NSIDDx: A Design Framework for Neuro-Symbolic, Practitioner-First Differential Diagnosis in Low-Resource Settings

• URL: http://arxiv.org/abs/2609.00256v1
• Date: Mon, 31 Aug 2026 18:58:59 GMT
• Title: NSIDDx: A Design Framework for Neuro-Symbolic, Practitioner-First Differential Diagnosis in Low-Resource Settings
• Abstract summary: We present NSIDDx (Neuro-Symbolic Integrated Differential Diagnosis System), a design framework arguing that DDx systems in low-resource settings must treat the clinician as an active reasoning agent.<n>We distill five design principles for clinician-in-the-loop clinical NLP and invite the prospective studies needed to validate the claim at scale.
• Score: 0.0
• License: http://creativecommons.org/licenses/by/4.0/
• Abstract: LLM-based diagnostic systems achieve high semantic accuracy on benchmarks, but open-ended evaluation on clinically uncommon presentations reveals a systematic gap between headline accuracy and verifiable clinical reliability. We evaluate an LLM+rare-disease-RAG pipeline across two cohorts and show that the paradigm produces confident outputs that are frequently unverifiable and systematically resistant to clinician interrogation. We present NSIDDx (Neuro-Symbolic Integrated Differential Diagnosis System), a design framework arguing that DDx systems in low-resource settings must treat the clinician as an active reasoning agent. We instantiate this through a neuro-symbolic pipeline with ternary symptom encoding, contradiction detection, audit strings, and practitioner override - running offline on consumer hardware. We distill five design principles for clinician-in-the-loop clinical NLP and invite the prospective studies needed to validate the claim at scale.

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