# SemioLLM: Evaluating Large Language Models for Diagnostic Reasoning from Unstructured Clinical Narratives in Epilepsy

arXiv: https://arxiv.org/abs/2407.03004 · HTML: https://mlsanity.com/paper/2407.03004/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 30 of its 84 references that are in the map.
- First posted on arXiv 3 Jul 2024.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 30 of 30)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Llama 2: Open Foundation and Fine-Tuned Chat Models](https://mlsanity.com/paper/2307.09288/) (2023)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [On the Opportunities and Risks of Foundation Models](https://mlsanity.com/paper/2108.07258/) (2021)
- [Qwen Technical Report](https://mlsanity.com/paper/2309.16609/) (2023)
- [Survey of Hallucination in Natural Language Generation](https://mlsanity.com/paper/2202.03629/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Mixtral of Experts](https://mlsanity.com/paper/2401.04088/) (2024)
- [A Survey on Hallucination in Large Language Models: Principles, Taxonomy, Challenges, and Open Questions](https://mlsanity.com/paper/2311.05232/) (2023)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [XTREME: A Massively Multilingual Multi-task Benchmark for Evaluating Cross-lingual Generalization](https://mlsanity.com/paper/2003.11080/) (2020)
- [A Survey on In-context Learning](https://mlsanity.com/paper/2301.00234/) (2022)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [ClinicalBERT: Modeling Clinical Notes and Predicting Hospital Readmission](https://mlsanity.com/paper/1904.05342/) (2019)
- [Augmented Language Models: a Survey](https://mlsanity.com/paper/2302.07842/) (2023)
- [Towards Expert-Level Medical Question Answering with Large Language Models](https://mlsanity.com/paper/2305.09617/) (2023)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [Can large language models reason about medical questions?](https://mlsanity.com/paper/2207.08143/) (2022)
- [In-Context Impersonation Reveals Large Language Models' Strengths and Biases](https://mlsanity.com/paper/2305.14930/) (2023)
- [Quantifying Aleatoric and Epistemic Uncertainty in Machine Learning: Are Conditional Entropy and Mutual Information Appropriate Measures?](https://mlsanity.com/paper/2209.03302/) (2022)
- [BioMedLM: A 2.7B Parameter Language Model Trained On Biomedical Text](https://mlsanity.com/paper/2403.18421/) (2024)
- [Diagnostic Reasoning Prompts Reveal the Potential for Large Language Model Interpretability in Medicine](https://mlsanity.com/paper/2308.06834/) (2023)
- [Calibrating Large Language Models with Sample Consistency](https://mlsanity.com/paper/2402.13904/) (2024)
- [Large Language Models Perform Diagnostic Reasoning](https://mlsanity.com/paper/2307.08922/) (2023)
- [AI Uncertainty Based on Rademacher Complexity and Shannon Entropy](https://mlsanity.com/paper/2102.07638/) (2021)

## Abstract (arXiv)

Large Language Models (LLMs) have been shown to encode clinical knowledge. Many evaluations, however, rely on structured question-answer benchmarks, overlooking critical challenges of interpreting and reasoning about unstructured clinical narratives in real-world settings. In this study we task eight Large Language models including two medical models (GPT-3.5, GPT-4, Mixtral-8x7B, Qwen-72B, LlaMa2, LlaMa3, OpenBioLLM, Med42) with a core diagnostic task in epilepsy: mapping seizure description phrases, after targeted filtering and standardization, to one of seven possible seizure onset zones using likelihood estimates. Most models yield results that often match the ground truth and even approach clinician-level performance after prompt engineering. Specifically, clinician-guided chain-of-thought reasoning leading to the most consistent improvements. Performance was further strongly modulated by clinical in-context impersonation, narrative length and language context (13.7%, 32.7% and 14.2% performance variation, respectively). However, expert analysis of reasoning outputs revealed that correct prediction can be based on hallucinated knowledge and inaccurate source citation, underscoring the need to improve interpretability of LLMs in clinical use. Overall, SemioLLM provides a scalable, domain-adaptable framework for evaluating LLMs in clinical disciplines where unstructured verbal descriptions encode diagnostic information. By identifying both the strengths and limitations of LLMs, our work contributes to testing the applicability of foundational AI systems for healthcare.