Personas Shift Clinical Action Thresholds in Large Language Models.

ABSTRACT:

Background and aims

Clinical LLM deployment is shifting from feasibility to liability, while current guidance largely treats model behavior as a control problem. We tested whether decision-style system prompts shift clinical action thresholds when clinical facts are held constant, and whether these shifts are consistent across settings and models.

Methods

We defined nine physician personas by crossing three ethical orientations (duty-, care-, utilitarian) with three cognitive styles (intuitive, integrative, analytic). Twenty open-weight LLMs were evaluated on 2,500 simulated ED vignettes and 2,500 MIMIC-IV-Note discharge summaries. For each text, models answered five binary decision items (safety, autonomy, treatment, resource use, follow-up). Each condition was repeated ten

SUBMITTER: Klang E 

PROVIDER: S-EPMC12772673 | biostudies-literature | 2026 Jan

REPOSITORIES: biostudies-literature