Whether attention weights faithfully reflect model reasoning has been actively debated in NLP, yet this question remains largely unexplored for the visual modality in Vision-Language Models (VLMs). We address this gap through causal perturbation analysis on current VLMs, evaluating both the comprehensiveness and sufficiency gap of attention-ranked visual tokens. Our analysis reveals that visual attention faithfulness is heterogeneous, manifesting in three distinct processing modes: *Faithful-Sufficient*, where top-k attention tokens are both necessary and sufficient for prediction; *Faithful-Distributed*, where they are necessary but broader visual context remains required; and *Non-Focal*, where no localized attention region is individually necessary while visual information remains an essential trigger for prediction. Furthermore, human-annotated ground-truth regions satisfy comprehensiveness in only ∼60% of cases compared with model attention rankings, revealing systematic divergence between model visual reliance and human intuition. We demonstrate these patterns across both general VQA on VQAv2 and document tasks on VRDU and ChartQA, showing that visual attention faithfulness varies systematically with processing demands and model architectures rather than being uniformly faithful or unfaithful.

Large Language Models (LLMs) are increasingly adopted for applications in healthcare, reaching the performance of domain experts on tasks such as question answering and document summarisation. Despite their success on these tasks, it is unclear how well LLMs perform on tasks that are traditionally pursued in the biomedical domain, such as structured information extration. To bridge this gap, in this paper, we systematically benchmark LLM performance in Medical Classification and Named Entity Recognition (NER) tasks. We aim to disentangle the contribution of different factors to the performance, particularly the impact of LLMs’ task knowledge and reasoning capabilities, their (parametric) domain knowledge, and addition of external knowledge. To this end, we evaluate various open LLMs—including BioMistral and Llama-2 models—on a diverse set of biomedical datasets, using standard prompting, Chain-of-Thought (CoT) and Self-Consistency based reasoning as well as Retrieval-Augmented Generation (RAG) with PubMed and Wikipedia corpora. Counter-intuitively, our results reveal that standard prompting consistently outperforms more complex techniques across both tasks, laying bare the limitations in the current application of CoT, self-consistency and RAG in the biomedical domain. Our findings suggest that advanced prompting methods developed for knowledge- or reasoning-intensive tasks, such as CoT or RAG, are not easily portable to biomedical tasks where precise structured outputs are required. This highlights the need for more effective integration of external knowledge and reasoning mechanisms in LLMs to enhance their performance in real-world biomedical applications.