Prompting language influences diagnostic reasoning and accuracy of large language models

[2605.19173] Prompting language influences diagnostic reasoning and accuracy of large language models

[Submitted on 18 May 2026]

Title:Prompting language influences diagnostic reasoning and accuracy of large language models

View a PDF of the paper titled Prompting language influences diagnostic reasoning and accuracy of large language models, by Adrien Bazoge and 3 other authors

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Abstract:Large language models (LLMs) are increasingly explored for clinical decision support, yet most evaluations are conducted in English, leaving their reliability in other languages uncertain. Here we evaluate the impact of prompting language on diagnostic reasoning and final diagnosis accuracy by comparing English and French performance across five LLMs (o3, DeepSeek-R1, GPT-4-Turbo, Llama-3.1-405B-Instruct, and BioMistral-7B). A total of 180 clinical vignettes covering 16 medical specialties were assessed by two physicians using an 18-point scale evaluating both diagnosis accuracy and reasoning quality. Four of the five models performed better in English (mean difference 0.37-0.91, adjusted p

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