Clinical framing -- the linguistic manner in which clinical information is presented -- can influence patient understanding and decision-making, with important implications for healthcare outcomes. Obstetrics is a high-stakes domain in which physicians counsel patients on delivery mode choices such as vaginal birth after cesarean (VBAC) and repeat cesarean section (RCS), yet counseling language remains underexplored in large-scale clinical text analysis. In this work, we analyze physician counseling language in 2,024 obstetric history and physical narratives for a rigorously defined cohort of patients for whom both VBAC and RCS were clinically viable options. To control for confounding due to medical contraindications, we first construct a VBAC-eligible cohort using structured clinical data supplemented by a large language model (LLM)-based extraction pipeline constrained to grounded, verbatim evidence from free-text narratives. We then apply a zero-shot LLM framework to categorize counseling segments into predefined framing categories capturing how physicians linguistically present delivery options. Our analysis reveals a significant difference in counseling framing distributions between VBAC and RCS notes; risk-focused language accounts for a substantially larger share of counseling segments in RCS documentation than in VBAC, with category-level differences confirmed by statistical testing, highlighting the value of controlled LLM-based framing analysis in obstetric care.
Large language models are increasingly used in healthcare communication, yet most evaluations emphasize response quality while assuming that the user's concern has been interpreted correctly. We introduce HerHealthEval, a controlled evaluation framework for multilingual understanding of women's-health communication. For each clinical case, HerHealthEval provides matched versions in English, French, and Modern Standard Arabic using six communicative forms: canonical, clinical, layperson, indirect or hedged, emotionally concerned, and deliberately under-specified. The first five express the same underlying concern and retain the same clinical information, whereas the under-specified form intentionally omits relevant details to test whether the model recognizes that clarification is needed. We evaluate a multilingual instruction model and QLoRA-adapted variants on concern classification, risk calibration, clarification behavior, parse compliance, and cross-form consistency. Results reveal that aggregate accuracy and consistency can conceal safety-relevant failures. A multilingual adaptation model reaches 0.994 under-triage in French and Arabic under language-asymmetric risk supervision. A controlled re-adaptation using source-derived, language-invariant risk labels reduces under-triage to 0.572 and 0.558, respectively. These findings show that robust multilingual healthcare evaluation requires explicit testing of register variation, uncertainty handling, and the provenance and invariance of adaptation labels.
Hassan Saeed Hassan Albattra, Mazen Mohammed Bahgat, Rahatara Ferdousi +2
We introduce FramingQA, a benchmark that measures the model sensitivity to question framing across law, medicine, finance, and robotic simulations. Large language models (LLMs) often change their responses to subtle rephrasings that align with an implied stance by users. This can leave users with advice tainted by how they happened to phrase a question rather than by the underlying facts, and the consequences are highly costly in high-stakes domains. Because in the realistic scenarios, both expert practitioners and non-expert users frequently ask LLMs questions containing incomplete or misleading assumptions, models are highly susceptible to those framings. To test this, we inject the framing bias across three nested levels: a framing-biased question phrasing (root), an injected framing-biased premise prepended to a neutral question (propositional), and a premise paired with a framing-biased question (global). Evaluating nine open models (3.8B-70B) across four families, we find that strong per-variant accuracy does not guarantee the robustness across differently phrased questions under the fixed factual information.
Hazel H. Kim, Andrew M. Bean, Guilherme Affonso Ferreira de Camargo +10
Large language models (LLMs) are increasingly used for clinical text tasks such as summarization and revision. While most studies evaluate the fluency and coherence of LLM-generated text, whether LLMs correctly preserve diagnostic uncertainty remains underexplored. In clinical practice, phrases such as ``possible pneumonia'' communicate the strength of available evidence and directly guide decisions about follow-up testing and treatment. Altering these uncertainty expressions can change the clinical meaning entirely. In this paper, we systematically evaluated this problem in two steps. First, we constructed a benchmark of 1,200 clinical documents with 9,184 uncertainty annotations across five levels. Second, we evaluated three LLMs on this benchmark. Our results show that (1) LLMs preserve the original uncertainty cues poorly, often less than half the time; (2) LLMs struggle with nuanced distinctions between adjacent levels. This work reveals a failure mode not captured by standard evaluation metrics and provides implications for the safe deployment of LLMs in clinical workflows.