测试临床对话系统在患者插话时能否保住关键医疗信息。
When Patients Cut In: Extending Clinical Conversational AI Safety to Interruptions
- 将对话重叠类型转化为三类可操作的插话类型,构建评估框架。
- 所有模型在问答场景中插话后内容丢失率达30/30,表现严重退化。
- 插话应对效果因任务类型和模型而异,需按场景单独评估。
临床语音助手已在日常诊疗中部署,但真实患者不会等待说完——他们会插话。现有系统多采用串行架构(语音转文字 → 大模型 → 文字转语音),当患者打断时,即使模型能处理合作性对话,关键临床内容仍可能丢失。然而当前临床对话AI评测几乎都假设患者等待,忽略了插话导致的信息缺失问题。本文提出基于对话转录的插话恢复评估方法,将会话分析中的重叠类别转化为三类可操作类型(识别性、竞争性、过渡性子单元),在四类任务组合(问诊信息收集与常见问题答复)中测试四种面向部署的非推理型LLM配置,评估其是否保留临床必需内容。在信息收集任务中,各模型目标问题失败率不一;在信息提供任务中,所有模型失败率均上升。尤其在竞争性问答插话下,四模型全部出现30/30内容丢失(置信区间95%:88.6%-100%;基线为0/30或4/30)。一句简短道歉标记(如“抱歉打断”)可使恢复率提升十余个百分点,但效果不一致,甚至降低某一模型表现。因此,插话鲁棒性无法用单一指标衡量,评估必须以内容为基础、按任务分组报告,并匹配实际部署中的插话特征。
原文摘要 · Abstract (English)
Clinical voice agents are now deployed in routine care, where real patients do not wait their turn: they interrupt. These systems typically use a cascaded architecture (speech-to-text -> LLM -> text-to-speech), so when a patient cuts the agent off mid-utterance, clinically required content can be lost even when the model handles cooperative transcripts well. Yet clinical conversational-AI benchmarks almost universally assume patients wait for the agent to finish, missing interruption-induced loss of required content. We present a transcript-based evaluation of interruption recovery, adapting conversation-analytic overlap categories into three operational types (recognitional, competitive, transitional sub-unit) and testing four deployment-oriented, non-reasoning LLM configurations across four cells spanning history-taking (information gathering) and FAQ (information provision), scored on whether the agent preserves the clinically required content. In the gathering cells, target-question failure varied across models; in the provision cells, where arms are directly comparable, failure rose for every model. Rankings differ across cells, and competitive FAQ interruption produced 30/30 provision-coverage failures for all four models (Wilson 95% CI: 88.6-100.0%; baseline 0/30 for three, 4/30 for Llama). A brief apology marker ("sorry to interrupt") shifts recovery by tens of percentage points, inconsistently across models, and for one it reduces recovery. Interruption robustness therefore cannot be a single score: evaluation must be content-grounded, reported per cell, and matched to the deployment's interruption profile.
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