Large language models improve physician accuracy but lead to false reliance

Medical knowledge evolves continuously, whereas the parametric knowledge encoded in large language models (LLMs) is fixed at training time. External retrieval, including retrieval-augmented generation (RAG), can provide access to newly available evidence, but retrieved information may be irrelevant, incomplete, or conflicting. As a result, external retrieval can in turn degrade the factual accuracy and evidence grounding of LLM outputs. To address this challenge, we propose \textbf{CLEAR}, an agentic framework for cross-source evidence adjudication in LLMs in medicine. CLEAR independently generates candidate answers from three complementary pathways---parametric knowledge, locally curated corpora, and dynamically retrieved evidence---reflecting three common sources of information available to LLMs. An aggregation verifier jointly evaluates the candidates, supporting evidence, provenance, and source-quality information to identify agreement and conflict across sources. An adjudication module then determines whether the current conclusion should be preserved or revised through complementary override-guard and challenge-audit mechanisms, while unresolved conflicts trigger targeted follow-up search and re-adjudication.

The most plausible near-term role of medical LLMs is to assist rather than replace physicians, yet current evaluations often test isolated capabilities: clinical knowledge, EHR system interaction, or patient communication. Physician assistance instead requires coordinating these capabilities within the same interaction, where physicians issue underspecified requests, patients describe symptoms ambiguously, and EHR systems demand precise tool use. We introduce PhysAssistBench, a benchmark for interactive doctor-patient-EHR assistance. Built from real MIMIC-IV cases, PhysAssistBench uses a scalable pipeline to construct agentic patients: interactive, record-grounded agents that turn static EHR records into multi-turn clinical scenarios while preserving clinical factuality. PhysAssistBench provides a curated bilingual evaluation set of 1,296 manually reviewed and physician-validated turns. Experiments with leading LLMs show that current models remain unreliable in this setting, which exposes a key bottleneck for clinical LLMs: reliable assistance requires coordination across knowledge, communication, and systems, not isolated gains in any of them.

Large Language Models (LLMs) are increasingly deployed in healthcare, yet their communicative alignment with clinical standards remains insufficiently quantified. We conduct a multidimensional evaluation of general-purpose and domain-specialized LLMs across structured medical explanations and real-world physician-patient interactions, analyzing semantic fidelity, readability, and affective resonance. Baseline models amplify affective polarity relative to physicians (Very Negative: 43.14-45.10% vs. 37.25%) and, in larger architectures such as GPT-5 and Claude, produce substantially higher linguistic complexity (FKGL up to 16.91-17.60 vs. 11.47-12.50 in physician-authored responses). Empathy-oriented prompting reduces extreme negativity and lowers grade-level complexity (up to -6.87 FKGL points for GPT-5) but does not significantly increase semantic fidelity. Collaborative rewriting yields the strongest overall alignment. Rephrase configurations achieve the highest semantic similarity to physician answers (up to mean = 0.93) while consistently improving readability and reducing affective extremity. Dual stakeholder evaluation shows that no model surpasses physicians on epistemic criteria, whereas patients consistently prefer rewritten variants for clarity and emotional tone. These findings suggest that LLMs function most effectively as collaborative communication enhancers rather than replacements for clinical expertise.