As large language models (LLMs) are increasingly used in clinical settings, it is critical to evaluate their reliability under realistic variation in clinical text. We study this question in clinical triage, comparing LLMs to practicing physicians under text perturbations that preserve the underlying clinical setting. We introduce a benchmark of over 6,000 clinical scenarios, 7,000 physician annotations, and 225,000 model responses. Using this benchmark, we make two key observations. First, LLMs are more likely than physicians to recommend unnecessary care at baseline, and this tendency increases under perturbed inputs. Further, we find that LLM recommendations are more sensitive to gender and tone perturbations than human recommendations. Together, these results demonstrate that LLMs can vary under clinically irrelevant textual changes, highlighting the need for deployment-oriented evaluations grounded in expert physician behavior.

For Large Language Models (LLMs) to be reliably deployed, models must effectively know when not to answer: abstain. Reasoning models, in particular, have gained attention for impressive performance on complex tasks. However, reasoning models have been shown to have worse abstention abilities. Taking the vulnerabilities of reasoning models into account, we propose our Query Misalignment Framework. Hallucinations resulting in failed abstention can be reinterpreted as LLMs answering the wrong question (rather than answering a question incorrectly). Based on this framework, we develop a new class of state-of-the-art abstention methods called Trace Inversion. First, we generate the reasoning trace of a model. Based on only the trace, we then reconstruct the most likely query that the model responded to. Finally, we compare the initial query with the reconstructed query. Low similarity score between the initial query and reconstructed query suggests that the model likely answered the question incorrectly and is flagged to abstain. Extensive experiments demonstrate that Trace Inversion effectively boosts abstention performance in four frontier LLMs across nine abstention QA datasets, beating competitive baselines in 33 out of 36 settings. The code is available at this https://anonymous.4open.science/r/trace-inversion-08BB/.