The Patient Is Always Right? Evaluating Sycophancy in Medical Diagnosis with Graded Patient Beliefs

Abstract

More people are seeking out general-purpose AI models for medical advice, including diagnosis. Yet, AI models are susceptible to sycophancy, like validating users' beliefs even when they are untrue, which could lead to false positive diagnoses. Here, we evaluate how nine AI models change their diagnostic decision when a patient presents a belief that they have a specific (but incorrect) medical condition. We vary how close the user belief is to the clinical evidence presented. Models sycophantically adopt the patient's belief on average 23.2\% of the time---sometimes even when the patient proposes a fictional, made-up condition. We also varied different personas, including a Rare Disease Claimer that got models to accept their belief 43.0\% of the time. Additional analyses find that medical fine-tuning and model scale makes models less susceptible to changing their diagnoses. Sycophantic bias in medical diagnosis raises implications for safety, especially as more people are using AI for health support.