Agentic AI Enhances Physician Trust in Clinical Decision Making
Authors: Zhiling Yan, Zhe Fang, David J King, Ann Pongsakul, Eashan Adhikarla, Hui Ren, Sunyang Fu, Quanzheng Li, +5 more
Organizations: Department of Computer Science and Engineering, Lehigh University, Bethlehem, PA, USA · Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA · Department of Medicine, Division of Cardiology, University of Florida, Gainesville, FL, USA · McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA · Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA · McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA · Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
Medical AI has shifted from reasoning to agentic AI, a new paradigm that autonomously invokes external tools during reasoning, rendering intermediate reasoning steps and tool outputs transparent to users. Although proven to outperform previous models, physician trust in agentic AI remains largely unexplored. To address this, three physicians evaluated 315 multimodal clinical cases quantifying both process-oriented cognitive trust and outcome-oriented behavioral reliance. Comparing agentic AI against non-agentic baselines, physicians exhibited significantly higher cognitive and behavioral trust for the agentic model (P < 0.001). Specifically, on treatment planning tasks, physicians trusted the agentic reasoning most, preferring it in 89.57% of cases. Furthermore, process-oriented cognitive trust is significantly associated with outcome-oriented behavioral reliance (P < 0.001). However, measurable over-reliance on incorrect agentic outputs still exists, highlighting the inherent limitations of decision-logic transparency alone and underscoring the continuous need for rigorous clinician oversight.
Question: Does atomic fact-checking, which decomposes AI treatment recommendations into individually verifiable claims linked to source guideline documents, increase clinician trust compared to traditional explainability approaches? Findings: In this randomized trial of 356 clinicians generating 7,476 trust ratings, atomic fact-checking produced a large effect on trust (Cohen's d = 0.94), increasing the proportion of clinicians expressing trust from 26.9% to 66.5%. Traditional transparency mechanisms showed a dose-response gradient of improvement over baseline (d = 0.25 to 0.50). Meaning: Decomposing AI recommendations into individually verifiable claims linked to source guidelines produces substantially higher clinician trust than traditional explainability approaches in high-stakes clinical decisions.
Large language models and multimodal foundation models are enabling medical artificial intelligence (AI) systems to move beyond isolated prediction and undertake multistep clinical tasks that require planning, tool use, memory, iterative correction, and coordination among specialized agents. However, the scope of agentic AI in medicine remains unsettled, and current evaluation practices are not yet aligned with the requirements of clinical use. We conducted a scoping review with systematic evidence mapping across five electronic sources, screened 1,649 exportable records, and provisionally included 557 unique studies that met predefined criteria for goal-directed task execution, tool use, interaction with external resources, feedback-based refinement, or multi-agent collaboration. The included studies describe single agents that use external tools, workflows supported by retrieval and external knowledge, multimodal agents, and multi-agent systems applied to medical question answering, image interpretation, electronic health record analysis, drug safety, and clinical trial prediction. The evidence base remains dominated by public benchmarks, simulated settings, retrospective datasets, and small-scale expert evaluation. Process reliability, evidence traceability, uncertainty, safety, workflow impact, and external validity are evaluated less consistently. Clinical translation will depend on clearer definitions, reproducible evaluation, auditable oversight, interoperable system design, and prospective validation in real-world clinical workflows.
Trust in clinical artificial intelligence (AI) cannot be reduced to model accuracy, fluency of generation, or overall positive user impression. In medicine, trust must be engineered as a measurable system property grounded in evidence, supervision, and operational boundaries of AI autonomy. This article proposes a practical framework for trustworthy clinical AI built around three principles: evidence, supervision, and staged autonomy. Rather than replacing deterministic clinical logic wholesale with end-to-end black-box models, the proposed approach combines a deterministic core, a patient-specific AI assistant for contextual validation, a multi-tier model escalation mechanism, and a human supervision layer for verification, escalation, and risk control. We demonstrate that trust also depends on selective verification of clinically critical findings, bounded clinical context, disciplined prompt architecture, and careful evaluation on realistic cases. Classifier-driven modular prompting is examined as an incremental path to scaling clinical depth without sacrificing prompt performance and without waiting for complete rule-based coverage. To operationalize trust, a set of trust metrics is proposed, built on metrological principles -- measurement uncertainty, calibration, traceability -- enabling quantitative rather than subjective assessment of each architectural layer. In this perspective, trustworthy clinical AI emerges not as a property of an individual model, but as an architectural outcome of a system into which evidence trails, human oversight, tiered escalation, and graduated action rights are embedded from the outset.