Evaluating Counterfactual Sensitivity to Patient Information in Medication-Safety Reasoning

• URL: http://arxiv.org/abs/2608.03028v1
• Date: Tue, 04 Aug 2026 02:17:16 GMT
• Title: Evaluating Counterfactual Sensitivity to Patient Information in Medication-Safety Reasoning
• Abstract summary: MedPIC-Bench is a benchmark of source-verifiable recommendations and expert-validated questions for patient-specific medication-safety reasoning.<n>It combines guideline-following questions with paired counterfactual questions in which a controlled change in patient information changes whether a rule applies.<n>Every model performs worse on counterfactual questions, with mean accuracy falling from 63.6% to 45.1%.
• Score: 26.32591007513051
• License: http://arxiv.org/licenses/nonexclusive-distrib/1.0/
• Abstract: Applying a valid medication-safety rule when its patient-specific conditions are not met can produce an incorrect decision. Existing medical evaluations largely use isolated and fixed scenarios. A model may therefore answer correctly by recalling a drug-risk association without showing that it used patient information to decide whether the rule applies. To address this gap, we introduce MedPIC-Bench, a benchmark of source-verifiable recommendations and expert-validated questions for patient-specific medication-safety reasoning. It combines guideline-following questions with paired counterfactual questions in which a controlled change in patient information changes whether a rule applies. The benchmark contains 467 questions annotated along six clinical and reasoning dimensions. Across 28 medical-specific, general, and proprietary LLMs, every model performs worse on counterfactual questions, with mean accuracy falling from 63.6\% to 45.1\%. Models perform well when an explicit patient attribute directly signals a familiar contraindication, but struggle when patient information must narrow or withdraw a safety warning. Model rationales often acknowledge the changed patient information, yet the final answers retain the previous safety judgment. This vulnerability persists among medical-specific LLMs, whose average CF performance trails that of general LLMs. MedPIC-Bench therefore makes conditional rule application measurable and highlights the limitations of static medication-safety accuracy for assessing patient-specific reliability.

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