让AI像医生一样,在信息不足时主动暂停判断。
KnowGuard: Knowledge-Driven Abstention for Multi-Round Clinical Reasoning
- 先系统检索医学知识图谱,再评估证据充分性才决定是否跳过
- 诊断准确率提升3.93%,对话轮次减少7.27轮
- 适合医疗决策、临床辅助等对安全要求高的场景
在临床实践中,医生常因信息不足而选择不作判断,这种行为称为'回避',是防止误诊的关键安全机制。尽管大语言模型(LLMs)已应用于医疗场景,但现有模型在缺乏足够信息时仍频繁给出过度自信的回答。这一问题源于传统回避方法仅依赖模型自我评估,缺乏结合外部医学证据识别知识边界的系统策略。为此,我们提出 extbf{KnowGuard},一种新的'先调查后回避'范式,通过整合系统化的知识图谱探索实现临床决策。该方法包含两个阶段:1)证据发现阶段,通过图谱扩展与直接检索系统探索医学知识空间;2)证据评估阶段,基于多因素对证据排序,并根据患者上下文和对话历史动态调整探索策略。该两阶段方法实现了系统的知识图谱探索,使模型能够追踪结构化推理路径并识别证据不足。我们在开放式多轮临床基准上评估了该回避策略,采用模拟真实诊断场景的评测指标,超越传统封闭形式评价。实验结果明确表明,KnowGuard优于现有最优回避方法,在诊断准确率提升3.93%的同时,平均减少7.27轮不必要的交互。
原文摘要 · Abstract (English)
In clinical practice, physicians refrain from making decisions when patient information is insufficient. This behavior, known as abstention, is a critical safety mechanism preventing potentially harmful misdiagnoses. Recent investigations have reported the application of large language models (LLMs) in medical scenarios. However, existing LLMs struggle with the abstentions, frequently providing overconfident responses despite incomplete information. This limitation stems from conventional abstention methods relying solely on model self-assessments, which lack systematic strategies to identify knowledge boundaries with external medical evidences. To address this, we propose \textbf{KnowGuard}, a novel \textit{investigate-before-abstain} paradigm that integrates systematic knowledge graph exploration for clinical decision-making. Our approach consists of two key stages operating on a shared contextualized evidence pool: 1) an evidence discovery stage that systematically explores the medical knowledge space through graph expansion and direct retrieval, and 2) an evidence evaluation stage that ranks evidence using multiple factors to adapt exploration based on patient context and conversation history. This two-stage approach enables systematic knowledge graph exploration, allowing models to trace structured reasoning paths and recognize insufficient medical evidence. We evaluate our abstention approach using open-ended multi-round clinical benchmarks that mimic realistic diagnostic scenarios, assessing abstention quality through accuracy-efficiency trade-offs beyond existing closed-form evaluations. Experimental evidences clearly demonstrate that KnowGuard outperforms state-of-the-art abstention approaches, improving diagnostic accuracy by 3.93\% while reducing unnecessary interaction by 7.27 turns on average.
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