Selin S. Everett

Ruican Zhong, Jiachen Li, Gary Hsieh et al. · uw

Electronic health records (EHRs) have improved data accessibility but have also introduced cognitive burden for physicians, given the sheer volume and complexity of the data involved. Advances in large language models (LLMs) create new opportunities to rethink how clinicians interact with medical data through dynamic, adaptive interfaces. In this position paper, we explore how generative AI can support physicians' information needs by enabling more dynamic interactions with patient data. Through semi-structured interviews with internal physicians at Microsoft, we identify key challenges in data navigation and synthesis, and characterize clinicians' information needs during diagnostic workflows. We further examine how physicians conceptualize AI can help their work process and how these mental models shape expectations for interaction and trust. Based on these insights, we discuss design considerations for generative user interfaces that support clinician-centered workflows.

Ivan Lopez, Selin S. Everett, Bryan J. Bunning et al.

Large language models (LLMs) are entering clinician workflows, yet evaluations rarely measure how clinician reasoning shapes model behavior during clinical interactions. We combined 61 New England Journal of Medicine Case Records with 92 real-world clinician-AI interactions to evaluate 21 reasoning LLM variants across 8 frontier models on differential diagnosis generation and next step recommendations under three conditions: reasoning alone, after expert clinician context, and after adversarial clinician context. LLM-clinician concordance increased substantially after clinician exposure, with simulations sharing >=3 differential diagnosis items rising from 65.8% to 93.5% and >=3 next step recommendations from 20.3% to 53.8%. Expert context significantly improved correct final diagnosis inclusion across all 21 models (mean +20.4 percentage points), reflecting both reasoning improvement and passive content echoing, while adversarial context caused significant diagnostic degradation in 14 models (mean -5.4 percentage points). Multi-turn disagreement probes revealed distinct model phenotypes ranging from highly conformist to dogmatic, with adversarial arguments remaining a persistent vulnerability even for otherwise resilient models. Inference-time scaling reduced harmful echoing of clinician-introduced recommendations across WHO-defined harm severity tiers (relative reductions: 62.7% mild, 57.9% moderate, 76.3% severe, 83.5% death-tier). In GPT-4o experiments, explicit clinician uncertainty signals improved diagnostic performance after adversarial context (final diagnosis inclusion 27% to 42%) and reduced alignment with incorrect arguments by 21%. These findings establish a foundation for evaluating clinician-AI collaboration, introducing interactive metrics and mitigation strategies essential for safety and robustness.