Medical Fine-Tuning Reshapes, Not Reduces, Patient-Facing AI Risk: A Rubric-Based, LLM-Judge

First, ensemble risk-bearing language is statistically independent of factual hallucination rate (pooled Spearman $\rho = -0.065$, $n = 300$, 95% CI $[-0.18, +0.05]$; distance correlation $= 0.10$, independence test $p = 0.24$). It comes from a paper posted to arXiv on 20 October 2026. Patient-facing medical question answering with large language models (LLMs) is moving from research demonstrations to production deployments, yet evaluation remains anchored on factual correctness. Factuality is necessary but not sufficient: a response can be factually grounded and still issue a directive that, if acted on, would harm the patient. We introduce a risk-sensitive evaluation framework that scores responses by the presence and severity of six categories of risk-bearing language (treatment directives, contraindications, dosage expressions, urgency-triage cues, high-alert medication mentions, and overconfident assertions), anchored on published clinical harm taxonomies. Severity is classified by a three-judge LLM ensemble. We apply this framework to six 7-9B instruction-tuned models, three general (Mistral-7B, Phi-3.5-mini, Llama-3.1-8B) and three medically adapted (BioMistral-7B, OpenBioLLM-Llama3-8B, Med42-Llama3-8B), on 200 real patient questions from the K-QA benchmark. Two findings emerge. Second, medical fine-tuning does not reduce aggregate risk but reshapes it: continued-pretraining adaptations (BioMistral, OpenBioLLM) consistently suppress high-alert medication mentions while amplifying overconfident assertions, whereas clinical instruction-tuning (Med42) suppresses dosing only, without amplifying overconfidence. Per-category Krippendorff $\alpha$ is fair to good for the four linguistically anchored categories (0.53-0.71) and low for the two clinical-judgment-dependent categories (0.19, 0.31), indicating where automatic safety evaluation is and is not yet reliable. We release the rubric, judge prompts, and evaluation code.

Why it counts

First, ensemble risk-bearing language is statistically independent of factual hallucination rate (pooled Spearman $\rho = -0.065$, $n = 300$, 95% CI $[-0.18, +0.05]$; distance correlation $= 0.10$, independence test $p = 0.24$).

Sources

Primary source: primary source

What is not known

This brief does not claim independent replication. Claims that appear only on X and not in the primary source stay unknown.