Alon Gorenshtein | Searcharxiv

arXiv2026

LLMs for Medical Consultation Are Evaluated Too Late: The Preformulation Gap

Large language models for medical consultation are often evaluated after a clinical problem has already been made clear, although real consultations may begin with a vague, minimized, or misframed concern. We evaluated three API models across four physician-authored, multi-turn vignettes under baseline and entry-to-care instruction conditions, yielding 24 fixed-script transcripts; two cases also used adaptive standardized-patient simulation, yielding 12 transcripts. Self-care or home-management advice before any patient answer appeared in 9 of 12 baseline case-model cells and 0 of 12 instruction cells, while structured handoff summaries appeared in 0 of 12 and 10 of 12 cells, respectively. The instruction changed sequencing and documentation, although it did not reliably ensure elicitation of decisive facts. The preformulation gap should therefore be evaluated directly through observable first-contact behavior rather than inferred from diagnostic accuracy or final-answer quality.

cs.AI↗

arXiv2025

A Multi-Agent Approach to Neurological Clinical Reasoning

Large language models (LLMs) have shown promise in medical domains, but their ability to handle specialized neurological reasoning requires systematic evaluation. We developed a comprehensive benchmark using 305 questions from Israeli Board Certification Exams in Neurology, classified along three complexity dimensions: factual knowledge depth, clinical concept integration, and reasoning complexity. We evaluated ten LLMs using base models, retrieval-augmented generation (RAG), and a novel multi-agent system. Results showed significant performance variation. OpenAI-o1 achieved the highest base performance (90.9% accuracy), while specialized medical models performed poorly (52.9% for Meditron-70B). RAG provided modest benefits but limited effectiveness on complex reasoning questions. In contrast, our multi-agent framework, decomposing neurological reasoning into specialized cognitive functions including question analysis, knowledge retrieval, answer synthesis, and validation, achieved dramatic improvements, especially for mid-range models. The LLaMA 3.3-70B-based agentic system reached 89.2% accuracy versus 69.5% for its base model, with substantial gains on level 3 complexity questions. The multi-agent approach transformed inconsistent subspecialty performance into uniform excellence, addressing neurological reasoning challenges that persisted with RAG enhancement. We validated our approach using an independent dataset of 155 neurological cases from MedQA. Results confirm that structured multi-agent approaches designed to emulate specialized cognitive processes significantly enhance complex medical reasoning, offering promising directions for AI assistance in challenging clinical contexts.

cs.IR↗