Despite strong performance on standard benchmarks, it remains unclear whether large language models (LLMs) evaluate social pragmatics in ways that align with human judgments. We evaluate LLM politeness judgments using two English-language datasets with complementary annotation formats: continuous human ratings and three-way categorical labels. Across the seven evaluated models, we find that inter-model agreement is stronger than model-human agreement. Strategy-level analyses suggest that model-human alignment is associated with explicit linguistic cues, while some rapport-building strategies occur more frequently in misaligned cases. In the categorical task, model predictions exhibit systematic neutral compression, characterized by the overproduction of Neutral labels and the underprediction of Impolite labels. This pattern persists when expert consensus is used as the reference on a diagnostic subset. Our findings highlight the need for pragmatic evaluations that go beyond aggregate agreement metrics by examining directional patterns of model-human disagreement across different human references.

Heart sound auscultation holds significant importance in the diagnosis of congenital heart disease. However, existing methods for Heart Sound Diagnosis (HSD) tasks are predominantly limited to a few fixed categories, framing the HSD task as a rigid classification problem that does not fully align with medical practice and offers only limited information to physicians. Besides, such methods do not utilize echocardiography reports, the gold standard in the diagnosis of related diseases. To tackle this challenge, we introduce HSDreport, a new benchmark for HSD, which mandates the direct utilization of heart sounds obtained from auscultation to predict echocardiography reports. This benchmark aims to merge the convenience of auscultation with the comprehensive nature of echocardiography reports. First, we collect a new dataset for this benchmark, comprising 2,275 heart sound samples along with their corresponding reports. Subsequently, we develop a knowledge-aware query-based transformer to handle this task. The intent is to leverage the capabilities of medically pre-trained models and the internal knowledge of large language models (LLMs) to address the task’s inherent complexity and variability, thereby enhancing the robustness and scientific validity of the method. Furthermore, our experimental results indicate that our method significantly outperforms traditional HSD approaches and existing multimodal LLMs in detecting key abnormalities in heart sounds.