LLMs for Medical Consultation Are Evaluated Too Late: The Preformulation Gap

Large language models for medical consultation are often evaluated after a clinical problem has already been made clear, although real consultations may begin with a vague, minimized, or misframed concern. We evaluated three API models across four physician-authored, multi-turn vignettes under baseline and entry-to-care instruction conditions, yielding 24 fixed-script transcripts; two cases also used adaptive standardized-patient simulation, yielding 12 transcripts. Self-care or home-management advice before any patient answer appeared in 9 of 12 baseline case-model cells and 0 of 12 instruction cells, while structured handoff summaries appeared in 0 of 12 and 10 of 12 cells, respectively. The instruction changed sequencing and documentation, although it did not reliably ensure elicitation of decisive facts. The preformulation gap should therefore be evaluated directly through observable first-contact behavior rather than inferred from diagnostic accuracy or final-answer quality.

StagedWorkspace: A Versioned Workspace for Knowledge-Work Agents

AI agents increasingly perform knowledge work (i.e., produce and modify persistent digital artifacts such as code repositories, documents, spreadsheets, slides, reports), yet the parsed views they search, the native files they edit, the changes they review, and the artifacts they submit can refer to different versions of the same work product. We formulate this as a workspace-state contract: every view should be explicitly tied to a version of the evolving workspace state. Coding agents partly address this need through repository contracts for search, diffs, and tests, whereas an analogous contract is less explicit for PDFs, spreadsheets, slides, notebooks, and mixed-format project folders. We propose StagedWorkspace, a versioned workspace for knowledge-work agents. The workspace binds parsed records and review diffs to content hashes of the native files as they change. In fixed-harness ablations on OfficeQA Pro and APEX-Agents, dual parsed/native access has the highest point estimate for every tested model; relative to the more limiting single view, it improves OfficeQA Pass@1 by 8.3-12.1 points and APEX mean rubric score by 4.7-9.2 points. SW-AGENT scores 63.9% with Gemini 3.1 Pro on OfficeQA and 42.1 with GPT-5.4 Nano on APEX, compared with published same-model scores of 29.3% and 25.5, respectively. A paired review-axis ablation on 57 file-editing tasks further finds higher observed scores when diffs are visible. These results identify workspace state as an experimental variable in knowledge-work agents and motivate benchmarks that score evidence, staged edits, and submitted artifacts as explicit state transitions.

CARE-Bench: Benchmarking Patient-Facing LLM Triage

Patient-facing medical LLMs and agents increasingly answer symptom questions before clinician contact, where the key safety question is what action the user should take next. We introduce CARE-Bench, a source-grounded benchmark that evaluates sequential patient-facing triage as a four-label per-turn current-action task. CARE-Bench contains 500 cases and 1,059 evaluated patient-disclosure prefixes reconstructed from medical dialogue, consultation, and follow-up-question sources. We evaluate 11 models on 269 held-out rounds under unprompted and minimally prompted open-ended protocols, using a fixed GPT-5.5 mapper to code each response into the four-label action space. Unprompted macro-F1 remains low, ranging from 31.2 to 50.4. Prompting improves 10 of 11 models, with prompted macro-F1 ranging from 46.9 to 63.4, but substantial threshold errors remain. Prompted models often recommend care before needed clarification is obtained; when the correct action was to ask for more information, only 33.5% of prompted outputs preserved the step. The persistence of these errors after prompting suggests that patient-facing triage is not a simple prompting problem and supports explicit evaluation of action timing before deployment.

Design and Report Benchmarks for Knowledge Work

The development of LLM agents has led to a growing body of work on knowledge-work AI, including coding, research, and healthcare. However, current knowledge-work evaluation and benchmark design still largely follow the logic of traditional NLP tasks. As a result, higher benchmark performance does not reliably show that a system can carry out knowledge work in real-world deployment settings. This paper contributes a three-step approach for making explicit how benchmarked tasks represent the work claims attached to their scores: defining the work activity under evaluation, specifying the tested setting, and scoring the appropriate work product. We review work studies showing that knowledge work is organized through roles and responsibilities, local materials and tools, and artifacts that must remain usable in downstream workflows. We then translate these concerns into benchmark design and reporting guidance, covering how tasks should be mapped to work activities, how tested settings should specify materials, tools, roles, and constraints, and how scoring should focus on the work product left by the system. To name the work activity being evaluated and distinguish it from common benchmark tasks, we derive an inventory of 18 work activities from the O{*}NET occupational task database. We demonstrate the approach through three benchmark case analyses: GDPval, a non-code occupational deliverable benchmark; OfficeQA Pro, a grounded document-analysis benchmark scored by final answers; and APEX-SWE, a software-engineering benchmark with executable scored products. These cases show how benchmark design choices shape the strongest work claim a score can support, and where gaps arise between the benchmarked task, tested setting, scored product, and broader work claim.