Research on Security Enhancement Methods for Adversarial Robust Large Language Model Intelligent Agents for Medical Decision-Making Tasks

Motivated by the challenge to improve the adversarial robustness, security, and trust of medical decision making intelligent agents, this study develops a full-link security enhancement framework, which describes "input risk perception - medical evidence constraint - knowledge consistency verification - decision confidence reweighting - security output control - adversarial feedback update." We propose ARSM-Agent and define a weighted joint objective consisting of decision accuracy loss, adversarial robustness loss, safety refusal loss, and knowledge consistency loss, with weights of 0.3, 0.3, 0.2, and 0.2, respectively. The whole medical decision formulation is implemented by multi-module collaborative linkage. We verify that the algorithm is more efficient than four baselines, including LLM-Agent, Retrieval-Agent, Filter-Agent, and Adv-Train-Agent. Under semantic perturbation, prompt injection, drug-name confusion, and false-evidence attacks, ARSM-Agent reduces the overall attack success rate to 8.7% and achieves a knowledge consistency score of 0.91. Ablation experiments quantify each module's contribution: removing risk perception, evidence retrieval, consistency verification, and confidence reweighting reduces accuracy by 6.7%, 9.1%, 7.6%, and 4.4%, respectively, and increases attack success rate by 13.8%, 11.1%, 8.6%, and 6.9%. The proposed approach addresses key security issues of medical decision making intelligent agents, obtains secure decision making in challenging scenarios, and provides reliable intelligent support for medical decision-making intelligent agents.