# Clinical Concept Centers in LLMs

arXiv: https://arxiv.org/abs/2610.02829 · HTML: https://mlsanity.com/paper/2610.02829/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Knowledge and representations inside LLMs, one of 13 directions in Mechanistic interpretability.
- Builds on 52 of its 64 references that are in the map.
- First posted on arXiv 2 Oct 2026.

## Placed in

- Mechanistic interpretability / [Knowledge and representations inside LLMs](https://mlsanity.com/mechinterp/knowledge-and-representations-inside-llms/)

## Builds on (most cited first, 30 of 52)

- [PyTorch: An Imperative Style, High-Performance Deep Learning Library](https://mlsanity.com/paper/1912.01703/) (2019)
- [Locating and Editing Factual Associations in GPT](https://mlsanity.com/paper/2202.05262/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Sparse Autoencoders Find Highly Interpretable Features in Language Models](https://mlsanity.com/paper/2309.08600/) (2023)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [Understanding intermediate layers using linear classifier probes](https://mlsanity.com/paper/1610.01644/) (2016)
- [Language Models Don't Always Say What They Think: Unfaithful Explanations in Chain-of-Thought Prompting](https://mlsanity.com/paper/2305.04388/) (2023)
- [Steering Llama 2 via Contrastive Activation Addition](https://mlsanity.com/paper/2312.06681/) (2023)
- [Does Reinforcement Learning Really Incentivize Reasoning Capacity in LLMs Beyond the Base Model?](https://mlsanity.com/paper/2504.13837/) (2025)
- [Steering Language Models With Activation Engineering](https://mlsanity.com/paper/2308.10248/) (2023)
- [Probing Classifiers: Promises, Shortcomings, and Advances](https://mlsanity.com/paper/2102.12452/) (2021)
- [The Linear Representation Hypothesis and the Geometry of Large Language Models](https://mlsanity.com/paper/2311.03658/) (2023)
- [The Geometry of Truth: Emergent Linear Structure in Large Language Model Representations of True/False Datasets](https://mlsanity.com/paper/2310.06824/) (2023)
- [Measuring Faithfulness in Chain-of-Thought Reasoning](https://mlsanity.com/paper/2307.13702/) (2023)
- [Designing and Interpreting Probes with Control Tasks](https://mlsanity.com/paper/1909.03368/) (2019)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [Sparse Feature Circuits: Discovering and Editing Interpretable Causal Graphs in Language Models](https://mlsanity.com/paper/2403.19647/) (2024)
- [HealthBench: Evaluating Large Language Models Towards Improved Human Health](https://mlsanity.com/paper/2505.08775/) (2025)
- [Layer by Layer: Uncovering Hidden Representations in Language Models](https://mlsanity.com/paper/2502.02013/) (2025)
- [Jumping Ahead: Improving Reconstruction Fidelity with JumpReLU Sparse Autoencoders](https://mlsanity.com/paper/2407.14435/) (2024)
- [LEACE: Perfect linear concept erasure in closed form](https://mlsanity.com/paper/2306.03819/) (2023)
- [LLMs Know More Than They Show: On the Intrinsic Representation of LLM Hallucinations](https://mlsanity.com/paper/2410.02707/) (2024)
- [Does Localization Inform Editing? Surprising Differences in Causality-Based Localization vs. Knowledge Editing in Language Models](https://mlsanity.com/paper/2301.04213/) (2023)
- [Explainable Prediction of Medical Codes from Clinical Text](https://mlsanity.com/paper/1802.05695/) (2018)
- [AxBench: Steering LLMs? Even Simple Baselines Outperform Sparse Autoencoders](https://mlsanity.com/paper/2501.17148/) (2025)
- [Scaling Monosemanticity: Extracting Interpretable Features from Claude 3 Sonnet](https://mlsanity.com/paper/2605.29358/) (2026)
- [A is for Absorption: Studying Feature Splitting and Absorption in Sparse Autoencoders](https://mlsanity.com/paper/2409.14507/) (2024)
- [GRAM: Graph-based Attention Model for Healthcare Representation Learning](https://mlsanity.com/paper/1611.07012/) (2016)
- [In-Context Impersonation Reveals Large Language Models' Strengths and Biases](https://mlsanity.com/paper/2305.14930/) (2023)

## Abstract (arXiv)

Large language models are increasingly used in clinical settings. However, research into the reliability and performance of these models has focused almost entirely on the language substrate, scoring what the model says. Mechanistic interpretability has found that the latent space carries a higher fidelity of representation than the text: internal representations not only encode substantially more than the output verbalizes, but the stated reasoning also systematically omits features that causally drive the answer. An evaluation of model behavior in terms of mechanistic interpretability has not been explored in clinical decision support. In this work, we extend behavioral evaluation into the latent space and ask whether clinical concepts exist as locatable, causally used representations inside open-weight LLMs. We find dedicated clinical concept centers in the latent space of all eleven open models we test. These concept centers are interpretable, firing only on their aligned clinical narratives, and meaningfully and causally drive model behavior in both constrained and open-ended settings. They are not just analytical representations, but circuits that can be utilized in clinical practice, and we explore their use from the perspective of both evaluation and performance. From the evaluation standpoint, models stay internally coherent and keep using the relevant concept centers even under adversarial role-based priming, while aligned priming improves downstream clinical performance. From a performance perspective, we simulate realistic deployment settings and find that steering models along these centers leads to meaningful downstream improvements. Finally, we conduct a blinded clinician validation and find the activation and usage of these concept centers predicts clinicians preferences.