Artificial Intelligence · 11.08.2026, 04:55 UTC
When Confidence Fails: Overconfidence in LLMs under Uncertainty and Missing Clinical Information
| Schweregrad | info |
|---|---|
| Kategorie | Artificial Intelligence |
| Quelle | arXiv cs.CL ↗ |
| Veröffentlicht | 11.08.2026 UTC |
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arXiv:2608.09080v1 Announce Type: new Abstract: Large Language Models (LLMs) have achieved strong performance in medical question answering and clinical reasoning tasks. However, their reliability under uncertainty remains poorly understood which raises critical concerns for deployment in high-stakes clinical settings. In such environments, incorrect predictions are inherently risky, but confident incorrect predictions can be particularly harmful as they may mislead clinical decision-making. In this paper, we conduct a systematic behavioral analysis of LLMs under clinical information uncertainty. We propose an evaluation framework based on the MedMCQA dataset consisting of two complementary uncertainty settings. First, we introduce linguistic uncertainty cues through prompt modifications to simulate ambiguous clinical contexts. Second, we construct an answer removal setting, wherein the correct option is deliberately excluded mandating the model to recognize insufficient information and abstain. We analyze both model accuracy and confidence behavior using multiple calibration metrics including calibration gap, Expected Calibration Error (ECE), and Unsafe Confident Error Rate (UCER) across 500 medical questions. Our results reveal a consistent failure mode, i.e., although accuracy degrades under increasing uncertainty, model confidence remains misaligned with accuracy. This leads to a substantial increase in unsafe confident errors, indicating that model confidence remains largely insensitive to clinically meaningful information loss. Furthermore, we observe significant …