Significant effort has been placed on developing decision support tools to improve patient care. However, drivers of real-world clinical decisions in complex medical scenarios are not yet well-understood, resulting in substantial gaps between these tools and practical applications. In light of this, we highlight that more attention on understanding clinical decision-making is required both to elucidate current clinical practices and to enable effective human-machine interactions. This is imperative in high-stakes scenarios with scarce available resources.

Urinary tract infection (UTI) flare-ups pose a significant health risk for older adults with chronic conditions. These infections often go unnoticed until they become severe, making early detection through innovative smart home technologies crucial. Traditional machine learning (ML) approaches relying on simple binary classification for UTI detection offer limited utility to nurses and practitioners as they lack insight into prediction uncertainty, hindering informed clinical decision-making. This paper presents a clinician-in-the-loop (CIL) smart home system that leverages ambient sensor data to extract meaningful behavioral markers, train robust predictive ML models, and calibrate them to enable uncertainty-aware decision support. The system incorporates a statistically valid uncertainty quantification method called Conformal-Calibrated Interval (CCI), which quantifies uncertainty and abstains from making predictions ("I don't know") when the ML model's confidence is low. Evaluated on real-world data from eight smart homes, our method outperforms baseline methods in recall and other classification metrics while maintaining the lowest abstention proportion and interval width. A survey of 42 nurses confirms that our system's outputs are valuable for guiding clinical decision-making, underscoring their practical utility in improving informed decisions and effectively managing UTIs and other condition flare-ups in older adults.

Large language models (LLMs) show promise for clinical use. They are often evaluated using datasets such as MedQA. However, Many medical datasets, such as MedQA, rely on simplified Question-Answering (Q\A) that underrepresents real-world clinical decision-making. Based on this, we propose a unifying paradigm that characterizes clinical decision-making tasks along two dimensions: Clinical Backgrounds and Clinical Questions. As the background and questions approach the real clinical environment, the difficulty increases. We summarize the settings of existing datasets and benchmarks along two dimensions. Then we review methods to address clinical decision-making, including training-time and test-time techniques, and summarize when they help. Next, we extend evaluation beyond accuracy to include efficiency, explainability. Finally, we highlight open challenges. Our paradigm clarifies assumptions, standardizes comparisons, and guides the development of clinically meaningful LLMs.

The decision that a patient and a clinician jointly make when a donor organ is offered for transplantation is critical and carries serious consequences.

Hallucinations in large language models (LLMs) during summarization of patient-clinician dialogues pose significant risks to patient care and clinical decision-making. However, the phenomenon remains understudied in the clinical domain, with uncertainty surrounding the applicability of general-domain hallucination detectors. The rarity and randomness of hallucinations further complicate their investigation. In this paper, we conduct an evaluation of hallucination detection methods in the medical domain, and construct two datasets for the purpose: A fact-controlled Leave-N-out dataset -- generated by systematically removing facts from source dialogues to induce hallucinated content in summaries; and a natural hallucination dataset -- arising organically during LLM-based medical summarization. We show that general-domain detectors struggle to detect clinical hallucinations, and that performance on fact-controlled hallucinations does not reliably predict effectiveness on natural hallucinations. We then develop fact-based approaches that count hallucinations, offering explainability not available with existing methods. Notably, our LLM-based detectors, which we developed using fact-controlled hallucinations, generalize well to detecting real-world clinical hallucinations. This research contributes a suite of specialized metrics supported by expert-annotated datasets to advance faithful clinical summarization systems.

Significant effort has been placed on developing decision support tools to improve patient care. However, drivers of real-world clinical decisions in complex medical scenarios are not yet well-understood, resulting in substantial gaps between these tools and practical applications. In light of this, we highlight that more attention on understanding clinical decision-making is required both to elucidate current clinical practices and to enable effective human-machine interactions. This is imperative in high-stakes scenarios with scarce available resources. We show that most existing machine learning methods are insufficient to meet these requirements and propose iTransplant, a novel data-driven framework to learn the factors affecting decisions on organ offers in an instance-wise fashion directly from clinical data, as a possible solution.

Although Large Language Models (LLMs) have shown promising performance in healthcare-related applications, their deployment in the medical domain poses unique challenges of ethical, regulatory, and technical nature. In this study, we employ a systematic participatory approach to investigate the needs and expectations regarding clinical applications of LLMs at Lausanne University Hospital, an academic medical center in Switzerland. Having identified potential LLM use-cases in collaboration with thirty stakeholders, including clinical staff across 11 departments as well nursing and patient representatives, we assess the current feasibility of these use-cases taking into account the regulatory frameworks, data protection regulation, bias, hallucinations, and deployment constraints. This study provides a framework for a participatory approach to identifying institutional needs with respect to introducing advanced technologies into healthcare practice, and a realistic analysis of the technology readiness level of LLMs for medical applications, highlighting the issues that would need to be overcome LLMs in healthcare to be ethical, and regulatory compliant.

Objectives: To investigate clinicians' attitudes towards current automated interpretation of ECG and novel AI technologies and their perception of computer-assisted interpretation. Materials and Methods: We conducted a series of interviews with clinicians in the UK. Our study: (i) explores the potential for AI, specifically future 'human-like' computing approaches, to facilitate ECG interpretation and support clinical decision making, and (ii) elicits their opinions about the importance of explainability and trustworthiness of AI algorithms. Results: We performed inductive thematic analysis on interview transcriptions from 23 clinicians and identified the following themes: (i) a lack of trust in current systems, (ii) positive attitudes towards future AI applications and requirements for these, (iii) the relationship between the accuracy and explainability of algorithms, and (iv) opinions on education, possible deskilling, and the impact of AI on clinical competencies. Discussion: Clinicians do not trust current computerised methods, but welcome future 'AI' technologies. Where clinicians trust future AI interpretation to be accurate, they are less concerned that it is explainable. They also preferred ECG interpretation that demonstrated the results of the algorithm visually. Whilst clinicians do not fear job losses, they are concerned about deskilling and the need to educate the workforce to use AI responsibly. Conclusion: Clinicians are positive about the future application of AI in clinical decision-making. Accuracy is a key factor of uptake and visualisations are preferred over current computerised methods. This is viewed as a potential means of training and upskilling, in contrast to the deskilling that automation might be perceived to bring.

It is becoming increasingly emphasis on the importance of LLM participating in clinical diagnosis decision-making. However, the low specialization refers to that current medical LLMs can not provide specific medical advice, which are more like a medical Q\&A. And there is no suitable clinical guidance tree data set that can be used directly with LLM. To address this issue, we first propose LLM-executavle clinical guidance tree(CGT), which can be directly used by large language models, and construct medical diagnostic decision-making dataset (MedDM), from flowcharts in clinical practice guidelines. We propose an approach to screen flowcharts from medical literature, followed by their identification and conversion into standardized diagnostic decision trees. Constructed a knowledge base with 1202 decision trees, which came from 5000 medical literature and covered 12 hospital departments, including internal medicine, surgery, psychiatry, and over 500 diseases.Moreover, we propose a method for reasoning on LLM-executable CGT and a Patient-LLM multi-turn dialogue framework.