Can LLMs Take Retrieved Information with a Grain of Salt?

Large Language Models (LLMs) have achieved strong performance in medical question answering and clinical reasoning tasks. However, their reliability under uncertainty remains poorly understood which raises critical concerns for deployment in high-stakes clinical settings. In such environments, incorrect predictions are inherently risky, but confident incorrect predictions can be particularly harmful as they may mislead clinical decision-making. In this paper, we conduct a systematic behavioral analysis of LLMs under clinical information uncertainty. We propose an evaluation framework based on the MedMCQA dataset consisting of two complementary uncertainty settings. First, we introduce linguistic uncertainty cues through prompt modifications to simulate ambiguous clinical contexts. Second, we construct an answer removal setting, wherein the correct option is deliberately excluded mandating the model to recognize insufficient information and abstain. We analyze both model accuracy and confidence behavior using multiple calibration metrics including calibration gap, Expected Calibration Error (ECE), and Unsafe Confident Error Rate (UCER) across 500 medical questions. Our results reveal a consistent failure mode, i.e., although accuracy degrades under increasing uncertainty, model confidence remains misaligned with accuracy. This leads to a substantial increase in unsafe confident errors, indicating that model confidence remains largely insensitive to clinically meaningful information loss. Furthermore, we observe significant variation across models in their ability to abstain when the correct answer is unavailable, with some models persistently producing high confidence hallucinated answers. These findings expose critical limitations in the epistemic reliability of current LLMs and highlight the need for uncertainty aware evaluation methods prior to their deployment in clinical workflows.

Large language models (LLMs) are increasingly deployed in settings where the available context is incomplete or degraded. We argue that an LLM generating answers under incomplete context can be viewed as an implicit imputer, and evaluated against a criterion from the multiple imputation (MI) literature: uncertainty should scale with the amount of missing information. We assess this criterion on SQuAD, using a controlled framework in which context availability is varied across five levels. We evaluate two answer-level uncertainty measures that can be estimated from repeated sampling: sampling-based confidence (empirical mode frequency) and response entropy. Confidence fails to reflect increasing missingness: it remains high even as accuracy collapses. Entropy, by contrast, increases with context removal, consistent with the MI analogy, and explains substantially more variance in accuracy than confidence across all evidence levels (quadratic $R^2$ gap up to 0.057). We further introduce a black-box diagnostic $ρ_R(α)$ that estimates the proportion of baseline uncertainty resolved by context level $α$, requiring only repeated sampling with and without context. These results suggest that entropy is a more responsive black-box uncertainty measure than confidence under incomplete context.

Large language models (LLMs) are widely used in decision-making across diverse domains. Ensuring the generation of safe and reliable responses is critical for the effective deployment of LLM-based applications, particularly in high-stakes domains such as healthcare and finance. Most of these applications typically use carefully crafted prompts to guide response generation; however, the relationship between prompts and the reliability of LLM-generated responses is not yet fully understood. To address this gap, we propose a novel prompt-response concept model that explains the relationship between the amount of task-relevant information (informativeness) provided in the prompt and the LLM-generated response uncertainty by identifying four sources of response uncertainty: prompt underspecification, model quality, task variability, and semantic redundancy. We prove that response uncertainty decreases as prompt informativeness or model quality increases, mirroring the behavior of epistemic uncertainty in probabilistic models. Our experimental results on real-world datasets further validate our proposed model and corroborate the theoretical results.