Beyond Idealized Patients: Evaluating LLMs under Challenging Patient Behaviors in Medical Consultations

Large language models (LLMs) are increasingly used for medical consultation and health information support. In this high-stakes setting, safety depends not only on medical knowledge, but also on how models respond when patient inputs are unclear, inconsistent, or misleading. However, most existing medical LLM evaluations assume idealized and well-posed patient questions, which limits their realism. In this paper, we study challenging patient behaviors that commonly arise in real medical consultations and complicate safe clinical reasoning. We define four clinically grounded categories of such behaviors: information contradiction, factual inaccuracy, self-diagnosis, and care resistance. For each behavior, we specify concrete failure criteria that capture unsafe responses. Building on four existing medical dialogue datasets, we introduce CPB-Bench (Challenging Patient Behaviors Benchmark), a bilingual (English and Chinese) benchmark of 692 multi-turn dialogues annotated with these behaviors. We evaluate a range of open- and closed-source LLMs on their responses to challenging patient utterances. While models perform well overall, we identify consistent, behavior-specific failure patterns, with particular difficulty in handling contradictory or medically implausible patient information. We also study four intervention strategies and find that they yield inconsistent improvements and can introduce unnecessary corrections. We release the dataset and code.

CounselReflect: A Toolkit for Auditing Mental-Health Dialogues

Mental-health support is increasingly mediated by conversational systems (e.g., LLM-based tools), but users often lack structured ways to audit the quality and potential risks of the support they receive. We introduce CounselReflect, an end-to-end toolkit for auditing mental-health support dialogues. Rather than producing a single opaque quality score, CounselReflect provides structured, multi-dimensional reports with session-level summaries, turn-level scores, and evidence-linked excerpts to support transparent inspection. The system integrates two families of evaluation signals: (i) 12 model-based metrics produced by task-specific predictors, and (ii) rubric-based metrics that extend coverage via a literature-derived library (69 metrics) and user-defined custom metrics, operationalized with configurable LLM judges. CounselReflect is available as a web application, browser extension, and command-line interface (CLI), enabling use in real-time settings as well as at scale. Human evaluation includes a user study with 20 participants and an expert review with 6 mental-health professionals, suggesting that CounselReflect supports understandable, usable, and trustworthy auditing. A demo video and full source code are also provided.