Why LLMs Give In: Conversational Factors and Reasoning Behind Medical Sycophancy

Abstract

Large language models can answer a medical question correctly and still abandon that answer when a user pushes back. We study this failure as medical sycophancy and ask when models are most likely to give in. Across five open-weight models, 500 MedQuAD questions, and 1.2 million trials, we use a fully crossed design over four conversational factors: user role, user evidence, interaction structure, and grounding. Medical sycophancy is nearly three times more common when users challenge an answer the model has already given than when the false claim appears in the initial query. Models are also more susceptible to users presented as physicians or medical students. Most strikingly, fabricated evidence has opposite effects across interaction structures. It increases sycophancy in single-turn interactions but reduces it after the model has already answered. Grounding helps, but does not eliminate the behavior. Sycophancy varies more across medical questions than across models, making question selection an important part of benchmark design. Reasoning traces suggest that multi-turn failures are associated with models turning back toward their own prior answer, while fabricated evidence receives more scrutiny after an initial response. Together, the results show that medical sycophancy depends as much on how a model is challenged and evaluated as on which model is tested.