# Challenges in Explaining Pretrained Clinical Text Classifiers

arXiv: https://arxiv.org/abs/2605.28060 · HTML: https://mlsanity.com/paper/2605.28060/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 4 of its 15 references that are in the map.
- First posted on arXiv 27 May 2026.

## Builds on (most cited first, 4 of 4)

- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [What Clinicians Want: Contextualizing Explainable Machine Learning for Clinical End Use](https://mlsanity.com/paper/1905.05134/) (2019)
- [Revisiting Transformer-based Models for Long Document Classification](https://mlsanity.com/paper/2204.06683/) (2022)

## Abstract (arXiv)

Explaining the predictions of neural models in clinical NLP remains a significant challenge, especially for complex tasks involving long, unstructured medical texts. While post-hoc methods like LIME and SHAP are widely used, they often fall short when applied to clinical narratives. In this paper, we identify core limitations of token-level and perturbation-based explanation techniques through targeted demonstra- tions on a hospital length-of-stay prediction task. Our findings reveal issues such as overemphasis on non-informative tokens, instability in at- tributions, and high-confidence predictions for incoherent input variants. These results underscore the need for explanation strategies that are clin- ically meaningful, semantically grounded, and robust to linguistic noise.