# Teaching LLMs to Recommend and Defer in Underrepresented Epilepsy Care

arXiv: https://arxiv.org/abs/2606.31036 · HTML: https://mlsanity.com/paper/2606.31036/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 35 of its 63 references that are in the map.
- First posted on arXiv 30 Jun 2026.

## Builds on (most cited first, 30 of 35)

- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Reflexion: Language Agents with Verbal Reinforcement Learning](https://mlsanity.com/paper/2303.11366/) (2023)
- [Simple and Scalable Predictive Uncertainty Estimation using Deep Ensembles](https://mlsanity.com/paper/1612.01474/) (2016)
- [Self-Refine: Iterative Refinement with Self-Feedback](https://mlsanity.com/paper/2303.17651/) (2023)
- [Voyager: An Open-Ended Embodied Agent with Large Language Models](https://mlsanity.com/paper/2305.16291/) (2023)
- [Language Models (Mostly) Know What They Know](https://mlsanity.com/paper/2207.05221/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Can You Trust Your Model's Uncertainty? Evaluating Predictive Uncertainty Under Dataset Shift](https://mlsanity.com/paper/1906.02530/) (2019)
- [Large Language Models Are Human-Level Prompt Engineers](https://mlsanity.com/paper/2211.01910/) (2022)
- [Large Language Models Cannot Self-Correct Reasoning Yet](https://mlsanity.com/paper/2310.01798/) (2023)
- [Can LLMs Express Their Uncertainty? An Empirical Evaluation of Confidence Elicitation in LLMs](https://mlsanity.com/paper/2306.13063/) (2023)
- [ExpeL: LLM Agents Are Experiential Learners](https://mlsanity.com/paper/2308.10144/) (2023)
- [Large Language Models as Optimizers](https://mlsanity.com/paper/2309.03409/) (2023)
- [Selective Classification for Deep Neural Networks](https://mlsanity.com/paper/1705.08500/) (2017)
- [DSPy: Compiling Declarative Language Model Calls into Self-Improving Pipelines](https://mlsanity.com/paper/2310.03714/) (2023)
- [Quantifying Language Models' Sensitivity to Spurious Features in Prompt Design or: How I learned to start worrying about prompt formatting](https://mlsanity.com/paper/2310.11324/) (2023)
- [Just Ask for Calibration: Strategies for Eliciting Calibrated Confidence Scores from Language Models Fine-Tuned with Human Feedback](https://mlsanity.com/paper/2305.14975/) (2023)
- [Automatic Prompt Optimization with "Gradient Descent" and Beam Search](https://mlsanity.com/paper/2305.03495/) (2023)
- [GEPA: Reflective Prompt Evolution Can Outperform Reinforcement Learning](https://mlsanity.com/paper/2507.19457/) (2025)
- [Can Generalist Foundation Models Outcompete Special-Purpose Tuning? Case Study in Medicine](https://mlsanity.com/paper/2311.16452/) (2023)
- [Optimizing Instructions and Demonstrations for Multi-Stage Language Model Programs](https://mlsanity.com/paper/2406.11695/) (2024)
- [Distribution-Free, Risk-Controlling Prediction Sets](https://mlsanity.com/paper/2101.02703/) (2021)
- [TextGrad: Automatic "Differentiation" via Text](https://mlsanity.com/paper/2406.07496/) (2024)
- [Consistent Estimators for Learning to Defer to an Expert](https://mlsanity.com/paper/2006.01862/) (2020)
- [Predict Responsibly: Improving Fairness and Accuracy by Learning to Defer](https://mlsanity.com/paper/1711.06664/) (2017)
- [MDAgents: An Adaptive Collaboration of LLMs for Medical Decision-Making](https://mlsanity.com/paper/2404.15155/) (2024)
- [GAMENet: Graph Augmented MEmory Networks for Recommending Medication Combination](https://mlsanity.com/paper/1809.01852/) (2018)
- [HSEvo: Elevating Automatic Heuristic Design with Diversity-Driven Harmony Search and Genetic Algorithm Using LLMs](https://mlsanity.com/paper/2412.14995/) (2024)
- [MedAgentBench: A Realistic Virtual EHR Environment to Benchmark Medical LLM Agents](https://mlsanity.com/paper/2501.14654/) (2025)
- [Direct Uncertainty Prediction for Medical Second Opinions](https://mlsanity.com/paper/1807.01771/) (2018)

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

- [Uncertainty Quantification for LLM Agents: A Taxonomy, an Evaluation Protocol, and an Empirical Study](https://mlsanity.com/paper/2609.07395/) (2026)

## Abstract (arXiv)

Specialist epilepsy expertise is scarce in resource-constrained settings, making LLM-based decision support attractive for frontline clinicians managing longitudinal treatment. Such systems must adapt to local prescribing practice and know when to defer. We study this problem in Ugandan pediatric epilepsy care, predicting anti-seizure medication regimens from longitudinal unstructured clinic notes. Standard prompting achieves non-trivial agreement with physician prescriptions, but neurologist review shows that many errors reflect distribution-miscalibrated prescribing defaults rather than failures to parse the local record. We introduce MANANA, a non-parametric prompt-learning framework that learns local prescribing guidance from a small patient-level training set. MANANA converts observed prescription errors into auditable prompt memories, instantiated in single-agent and multi-agent variants, and improves over classical ML models, direct LLM prompting, and prompt-optimization baselines across two independently collected Ugandan cohorts. We further propose Bayesian prompt averaging, which converts the learned prompt trajectory into prescription likelihoods and an uncertainty-based deferral signal. On the independently collected held-out cohort, this improves visit-level top-3 prescription accuracy by 4-8 percentage points over prompt-optimization baselines and enables selective prediction: the system can auto-handle the most confident half of cases at 95% precision, or the most confident quarter at 99% precision, while deferring lower-confidence cases for specialist review.