临床文档中的歧视性语言会误导大模型,导致医疗决策更保守。
Artificial Intolerance: Stigmatizing Language in Clinical Documentation Skews Large Language Model Decision-Making

- 用不同强度的歧视性语言测试九个前沿大模型
- 一句歧视性语句就让模型决策变保守,呈剂量效应
- 现有缓解方法效果差,模型难识别但会被潜移默化影响
大型语言模型(LLMs)在临床决策支持和医疗记录中日益应用,但其对细微语言差异——尤其是人类病历中常见的歧视性语言(SL)——的鲁棒性仍严重缺乏研究。本文系统评估了九个前沿LLM在四种受歧视医疗状况下的表现,使用注入不同程度和类型SL(怀疑、责备、恶意)的临床案例。结果表明,所有模型均表现出显著偏见,临床决策明显倾向于更保守的患者管理。值得注意的是,模型对语言框架高度敏感,仅一句SL即可改变输出,揭示明显的剂量-反应关系。此外,我们测试了基于提示的标准缓解策略,包括思维链(CoT)推理和模型自我去偏,但效果有限;模型难以显式识别SL,却仍受其隐性影响。研究暴露了当前LLM在临床自然语言处理中公平性和鲁棒性的关键漏洞,强调需建立严格的算法防护机制,防止健康不平等被自动化放大。
原文摘要 · Abstract (English)
Large Language Models (LLMs) are increasingly deployed in high-stakes domains such as clinical decision support and medical documentation. However, the robustness of these models against subtle linguistic variations, specifically stigmatizing language (SL) commonly found in human-authored clinical notes, remains critically under-explored. In this work, we investigate whether frontier LLMs inherit and propagate this human bias when processing clinical text. We systematically evaluate nine frontier LLMs across four stigmatized medical conditions, utilizing clinical vignettes injected with varying intensities and phenotypes of SL (doubt, blame, and maligning). Our results demonstrate that all evaluated models exhibit substantial bias, with clinical decision-making significantly skewed towards less aggressive patient management. Notably, we observe a high sensitivity to linguistic framing, where a single SL sentence is sufficient to alter model outputs, revealing a clear dose-response relationship. Furthermore, we evaluate standard prompt-based mitigation strategies, including Chain-of-Thought (CoT) reasoning and model self-debiasing. These approaches show limited efficacy; models struggle to explicitly identify SL while remaining implicitly influenced by it. Our findings expose a critical vulnerability in current LLMs regarding fairness and robustness in clinical NLP, underscoring the need for rigorous algorithmic guardrails to prevent the automation of health disparities.
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