From Hindsight to Foresight: Dissecting Clinical Evidence Acquisition in Large Language Models

Abstract

Large language models (LLMs) often diagnose full sight, static clinical cases well yet struggle in foresight, dynamic diagnosis. Prior work has improved this limitation by quantifying the information models acquire and by developing stronger follow-up strategies to improve diagnostic accuracy. In contrast, we introduce a distinctive hindsight to systematically dissect why LLMs fail to acquire diagnostically critical evidence, tracing the failure from evidence identification, utilization and downstream diagnostic updating through not only diagnostic accuracy, but also evidence coverage, trajectory dynamics, and elicited probability and information entropy. Starting experiments from the breakdown at the level of capabilities, to the diagnosis of the pre-event state before the evidence arrives, and to the post-event state transition after the evidence arrives, our research has revealed the profound limitations and internal causes existing in the dynamic diagnostic process. At the same time, we have also conducted sufficient verification and generalization experiments to prove that these limitations are widespread. Together, these findings shift the central challenge from whether LLMs possess relevant clinical knowledge to whether they can identify, acquire, and effectively use the right evidence under clinical diagnosis and conduct a more detailed mechanism analysis to identify the exact location of the capability gap.