arXiv:2608.10258cs.CLcs.AI2026-08

测试大模型在连续对话中是否坚持用药安全,发现多数情况下会中途失守。

TAF-MED: Multi-Turn Safety Refusal Collapse in LLMs Under Declared Self-Treatment Intent

论文配图:TAF-MED: Multi-Turn Safety Refusal Collapse in LLMs Under Declared Self-Treatment Intent
图 1 · 摘自论文原文
  • 构建3000次三轮医疗对话的基准,评估模型安全响应持续性
  • 超70%对话出现不安全回复,近六成初始安全回应后期崩溃
  • 自动化评分与医生标注高度一致,适合研究多轮医疗对话安全

大型语言模型(LLMs)越来越多地提供可能影响治疗决策的对话式健康信息,但现有基准未能分离出在明确自疗意图后,药物安全边界是否能在后续追问中保持。我们提出TAF-MED,一个由医师评审的500个固定三轮场景基准,评估8个LLM在4,000次对话中的表现。采用基于规则的自动评判器将回应标记为SAFE、LEAKY或UNSAFE,两名医师独立标注了400个模型平衡的随机样本。评估内容包括不安全建议、初始严格安全回应后的崩溃现象及模型排名稳定性。结果显示,71.6%的对话包含UNSAFE回应,其中61.4%起始于严格安全回应却最终崩溃;模型级崩溃率从24.4%到96.2%不等。28对模型中有4对在初始不安全率与崩溃率上的排序发生反转。自动化标签与经仲裁的医师参考结果达成94.3%的一致性(κ=0.895)。这些发现表明,首轮安全不能代表整个对话的安全性,呼吁在完整对话轨迹上进行评估。我们将把TAF-MED发布于Hugging Face,以支持可复现的多轮医疗安全研究。

原文摘要 · Abstract (English)

Large language models (LLMs) increasingly provide conversational health information that may influence treatment decisions, yet existing benchmarks do not isolate whether medication-safety boundaries persist across follow-ups after explicit self-treatment intent. We introduce TAF-MED, a physician-reviewed benchmark of 500 fixed three-turn scenarios, and evaluate eight LLMs across 4,000 conversations. A rubric-based automated judge labelled responses as SAFE, LEAKY, or UNSAFE, and two physicians independently annotated a model-balanced random subset of 400 conversations. We assessed unsafe guidance, collapse after a strictly SAFE initial response, and model-ranking stability. Overall, 71.6% of conversations contained an UNSAFE response, and 61.4% of those beginning with a strictly SAFE response later collapsed to UNSAFE; model-level collapse rates ranged from 24.4% to 96.2%. Four of 28 model pairs reversed order between initial unsafe and collapse rates. Automated labels achieved 94.3% agreement with the adjudicated physician reference ($κ= 0.895$). These findings show that first-turn safety is an incomplete proxy for conversational safety persistence and motivate evaluation across complete dialogue trajectories. We will release TAF-MED on Hugging Face to support reproducible research on multi-turn medical safety.

医疗安全多轮对话大模型评测

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