Stop Listening to Me! How Multi-turn Conversations Can Degrade Diagnostic Reasoning

Abstract

Patients and clinicians are increasingly using chatbots powered by large language models (LLMs) for healthcare inquiries. While state-of-the-art LLMs exhibit high performance on static diagnostic reasoning benchmarks, their efficacy across multi-turn conversations, which better reflect real-world usage, has been understudied. In this paper, we evaluate 17 LLMs across three clinical datasets to investigate how partitioning the decision-space into multiple simpler turns of conversation influences their diagnostic reasoning. Specifically, we develop a "stick-or-switch" evaluation framework to measure model conviction (i.e., defending a correct diagnosis or safe abstention against incorrect suggestions) and flexibility (i.e., recognizing a correct suggestion when it is introduced) across conversations. Our experiments reveal the conversation tax, where multi-turn interactions consistently degrade performance when compared to single-shot baselines. Notably, models frequently abandon initial correct diagnoses and safe abstentions to align with incorrect user suggestions. Additionally, several models exhibit blind switching, failing to distinguish between signal and incorrect suggestions.