← 研踪 PaperTrailarXiv:2610.35326 · v1
Being judged through the record: A Rosenhan-inspired test of psychiatric label sensitivity in large language models
首次提交 2026-10-26 20:24
版本更新 2026-10-26 20:24
雷达观测 2026-10-29 00:36
摘要
The integration of large language models (LLMs) into clinical decision-making raises unresolved questions regarding diagnostic bias. We investigate whether a documented psychiatric history alters LLM recommendations when the current clinical evidence is identical. Using a counterfactual experiment inspired by Rosenhan's 1973 field study, we factorially varied diagnostic-history condition (no prior diagnosis stated vs. prior schizophrenia diagnosis) and current-evidence condition (voices ceased vs. voices persisted) within a clinical vignette. Across five LLMs (GPT-5.6 Sol, Claude Sonnet 5, Gemini 3.6 Flash, Grok 4.6, and Mistral Large 2512), we generated 20,000 model responses across independent queries. When evidence supported discharge, adding a prior schizophrenia diagnosis increased recommendations for continued hospitalization nearly fivefold, from 4.7% to 22.3% (risk difference, 17.5 percentage points; 95% CI, 16.2-18.8). This shift occurred across all five models (risk-difference range, 10.4-34.4 percentage points). In the same condition, reference concordance decreased from 95.3% to 77.7%, while stated decision confidence increased. Across all model-by-evidence contrasts, confidence increases corresponded to Cohen's d values of 0.35-1.09. Signal-detection analyses showed that the prior diagnosis shifted the decision criterion toward hospitalization across all five models and reduced discrimination between the two current-evidence conditions in three of them. When current evidence supported continued hospitalization, the label increased the recommendation for hospitalization from 92.6% to 97.0%.
观测到的版本
相邻记录可能跳过中间版本；首次发现 v2 及以上也会标为版本更新。
v1 · 2026-10-26 20:24 · 最新观测版本
Being judged through the record: A Rosenhan-inspired test of psychiatric label sensitivity in large language models
The integration of large language models (LLMs) into clinical decision-making raises unresolved questions regarding diagnostic bias. We investigate whether a documented psychiatric history alters LLM recommendations when the current clinical evidence is identical. Using a counterfactual experiment inspired by Rosenhan's 1973 field study, we factorially varied diagnostic-history condition (no prior diagnosis stated vs. prior schizophrenia diagnosis) and current-evidence condition (voices ceased vs. voices persisted) within a clinical vignette. Across five LLMs (GPT-5.6 Sol, Claude Sonnet 5, Gemini 3.6 Flash, Grok 4.6, and Mistral Large 2512), we generated 20,000 model responses across independent queries. When evidence supported discharge, adding a prior schizophrenia diagnosis increased recommendations for continued hospitalization nearly fivefold, from 4.7% to 22.3% (risk difference, 17.5 percentage points; 95% CI, 16.2-18.8). This shift occurred across all five models (risk-difference range, 10.4-34.4 percentage points). In the same condition, reference concordance decreased from 95.3% to 77.7%, while stated decision confidence increased. Across all model-by-evidence contrasts, confidence increases corresponded to Cohen's d values of 0.35-1.09. Signal-detection analyses showed that the prior diagnosis shifted the decision criterion toward hospitalization across all five models and reduced discrimination between the two current-evidence conditions in three of them. When current evidence supported continued hospitalization, the label increased the recommendation for hospitalization from 92.6% to 97.0%.
查看此版本解读 →查看此版本原文 ↗