Farrukh Zaidi

Danish Ali, Li Xiaojian, Sundas Iqbal et al.

Multilingual orthopedic decision support remains challenging in low-resource healthcare settings, where clinical narratives contain specialized terminology, mixed scripts, incomplete evidence, label imbalance and language-dependent documentation patterns. This article presents a reliability-oriented framework for classifying free-text orthopedic notes in English, Hindi and Punjabi. We compare task-aligned multilingual transformer encoders, a task-fine-tuned DistilBERT baseline, zero-shot instruction-tuned large language models (LLMs) and a domain-adaptive encoder, IndicBERT-HPA. IndicBERT-HPA augments IndicBERT with language-aware orthopedic adapter heads to support clinically relevant multilingual representation learning. Evaluation extends beyond aggregate accuracy to per-class performance, ROC-AUC, AUPRC, expected calibration error, cross-language stability and robustness under controlled balanced and natural-prevalence distributions. The evaluated zero-shot LLMs remain substantially less effective than task-adapted encoders for closed-set classification, with language-dependent instability. Under natural clinical prevalence, IndicBERT-HPA achieves the strongest overall performance, reaching an averaged Macro-F1 of 0.8792, Macro-AUROC of 0.894 and AUPRC of 0.902. We further implement a deterministic selective-verification layer combining confidence gating, evidence-consistency checking and language-risk screening. On a randomly selected held-out 5,000-record subset, it achieves 84.4% selective accuracy and 0.76 selective Macro-F1 at 72.3% coverage, compared with 71.5% accuracy and 0.65 Macro-F1 for accept-all prediction. These results support reliability-oriented multilingual clinical decision support with explicit deferral.

Danish Ali, Li Xiaojian, Sundas Iqbal et al.

Large Language Models (LLMs) are increasingly proposed for clinical decision support including multilingual diagnosis in low-resource settings. However, their reliability, calibration and safety characteristics remain insufficiently understood for structured, high-risk tasks. We present a system-level analysis of multilingual orthopedic diagnosis from free-text clinical notes in English, Hindi and Punjabi. We evaluate three modeling regimes: (i) task-aligned multilingual transformer encoders, (ii) a task-fine-tuned baseline (DistilBERT), and (iii) a domain-adaptive architecture tailored to orthopedic text (IndicBERT-HPA). These models are compared with zero-shot, instruction-tuned LLMs to assess suitability for structured diagnostic classification. Results indicate that while LLMs exhibit strong linguistic fluency, they show unstable calibration and reduced reliability under structured multilingual conditions, particularly in low-resource languages. These findings are specific to zero-shot evaluation and do not imply limitations of fine-tuned models. Domain-adaptive specialization substantially improves cross-lingual discrimination and confidence behavior. IndicBERT-HPA, with language-specific orthopedic adapter heads achieves consistently strong performance across six diagnostic categories and more predictable deployment characteristics than task-only adaptation. Building on these observations, we outline a conceptual deterministic agent-based validation framework for future implementation, formalizing evidence checks, language-sensitive validation and conservative human-in-the-loop gating. Reliable multilingual clinical decision support requires specialized architecture, explicit reliability analysis, and structured validation for safety-critical systems.