When Metrics Disagree: Automatic Similarity vs. LLM-as-a-Judge for Clinical Dialogue Evaluation

• URL: http://arxiv.org/abs/2603.00314v1
• Date: Fri, 27 Feb 2026 21:09:43 GMT
• Title: When Metrics Disagree: Automatic Similarity vs. LLM-as-a-Judge for Clinical Dialogue Evaluation
• Authors: Bian Sun, Zhenjian Wang, Orvill de la Torre, Zirui Wang,
• Abstract summary: Large language models (LLMs) are increasingly employed to address diverse problems, including medical queries.<n>LLMs often perform poorly in medical contexts, potentially leading to harmful misguidance for users.<n>This paper focuses on fine-tuning the Llama 2 7B, a transformer-based, decoder-only model, using transcripts from real patient-doctor interactions.
• Score: 18.338933046286257
• License: http://arxiv.org/licenses/nonexclusive-distrib/1.0/
• Abstract: This paper details the baseline model selection, fine-tuning process, evaluation methods, and the implications of deploying more accurate LLMs in healthcare settings. As large language models (LLMs) are increasingly employed to address diverse problems, including medical queries, concerns about their reliability have surfaced. A recent study by Long Island University highlighted that LLMs often perform poorly in medical contexts, potentially leading to harmful misguidance for users. To address this, our research focuses on fine-tuning the Llama 2 7B, a transformer-based, decoder-only model, using transcripts from real patient-doctor interactions. Our objective was to enhance the model's accuracy and precision in responding to medical queries. We fine-tuned the model using a supervised approach, emphasizing domain-specific nuances captured in the training data. In the best scenario, the model results should be reviewed and evaluated by real medical experts. Due to resource constraints, the performance of the fine-tuned model was evaluated using text similarity metrics. The fine-tuned model demonstrated significant improvements across all key dimensions except GPT-4's evaluation. The evaluations of ChatGPT4 are quite different from the quantitative results; here, we not only suggest, but also propose that the result should be evaluated by human medical experts.

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