# Untangling the Mechanisms of Misleading Context in Medical Question Answering

arXiv: https://arxiv.org/abs/2609.02754 · HTML: https://mlsanity.com/paper/2609.02754/

## 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 31 of its 55 references that are in the map.
- First posted on arXiv 2 Sep 2026.

## Placed in

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

## Builds on (most cited first, 30 of 31)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Efficient Memory Management for Large Language Model Serving with PagedAttention](https://mlsanity.com/paper/2309.06180/) (2023)
- [Not what you've signed up for: Compromising Real-World LLM-Integrated Applications with Indirect Prompt Injection](https://mlsanity.com/paper/2302.12173/) (2023)
- [gpt-oss-120b & gpt-oss-20b Model Card](https://mlsanity.com/paper/2508.10925/) (2025)
- [Language Models Don't Always Say What They Think: Unfaithful Explanations in Chain-of-Thought Prompting](https://mlsanity.com/paper/2305.04388/) (2023)
- [Towards Understanding Sycophancy in Language Models](https://mlsanity.com/paper/2310.13548/) (2023)
- [Measuring Faithfulness in Chain-of-Thought Reasoning](https://mlsanity.com/paper/2307.13702/) (2023)
- [Reasoning Models Don't Always Say What They Think](https://mlsanity.com/paper/2505.05410/) (2025)
- [Monitoring Reasoning Models for Misbehavior and the Risks of Promoting Obfuscation](https://mlsanity.com/paper/2503.11926/) (2025)
- [Chain of Thought Monitorability: A New and Fragile Opportunity for AI Safety](https://mlsanity.com/paper/2507.11473/) (2025)
- [Chain-of-Thought Reasoning In The Wild Is Not Always Faithful](https://mlsanity.com/paper/2503.08679/) (2025)
- [Thought Anchors: Which LLM Reasoning Steps Matter?](https://mlsanity.com/paper/2506.19143/) (2025)
- [The Earth is Flat because...: Investigating LLMs' Belief towards Misinformation via Persuasive Conversation](https://mlsanity.com/paper/2312.09085/) (2023)
- [When Chain of Thought is Necessary, Language Models Struggle to Evade Monitors](https://mlsanity.com/paper/2507.05246/) (2025)
- [MEDEC: A Benchmark for Medical Error Detection and Correction in Clinical Notes](https://mlsanity.com/paper/2412.19260/) (2024)
- [Are DeepSeek R1 And Other Reasoning Models More Faithful?](https://mlsanity.com/paper/2501.08156/) (2025)
- [CoT Red-Handed: Stress Testing Chain-of-Thought Monitoring](https://mlsanity.com/paper/2505.23575/) (2025)
- [MedFuzz: Exploring the Robustness of Large Language Models in Medical Question Answering](https://mlsanity.com/paper/2406.06573/) (2024)
- [PhysicianBench: Evaluating LLM Agents in Real-World EHR Environments](https://mlsanity.com/paper/2605.02240/) (2026)
- [Measuring Chain-of-Thought Monitorability Through Faithfulness and Verbosity](https://mlsanity.com/paper/2510.27378/) (2025)
- [Thought Branches: Interpreting LLM Reasoning Requires Resampling](https://mlsanity.com/paper/2510.27484/) (2025)
- [Is Chain-of-Thought Really Not Explainability? Chain-of-Thought Can Be Faithful without Hint Verbalization](https://mlsanity.com/paper/2512.23032/) (2025)
- [Cancer-Myth: Evaluating Large Language Models on Patient Questions with False Presuppositions](https://mlsanity.com/paper/2504.11373/) (2025)
- [Shallow Robustness, Deep Vulnerabilities: Multi-Turn Evaluation of Medical LLMs](https://mlsanity.com/paper/2510.12255/) (2025)
- [MedOmni-45deg: A Safety-Performance Benchmark for Reasoning-Oriented LLMs in Medicine](https://mlsanity.com/paper/2508.16213/) (2025)
- [Why Models Know But Don't Say: Chain-of-Thought Faithfulness Divergence Between Thinking Tokens and Answers in Open-Weight Reasoning Models](https://mlsanity.com/paper/2603.26410/) (2026)
- [Measuring Epistemic Resilience of LLMs Under Misleading Medical Context](https://mlsanity.com/paper/2606.12291/) (2026)
- [Faithful or Just Plausible? Evaluating the Faithfulness of Closed-Source LLMs in Medical Reasoning](https://mlsanity.com/paper/2603.13988/) (2026)

## Abstract (arXiv)

Large language models now answer medical questions with expert-level performance. However, the context these systems act on can be misleading, and misleading context can corrupt a model's medical judgment. To understand how misleading context corrupts this judgment, we examine the model's susceptibility to the context, disclosure of it, mechanism of corrupted reasoning, and monitorability of the decision. On the medical reasoning subset of MedMisBench, a clinician-reviewed question-answering benchmark of 8,627 questions, we inject two types of misleading context cues, fabricated evidence and a bare assertion. We test three reasoning models, two that expose their full reasoning trace and one frontier model that exposes only its response. All three are more susceptible to the assertion than to the fabricated evidence, adopting the asserted answer 10 to 27 points more often. The misleading cues are disclosed in 81 to 98% of traces but only 7 to 90% of responses, and the assertion is disclosed less often than evidence based cues. Resampling from reasoning traces without disclosure shows the two cues corrupt reasoning differently, evidence entering early and accumulating while the assertion redirects the conclusion near its end. An LLM monitor catches 78% of corrupted decisions at 5% false positives when reading an open model's trace with guidance, against at most 32% from any response. The misleading context that models are most susceptible to is disclosed least, and was caught reliably only from an open reasoning trace, which frontier providers withhold.