable measurement at a fraction of the cost. In addition, we leverage this difficulty predictor to further improve the evaluation efficiency through training a question generator given a difficulty level. This question generator is essential in adaptive testing, where, instead of using a random subset of the benchmark questions, informative questions are adaptively chosen based on the current estimation of LLM performance. Experiments on 22 common natural language benchmarks and 172 LMs show that this approach is more reliable and efficient compared to current common practice.

  • 5 authors
·
Mar 17, 2025

A Multifaceted Analysis of Negative Bias in Large Language Models through the Lens of Parametric Knowledge

Negative bias refers to the tendency of large language models (LLMs) to excessively generate negative responses in binary decision tasks (e.g., yes-no question answering). Previous research has focused on detecting and addressing negative attention heads that induce negative bias. However, the underlying detailed factors influencing negative bias remain underexplored. In this paper, we demonstrate that LLMs exhibit format-level negative bias, meaning the prompt format more influences their responses than the semantics of the negative response. For the fine-grained study of the negative bias, we introduce a pipeline for constructing the evaluation set, which systematically categorizes the dataset into three subsets based on the model's parametric knowledge: correct, incorrect, and insufficient relevant knowledge. Through analysis of this evaluation set, we identify a shortcut behavior in which models tend to generate negative responses when they lack sufficient knowledge to answer a yes-no question, leading to negative bias. We further examine how negative bias changes under various prompting scenarios related to parametric knowledge. We observe that providing relevant context and offering an "I don't know" option generally reduces negative bias, whereas chain-of-thought prompting tends to amplify the bias. Finally, we demonstrate that the degree of negative bias can vary depending on the type of prompt, which influences the direction of the response. Our work reveals the various factors that influence negative bias, providing critical insights for mitigating it in LLMs.

  • 3 authors
·
Nov 13, 2025

Selective Machine Learning of the Average Treatment Effect with an Invalid Instrumental Variable

Instrumental variable methods have been widely used to identify causal effects in the presence of unmeasured confounding. A key identification condition known as the exclusion restriction states that the instrument cannot have a direct effect on the outcome which is not mediated by the exposure in view. In the health and social sciences, such an assumption is often not credible. To address this concern, we consider identification conditions of the population average treatment effect with an invalid instrumental variable which does not satisfy the exclusion restriction, and derive the efficient influence function targeting the identifying functional under a nonparametric observed data model. We propose a novel multiply robust locally efficient estimator of the average treatment effect that is consistent in the union of multiple parametric nuisance models, as well as a multiply debiased machine learning estimator for which the nuisance parameters are estimated using generic machine learning methods, that effectively exploit various forms of linear or nonlinear structured sparsity in the nuisance parameter space. When one cannot be confident that any of these machine learners is consistent at sufficiently fast rates to ensure n-consistency for the average treatment effect, we introduce a new criteria for selective machine learning which leverages the multiple robustness property in order to ensure small bias. The proposed methods are illustrated through extensive simulations and a data analysis evaluating the causal effect of 401(k) participation on savings.

  • 3 authors
·
Jul 27, 2019

Missing Premise exacerbates Overthinking: Are Reasoning Models losing Critical Thinking Skill?

We find that the response length of reasoning LLMs, whether trained by reinforcement learning or supervised learning, drastically increases for ill-posed questions with missing premises (MiP), ending up with redundant and ineffective thinking. This newly introduced scenario exacerbates the general overthinking issue to a large extent, which we name as the MiP-Overthinking. Such failures are against the ``test-time scaling law'' but have been widely observed on multiple datasets we curated with MiP, indicating the harm of cheap overthinking and a lack of critical thinking. Surprisingly, LLMs not specifically trained for reasoning exhibit much better performance on the MiP scenario, producing much shorter responses that quickly identify ill-posed queries. This implies a critical flaw of the current training recipe for reasoning LLMs, which does not encourage efficient thinking adequately, leading to the abuse of thinking patterns. To further investigate the reasons behind such failures, we conduct fine-grained analyses of the reasoning length, overthinking patterns, and location of critical thinking on different types of LLMs. Moreover, our extended ablation study reveals that the overthinking is contagious through the distillation of reasoning models' responses. These results improve the understanding of overthinking and shed novel insights into mitigating the problem.

  • 4 authors
·
Apr 8, 2025 3

OpenAI GPT-5 System Card

This is the system card published alongside the OpenAI GPT-5 launch, August 2025. GPT-5 is a unified system with a smart and fast model that answers most questions, a deeper reasoning model for harder problems, and a real-time router that quickly decides which model to use based on conversation type, complexity, tool needs, and explicit intent (for example, if you say 'think hard about this' in the prompt). The router is continuously trained on real signals, including when users switch models, preference rates for responses, and measured correctness, improving over time. Once usage limits are reached, a mini version of each model handles remaining queries. This system card focuses primarily on gpt-5-thinking and gpt-5-main, while evaluations for other models are available in the appendix. The GPT-5 system not only outperforms previous models on benchmarks and answers questions more quickly, but -- more importantly -- is more useful for real-world queries. We've made significant advances in reducing hallucinations, improving instruction following, and minimizing sycophancy, and have leveled up GPT-5's performance in three of ChatGPT's most common uses: writing, coding, and health. All of the GPT-5 models additionally feature safe-completions, our latest approach to safety training to prevent disallowed content. Similarly to ChatGPT agent, we have decided to treat gpt-5-thinking as High capability in the Biological and Chemical domain under our Preparedness Framework, activating the associated safeguards. While we do not have definitive evidence that this model could meaningfully help a novice to create severe biological harm -- our defined threshold for High capability -- we have chosen to take a precautionary approach.

