# CARE: Privacy-Compliant Agentic Reasoning with Evidence Discordance

arXiv: https://arxiv.org/abs/2604.01113 · HTML: https://mlsanity.com/paper/2604.01113/

## 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 19 of its 45 references that are in the map.
- First posted on arXiv 1 Apr 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 19 of 19)

- [ReAct: Synergizing Reasoning and Acting in Language Models](https://mlsanity.com/paper/2210.03629/) (2022)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [Toolformer: Language Models Can Teach Themselves to Use Tools](https://mlsanity.com/paper/2302.04761/) (2023)
- [A Survey on Large Language Model based Autonomous Agents](https://mlsanity.com/paper/2308.11432/) (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)
- [Improving Factuality and Reasoning in Language Models through Multiagent Debate](https://mlsanity.com/paper/2305.14325/) (2023)
- [Calibrate Before Use: Improving Few-Shot Performance of Language Models](https://mlsanity.com/paper/2102.09690/) (2021)
- [gpt-oss-120b & gpt-oss-20b Model Card](https://mlsanity.com/paper/2508.10925/) (2025)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [RETAIN: An Interpretable Predictive Model for Healthcare using Reverse Time Attention Mechanism](https://mlsanity.com/paper/1608.05745/) (2016)
- [MedAgents: Large Language Models as Collaborators for Zero-shot Medical Reasoning](https://mlsanity.com/paper/2311.10537/) (2023)
- [MediQ: Question-Asking LLMs and a Benchmark for Reliable Interactive Clinical Reasoning](https://mlsanity.com/paper/2406.00922/) (2024)
- [Debate or Vote: Which Yields Better Decisions in Multi-Agent Large Language Models?](https://mlsanity.com/paper/2508.17536/) (2025)
- [MedAlign: A Clinician-Generated Dataset for Instruction Following with Electronic Medical Records](https://mlsanity.com/paper/2308.14089/) (2023)
- [LLaDA2.1: Speeding Up Text Diffusion via Token Editing](https://mlsanity.com/paper/2602.08676/) (2026)
- [Enhancing Multi-Agent Debate System Performance via Confidence Expression](https://mlsanity.com/paper/2509.14034/) (2025)
- [Vision-Language and Large Language Model Performance in Gastroenterology: GPT, Claude, Llama, Phi, Mistral, Gemma, and Quantized Models](https://mlsanity.com/paper/2409.00084/) (2024)
- [FACTS: Table Summarization via Offline Template Generation with Agentic Workflows](https://mlsanity.com/paper/2510.13920/) (2025)

## Abstract (arXiv)

Large language model (LLM) systems are increasingly used to support high-stakes decision-making, but they typically perform worse when the available evidence is internally inconsistent. Such a scenario exists in real-world healthcare settings, with patient-reported symptoms contradicting medical signs. To study this problem, we introduce MIMIC-DOS, a dataset for short-horizon organ dysfunction worsening prediction in the intensive care unit (ICU) setting. We derive this dataset from the widely recognized MIMIC-IV, a publicly available electronic health record dataset, and construct it exclusively from cases in which discordance between signs and symptoms exists. This setting poses a substantial challenge for existing LLM-based approaches, with single-pass LLMs and agentic pipelines often struggling to reconcile such conflicting signals. To address this problem, we propose CARE: a multi-stage privacy-compliant agentic reasoning framework in which a proprietary LLM provides guidance by generating structured categories and transitions without accessing sensitive patient data, while a local LLM uses these categories and transitions to support evidence acquisition and final decision-making. Empirically, under controlled retrospective evaluation on MIMIC-DOS, CARE achieves the best overall performance across key metrics among the evaluated LLMs and agentic workflows, showing that it can more robustly handle conflicting clinical evidence while preserving privacy.