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arXiv · 2512.13747

Why Text Prevails: Vision May Undermine Multimodal Medical Decision Making

Siyuan Dai·Lunxiao Li·Kun Zhao·Eardi Lila·Paul K. Crane·Heng Huang·Dongkuan Xu·Haoteng Tang·Liang Zhan
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Abstract

With the rapid progress of large language models (LLMs), advanced multimodal large language models (MLLMs) have demonstrated impressive zero-shot capabilities on vision-language tasks. In the biomedical domain, however, even state-of-the-art MLLMs struggle with basic Medical Decision Making (MDM) tasks. We investigate this limitation using two challenging datasets: (1) three-stage Alzheimer's disease (AD) classification (normal, mild cognitive impairment, dementia), where category differences are visually subtle, and (2) MIMIC-CXR chest radiograph classification with 14 non-mutually exclusive conditions. Our empirical study shows that text-only reasoning consistently outperforms vision-only or vision-text settings, with multimodal inputs often performing worse than text alone. To mitigate this, we explore three strategies: (1) in-context learning with reason-annotated exemplars, (2) vision captioning followed by text-only inference, and (3) few-shot fine-tuning of the vision tower with classification supervision. These findings reveal that current MLLMs lack grounded visual understanding and point to promising directions for improving multimodal decision making in healthcare.

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Siyuan Dai, Lunxiao Li, Kun Zhao, Eardi Lila, Paul K. Crane, Heng Huang, Dongkuan Xu, Haoteng Tang, Liang Zhan. 2025-12-15. Why Text Prevails: Vision May Undermine Multimodal Medical Decision Making. https://arxiv.org/abs/2512.13747

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