只微调GPT-2的末层，用6%参数实现91%医学文本分类准确率。

The rapid expansion of electronic health record (EHR) systems has generated large volumes of unstructured clinical narratives that contain valuable information for disease identification, patient cohort discovery, and clinical decision support. Extracting structured knowledge from these free-text documents remains challenging because clinical language is highly specialized, labeled datasets are limited, and full fine-tuning of large pretrained language models can require substantial computational resources. Efficient adaptation strategies are therefore essential for practical clinical natural language processing applications. This study proposes a parameter-efficient selective fine-tuning framework for adapting GPT-2 to clinical text classification tasks. Instead of updating the entire pretrained model, the majority of network parameters are frozen, and only the final Transformer block, the final layer normalization module, and a lightweight classification head are updated during training. This design substantially reduces the number of trainable parameters while preserving the contextual representation capabilities learned during pretraining. The proposed approach is evaluated using radiology reports from the MIMIC-IV-Note dataset with automatically derived CheXpert-style labels. Experiments on 50,000 radiology reports demonstrate that selective fine-tuning achieves approximately 91% classification accuracy while updating fewer than 6% of the model parameters. Comparative experiments with head-only training and full-model fine-tuning show that the proposed method provides a favorable balance between predictive performance and computational efficiency. These results indicate that selective fine-tuning offers an efficient and scalable framework for clinical text classification.