测试大模型在多轮医患对话中纠正错误认知的能力,发现性能随对话轮次明显下降。
Evaluating Large Language Models on Misconceptions in Multi-Turn Medical Conversations
- 构建2437个真实医患对话的多轮数据集ThReadMed-QA,用于评估模型纠错能力。
- 顶尖模型初始纠错率约85%,两轮后下降至约50%,存在严重性能衰减。
- 错误传播是主要问题,即使上下文正确,模型仍难持续准确纠正错误。
寻求医疗信息的患者常提出包含错误假设或误解的问题。安全的医学沟通不仅需回答问题,还需识别并纠正潜在的错误信念。这类交互自然呈现多轮特征,如今也体现在大语言模型(LLM)的对话中。然而现有评估框架未涵盖此类场景下模型行为,其中误解可能产生、持续或演变。本研究引入ThReadMed-QA,一个由2,437条患者-医生对话线程组成的多轮医学对话数据集,共含8,204个问答对,源自真实患者在AskDocs平台的互动。该数据集支持系统性评估模型在多轮语境下检测与纠正误解的能力。我们采用基于评分的LLM-as-a-Judge框架,评估五种主流大模型的表现。实验显示一致模式:即使前沿模型能在单轮中处理误解,其表现随后续轮次显著下降。GPT-5和Claude-Haiku在初始问题中纠正错误约85%,但在两轮后降至约50%。通过用医生回复替换模型输出的“理想”分析表明,大部分性能下降源于错误传播,且即使在正确上下文中,模型表现依然不完美。这揭示了模型在多轮场景下给出不一致甚至危险建议的风险,凸显建立能捕捉多轮行为的评估框架的必要性。
原文摘要 · Abstract (English)
Patients seeking medical information often ask questions that embed incorrect assumptions or misconceptions. In such cases, safe medical communication requires not only answering the question, but identifying and correcting the underlying false belief. These interactions naturally unfold over multiple turns, a pattern now mirrored in interactions with LLMs. Yet current evaluation frameworks do not capture model behavior in these settings, where misconceptions can emerge, persist, or evolve over the course of a conversation. Whether LLMs can reliably correct such misconceptions over time remains largely unexamined. To study this, we introduce ThReadMed-QA, a multi-turn medical dialogue dataset of 2,437 patient-physician conversation threads comprising 8,204 question-answer pairs, derived from real patient interactions on AskDocs. This dataset enables systematic evaluation of whether models can detect and correct misconceptions under a multi-turn context. We evaluate five LLMs using a rubric-based LLM-as-a-Judge framework that scores responses based on their ability to identify and correct misconceptions. Our experiments reveal a consistent pattern: even frontier models that can address misconceptions in a single interaction degrade substantially over subsequent turns. GPT-5 and Claude-Haiku correct these false presuppositions around 85% on initial questions but drop to roughly 50% within two follow-ups. An oracle analysis replacing prior model outputs with physician responses shows that much of the degradation is driven by error propagation, while performance remains imperfect even under correct context. Even when models tend to correct misconceptions initially, their performance degrades substantially over later turns, leading to inconsistent and potentially unsafe guidance in patient-facing settings and highlighting the need for evaluation frameworks that capture multi-turn behavior.
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