Safe deployment of clinical vision-language models (VLMs) requires reliable uncertainty estimation (UE): a signal indicating when predictions should be trusted or escalated to a clinician. We test whether current UE methods actually deliver this signal. Benchmarking 8 methods across 12 VLMs on clinical visual question-answering (VQA), we find that UE quality is not an intrinsic property of the UE method: it tracks model accuracy, degrading precisely where the model performance is weakest, and therefore where reliability is most needed. When we stress-test models by hiding the correct option among the multiple-choice answers (NOTA perturbations), accuracy collapses while uncertainty barely changes, leaving models systematically miscalibrated. Yet, we find that uncertainty on the unperturbed input reliably anticipates which predictions will collapse under NOTA, indicating that UE in current VLMs carries diagnostic information about model fragility. Our results position UE as a diagnostic tool for identifying fragile predictions and motivate perturbation-based evaluation as a path toward safe clinical deployment.

Linear classifiers trained on hidden states of a large language model (LLM)—*linear probes*—can flag factual errors from a single forward pass. Geometrically, that implies that true and false statements separate along a stable direction in hidden state space, i.e., the *truth direction*. Prior work disagrees on whether this generalises across input shifts, but the disagreement is hard to interpret because cross-dataset probe transfer experiments confound several kinds of input change at once. We isolate three such variables in medical question-answering (QA): writing style (register), domain (medical specialty), and corpus (dataset). We build a benchmark using 500 MedQA entries, each rewritten into four styles (textbook, patient, clinical note, colloquial), annotated with clinical specialty, and grouped with two other exam corpora, MedMCQA and MMLU-medical, for cross-dataset evaluation. Probing four open-weight LLMs (2–8B), we find that the truth direction is largely robust to writing style (mean 𝛥register ≈ 0.10 AUROC on held-out facts) and to medical specialty (𝛥specialty ≈ 0.03), but degrades unevenly across corpora: by 0.12 AUROC on MMLU-medical and by 0.21 on MedMCQA, roughly twice the register gap. The register result replicates with a second generator and carries over to human-written patient questions. The truth direction is therefore largely stable within the medical domain but breaks under some corpus shifts, and question format does not explain the break, which suggests that the signal a linear probe recovers is partly bound to dataset structure rather than to medical knowledge alone.

Protecting patient privacy in clinical narratives is essential for enabling secondary use of healthcare data under regulations such as GDPR and HIPAA. While manual de-identification remains the gold standard, it is costly and slow, motivating the need for automated methods that combine privacy guarantees with high utility. Historically, most automated text de-identification pipelines employed named entity recognition (NER) to identify protected entities for redaction. Although methods based on differential privacy (DP) provide formal privacy guarantees, more recently also large language models (LLMs) are increasingly used for text de-identification in the clinical domain. In this work, we present the first comparative study of DP, NER, and LLMs for Dutch clinical text de-identification. We investigate these methods separately as well as hybrid strategies that apply NER or LLM preprocessing prior to DP, and assess performance in terms of privacy leakage and extrinsic evaluation (entity and relation classification). We show that DP mechanisms alone degrade utility substantially, but combining them with linguistic preprocessing, especially LLM-based redaction, significantly improves the privacy–utility trade-off.

Generating high-quality summaries for chat dialogs often requires large labeled datasets. We propose a method to efficiently use unlabeled data for extractive summarization of customer-agent dialogs. In our method, we frame summarization as a question-answering problem and use state-of-the-art large language models (LLMs) to generate pseudo-labels for a dialog. We then use these pseudo-labels to fine-tune a chat summarization model, effectively transferring knowledge from the large LLM into a smaller specialized model. We demonstrate our method on the TWEETSUMM dataset, and show that using 10% of the original labelled data set we can achieve 65.9/57.0/61.0 ROUGE-1/-2/-L, whereas the current state-of-the-art trained on the entire training data set obtains 65.16/55.81/64.37 ROUGE-1/-2/-L. In other words, in the worst case (i.e., ROUGE-L) we still effectively retain 94.7% of the performance while using only 10% of the data.