MedDialBench: Benchmarking LLM Diagnostic Robustness under Parametric Adversarial Patient Behaviors
This addresses the need for robust medical dialogue systems by providing a controlled benchmark to analyze LLM vulnerabilities to adversarial patient behaviors, though it is incremental as it builds on existing interactive medical dialogue benchmarks.
The paper tackles the problem of LLM diagnostic accuracy degrading with non-cooperative patients by introducing MedDialBench, a benchmark that decomposes patient behavior into five dimensions with graded severity, and finds that information pollution (fabricating symptoms) causes 1.7-3.4x larger accuracy drops than information deficit, with worst-case drops up to 54.1 percentage points.
Interactive medical dialogue benchmarks have shown that LLM diagnostic accuracy degrades significantly when interacting with non-cooperative patients, yet existing approaches either apply adversarial behaviors without graded severity or case-specific grounding, or reduce patient non-cooperation to a single ungraded axis, and none analyze cross-dimension interactions. We introduce MedDialBench, a benchmark enabling controlled, dose-response characterization of how individual patient behavior dimensions affect LLM diagnostic robustness. It decomposes patient behavior into five dimensions -- Logic Consistency, Health Cognition, Expression Style, Disclosure, and Attitude -- each with graded severity levels and case-specific behavioral scripts. This controlled factorial design enables graded sensitivity analysis, dose-response profiling, and cross-dimension interaction detection. Evaluating five frontier LLMs across 7,225 dialogues (85 cases x 17 configurations x 5 models), we find a fundamental asymmetry: information pollution (fabricating symptoms) produces 1.7-3.4x larger accuracy drops than information deficit (withholding information), and fabricating is the only configuration achieving statistical significance across all five models (McNemar p < 0.05). Among six dimension combinations, fabricating is the sole driver of super-additive interaction: all three fabricating-involving pairs produce O/E ratios of 0.70-0.81 (35-44% of eligible cases fail under the combination despite succeeding under each dimension alone), while all non-fabricating pairs show purely additive effects (O/E ~ 1.0). Inquiry strategy moderates deficit but not pollution: exhaustive questioning recovers withheld information, but cannot compensate for fabricated inputs. Models exhibit distinct vulnerability profiles, with worst-case drops ranging from 38.8 to 54.1 percentage points.