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Paper · arXiv

Clinical Reasoning Graphs: Structured Evaluation of LLM Diagnostic Reasoning Reveals Competence Without Consistency

Modern large language models (LLMs) reach 60-70% diagnostic accuracy on complex clinical case benchmarks, but accuracy alone cannot distinguish stable clinically-grounded reasoning from pattern matching. We introduce clinical reasoning graphs, structured graph representations extracted from free-text LLM diagnostic traces using a domain-grounded ontology with 5 node types and 7 edge types. We apply this pipeline to 750 traces from five LLMs across 50 New England Journal of Medicine Clinicopathological Conference cases and three prompt conditions, and test whether diagnostic traces show stable structured reasoning patterns, or diagnostic schemas, for clinically similar cases. We operationa...

AuthorsNisarg A. Patel
Primary categorycs.CL
Published29 June 2026
Last updated at source29 June 2026
cs.CLcs.AIq-bio.QM
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