# Silence is Not Consensus: Disrupting Agreement Bias in Multi-Agent LLMs via Catfish Agent for Clinical Decision Making

arXiv: https://arxiv.org/abs/2505.21503 · HTML: https://mlsanity.com/paper/2505.21503/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 23 of its 54 references that are in the map.
- First posted on arXiv 27 May 2025.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 23 of 23)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [AutoGen: Enabling Next-Gen LLM Applications via Multi-Agent Conversation](https://mlsanity.com/paper/2308.08155/) (2023)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [DeepSeek-V3 Technical Report](https://mlsanity.com/paper/2412.19437/) (2024)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [PathVQA: 30000+ Questions for Medical Visual Question Answering](https://mlsanity.com/paper/2003.10286/) (2020)
- [PMC-VQA: Visual Instruction Tuning for Medical Visual Question Answering](https://mlsanity.com/paper/2305.10415/) (2023)
- [MedAgents: Large Language Models as Collaborators for Zero-shot Medical Reasoning](https://mlsanity.com/paper/2311.10537/) (2023)
- [HuatuoGPT-o1, Towards Medical Complex Reasoning with LLMs](https://mlsanity.com/paper/2412.18925/) (2024)
- [Unleashing the Emergent Cognitive Synergy in Large Language Models: A Task-Solving Agent through Multi-Persona Self-Collaboration](https://mlsanity.com/paper/2307.05300/) (2023)
- [MedXpertQA: Benchmarking Expert-Level Medical Reasoning and Understanding](https://mlsanity.com/paper/2501.18362/) (2025)
- [Benchmarking Large Language Models on Answering and Explaining Challenging Medical Questions](https://mlsanity.com/paper/2402.18060/) (2024)
- [MedExQA: Medical Question Answering Benchmark with Multiple Explanations](https://mlsanity.com/paper/2406.06331/) (2024)
- [MedCoT: Medical Chain of Thought via Hierarchical Expert](https://mlsanity.com/paper/2412.13736/) (2024)
- [Towards Efficient LLM Grounding for Embodied Multi-Agent Collaboration](https://mlsanity.com/paper/2405.14314/) (2024)
- [Baichuan-M1: Pushing the Medical Capability of Large Language Models](https://mlsanity.com/paper/2502.12671/) (2025)
- [MedicalAgentsBench for Complex Medical Reasoning: Comparing Internalized Reasoning Models versus Externalized Agent-based Frameworks](https://mlsanity.com/paper/2503.07459/) (2025)
- [Self-Supervised Prompt Optimization](https://mlsanity.com/paper/2502.06855/) (2025)
- [Beyond Direct Diagnosis: LLM-based Multi-Specialist Agent Consultation for Automatic Diagnosis](https://mlsanity.com/paper/2401.16107/) (2024)

## Built on by (most cited first, 2 of 2)

- [Free-MAD: Consensus-Free Multi-Agent Debate](https://mlsanity.com/paper/2509.11035/) (2025)
- [Position: Safety and Fairness in Agentic AI Depend on Interaction Topology, Not on Model Scale or Alignment](https://mlsanity.com/paper/2605.01147/) (2026)

## Abstract (arXiv)

Large language models (LLMs) have demonstrated strong potential in clinical question answering, with recent multi-agent frameworks further improving diagnostic accuracy via collaborative reasoning. However, we identify a recurring issue of Silent Agreement, where agents prematurely converge on diagnoses without sufficient critical analysis, particularly in complex or ambiguous cases. We present a new concept called Catfish Agent, a role-specialized LLM designed to inject structured dissent and counter silent agreement. Inspired by the ``catfish effect'' in organizational psychology, the Catfish Agent is designed to challenge emerging consensus to stimulate deeper reasoning. We formulate two mechanisms to encourage effective and context-aware interventions: (i) a complexity-aware intervention that modulates agent engagement based on case difficulty, and (ii) a tone-calibrated intervention articulated to balance critique and collaboration. Evaluations on nine medical Q&A and three medical VQA benchmarks show that our approach consistently outperforms both single- and multi-agent LLMs frameworks, including leading commercial models such as GPT-4o and DeepSeek-R1.