  • 484 authors
·
Dec 19, 2025

Wrong Answers Can Also Be Useful: PlausibleQA -- A Large-Scale QA Dataset with Answer Plausibility Scores

Large Language Models (LLMs) are revolutionizing information retrieval, with chatbots becoming an important source for answering user queries. As by their design, LLMs prioritize generating correct answers, the value of highly plausible yet incorrect answers (candidate answers) tends to be overlooked. However, such answers can still prove useful, for example, they can play a crucial role in tasks like Multiple-Choice Question Answering (MCQA) and QA Robustness Assessment (QARA). Existing QA datasets primarily focus on correct answers without explicit consideration of the plausibility of other candidate answers, limiting opportunity for more nuanced evaluations of models. To address this gap, we introduce PlausibleQA, a large-scale dataset comprising 10,000 questions and 100,000 candidate answers, each annotated with plausibility scores and justifications for their selection. Additionally, the dataset includes 900,000 justifications for pairwise comparisons between candidate answers, further refining plausibility assessments. We evaluate PlausibleQA through human assessments and empirical experiments, demonstrating its utility in MCQA and QARA analysis. Our findings show that plausibility-aware approaches are effective for MCQA distractor generation and QARA. We release PlausibleQA as a resource for advancing QA research and enhancing LLM performance in distinguishing plausible distractors from correct answers.

  • 4 authors
·
Feb 22, 2025

The impact of using an AI chatbot to respond to patient messages

Documentation burden is a major contributor to clinician burnout, which is rising nationally and is an urgent threat to our ability to care for patients. Artificial intelligence (AI) chatbots, such as ChatGPT, could reduce clinician burden by assisting with documentation. Although many hospitals are actively integrating such systems into electronic medical record systems, AI chatbots utility and impact on clinical decision-making have not been studied for this intended use. We are the first to examine the utility of large language models in assisting clinicians draft responses to patient questions. In our two-stage cross-sectional study, 6 oncologists responded to 100 realistic synthetic cancer patient scenarios and portal messages developed to reflect common medical situations, first manually, then with AI assistance. We find AI-assisted responses were longer, less readable, but provided acceptable drafts without edits 58% of time. AI assistance improved efficiency 77% of time, with low harm risk (82% safe). However, 7.7% unedited AI responses could severely harm. In 31% cases, physicians thought AI drafts were human-written. AI assistance led to more patient education recommendations, fewer clinical actions than manual responses. Results show promise for AI to improve clinician efficiency and patient care through assisting documentation, if used judiciously. Monitoring model outputs and human-AI interaction remains crucial for safe implementation.

  • 15 authors
·
Oct 26, 2023

Bias Runs Deep: Implicit Reasoning Biases in Persona-Assigned LLMs

Recent works have showcased the ability of LLMs to embody diverse personas in their responses, exemplified by prompts like 'You are Yoda. Explain the Theory of Relativity.' While this ability allows personalization of LLMs and enables human behavior simulation, its effect on LLMs' capabilities remains unclear. To fill this gap, we present the first extensive study of the unintended side-effects of persona assignment on the ability of LLMs to perform basic reasoning tasks. Our study covers 24 reasoning datasets, 4 LLMs, and 19 diverse personas (e.g. an Asian person) spanning 5 socio-demographic groups. Our experiments unveil that LLMs harbor deep rooted bias against various socio-demographics underneath a veneer of fairness. While they overtly reject stereotypes when explicitly asked ('Are Black people less skilled at mathematics?'), they manifest stereotypical and erroneous presumptions when asked to answer questions while adopting a persona. These can be observed as abstentions in responses, e.g., 'As a Black person, I can't answer this question as it requires math knowledge', and generally result in a substantial performance drop. Our experiments with ChatGPT-3.5 show that this bias is ubiquitous - 80% of our personas demonstrate bias; it is significant - some datasets show performance drops of 70%+; and can be especially harmful for certain groups - some personas suffer statistically significant drops on 80%+ of the datasets. Overall, all 4 LLMs exhibit this bias to varying extents, with GPT-4-Turbo showing the least but still a problematic amount of bias (evident in 42% of the personas). Further analysis shows that these persona-induced errors can be hard-to-discern and hard-to-avoid. Our findings serve as a cautionary tale that the practice of assigning personas to LLMs - a trend on the rise - can surface their deep-rooted biases and have unforeseeable and detrimental side-effects.

  • 7 authors
·
Nov 8, 2023