When Health Assistants Agree Too Readily: A Benchmark of Time-Critical Self-Diagnosis

Marilyn Zhang, Tianfeng Chen, Patricia M Pechter, Mark E. Whiting

Every day, more than 40 million people ask ChatGPT a health question, such as whether laptop posture explains a stiff neck and days of pounding headache. Posture is plausible, but meningitis is a time-critical possibility. We introduce SelfDx, a paired benchmark for whether models have the appropriate response behavior, a form of epistemic independence, in health questions where misplaced agreement with the user's self-diagnosis could delay urgent or emergency care. Each of 100 pairs contrasts a caution case, where a serious alternative remains possible, with an agreement case, where the user supplies evidence that rules out the alternative and it is safe for the model to agree. We find across 27 frontier models that they tend to inappropriately agree with the user's self-diagnosis in cases that require caution. Even the best current-generation model reaches only a 77.0% appropriate caution rate on time-critical condition cases. To address this gap, we experiment with three prompt variants that increase appropriate caution but reduce appropriate agreement by 9-35%, indicating excessive caution. In contrast, supervised fine-tuning on 128 balanced examples improves both rates…