When Health Assistants Agree Too Readily: A Benchmark of Time-Critical Self-Diagnosis

A recent Nature Medicine study reported that ChatGPT Health under-triages 51.6% of emergencies and concluded that consumer-facing AI triage poses safety risks. Its protocol, however, was an exam-style scaffold (forced A/B/C/D output, knowledge suppression, no clarifying questions) unlike how consumers use health chatbots. We ask how much of the headline error rate is a property of the measurement rather than of the models. In a first, mechanistic study, five frontier LLMs on a 17-scenario bank scored 6.4 points higher under naturalistic patient-style messages than under the constrained scaffold (p=0.015). In a second, faithful replication we ran the authors' own 60 released vignettes through six frontier models under four matched formats, with clinician validation of the rewrites and a blinded clinician audit of the LLM adjudicators. Here the direction reversed: free-text rewrites scored slightly below the exact prompt (78.7% vs 81.8%, p=0.020), removing only the answer scaffold changed little (80.6% vs 81.4%, p=0.81), and naturalistic input with a forced categorical answer beat both the exact prompt (84.4%, p=0.023) and free text (p=0.0001). On the four vignettes defining the original emergency rate, under-triage was 17% with the exact scaffold, 50% in free text, and 21% with a forced letter on the same message; every free-text "under-triage" was a same-day recommendation scored C rather than D, and 60% made escalation conditional on information the patient was asked to check, behavior a single-turn benchmark cannot score. The headline rate did not reproduce as a stable cross-model finding; much of it depends on output format and on mapping prose onto a four-point scale. Each format elicits a separate response, so the design measures format sensitivity, not format versus capability. Safety claims should report sensitivity to input wording, output format and adjudication.

Millions of clinicians use ChatGPT to support clinical care, but evaluations of the most common use cases in model-clinician conversations are limited. We introduce HealthBench Professional, an open benchmark for evaluating large language models on real tasks that clinicians bring to ChatGPT in the course of their work. The benchmark is organized around three common use cases central to clinical practice: care consult, writing and documentation, and medical research. Each example includes a physician-authored conversation with ChatGPT for Clinicians and is scored via rubrics written and iteratively adjudicated by three or more physicians across three phases. HealthBench Professional examples were carefully selected for quality, representativeness, and difficulty for OpenAI's current frontier models, to enable continued measurement of progress. Difficult examples for recent OpenAI models were enriched by roughly 3.5 times relative to the candidate pool of 15,079 examples. Additionally, about one-third of examples involve physicians conducting deliberate adversarial testing of models. As a strong baseline, we also collected human physician responses for all tasks (unbounded time, specialist-matched, web access). The best scoring system, GPT-5.4 in ChatGPT for Clinicians, outperforms base GPT-5.4, all other models, and human physicians. We hope HealthBench Professional provides the healthcare AI community a measure to track frontier model progress in real-world clinical tasks and build systems that clinicians can trust to improve care.

People increasingly bring their health questions to ChatGPT, yet safety evaluations of LLM health advice rest almost entirely on clinician-authored vignettes, synthetic prompts, or simulated user profiles. The gap is widest for the Global South, where concerns about demographic bias and unsafe recommendations are well documented but have never been tested on real usage. We present, to our knowledge, the first demographically grounded safety evaluation of real-world health conversations with ChatGPT. From a consent-based data-donation corpus of 202,590 conversations from 1,252 users in India, Nigeria, Brazil, and Pakistan (December 2022 to February 2026), each linked to self-reported age and gender, we identify 15,555 health conversations, classify their health intent using an LLM classifier adapted from an established taxonomy, and score response safety under both a context-blind and a user-context-aware rubric. Roughly one in five health conversations receives a high-risk rating. Risk concentrates in symptom and condition queries and recurs through identifiable failure modes: unsafe medication or dosage guidance, harmful self-diagnosis, missing safety warnings, encouraging over-reliance on the model, and failure to refer users to professionals. Supplying the user's own accumulated context raises the high-risk share by 13-17 percentage points, and about one in four conversations rated safe in isolation turns out to be unsafe for the specific person asking. Safety evaluations built on synthetic cases are likely to miss these harms.