# Active Evidence-Seeking and Diagnostic Reasoning in Large Language Models for Clinical Decision Support

arXiv: https://arxiv.org/abs/2605.22047 · HTML: https://mlsanity.com/paper/2605.22047/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 18 of its 46 references that are in the map.
- First posted on arXiv 21 May 2026.

## Placed in

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

## Builds on (most cited first, 18 of 18)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [PubMedQA: A Dataset for Biomedical Research Question Answering](https://mlsanity.com/paper/1909.06146/) (2019)
- [Qwen2.5-Coder Technical Report](https://mlsanity.com/paper/2409.12186/) (2024)
- [ChatGLM: A Family of Large Language Models from GLM-130B to GLM-4 All Tools](https://mlsanity.com/paper/2406.12793/) (2024)
- [Gemini: A Family of Highly Capable Multimodal Models](https://mlsanity.com/paper/2312.11805/) (2023)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [MedDialog: Two Large-scale Medical Dialogue Datasets](https://mlsanity.com/paper/2004.03329/) (2020)
- [Baichuan-M1: Pushing the Medical Capability of Large Language Models](https://mlsanity.com/paper/2502.12671/) (2025)
- [Automatic Interactive Evaluation for Large Language Models with State Aware Patient Simulator](https://mlsanity.com/paper/2403.08495/) (2024)
- [MedCaseReasoning: Evaluating and learning diagnostic reasoning from clinical case reports](https://mlsanity.com/paper/2505.11733/) (2025)
- [MediTOD: An English Dialogue Dataset for Medical History Taking with Comprehensive Annotations](https://mlsanity.com/paper/2410.14204/) (2024)
- [Ask Patients with Patience: Enabling LLMs for Human-Centric Medical Dialogue with Grounded Reasoning](https://mlsanity.com/paper/2502.07143/) (2025)
- [MedQA-CS: Objective Structured Clinical Examination (OSCE)-Style Benchmark for Evaluating LLM Clinical Skills](https://mlsanity.com/paper/2410.01553/) (2024)

## Built on by (most cited first, 1 of 1)

- [Japanese Stroke LLM Evaluation: A Conversational Benchmark for Safe Stroke Care in Japanese Using Large Language Models](https://mlsanity.com/paper/2609.16739/) (2026)

## Abstract (arXiv)

Large language models perform well on static medical examinations, yet clinical diagnosis often requires iterative evidence gathering under uncertainty. Building on prior interactive evaluation efforts, we introduce an OSCE-inspired standardized patient simulator and a controlled, reproducible benchmark for active diagnostic inquiry. Across 468 cases and 15 models in our protocol, we observe that multi-turn evidence seeking reduces diagnostic accuracy by 12.75% and lowers supporting-evidence quality by 24.36% relative to full-context evaluation; error analyses associate these drops with premature diagnostic closure and inefficient questioning. Together, these results suggest that static full-context benchmarks may overestimate performance in interactive evidence-seeking settings, motivating complementary interactive assessment for safer clinical decision support.