Current evaluation of large language models (LLMs) overwhelmingly prioritizes accuracy; however, in real-world and safety-critical applications, the ability to abstain when uncertain is equally vital for trustworthy deployment. We introduce a unified benchmark and evaluation protocol for abstention in medical multiple-choice question answering (MCQA), integrating conformal prediction, adversarial question perturbations, and explicit abstention options. Our systematic evaluation of both open- and closed-source LLMs reveals that even state-of-the-art, high-accuracy models often fail to abstain when uncertain. Notably, providing explicit abstention options consistently increases model uncertainty and safer abstention, far more than input perturbations, while scaling model size or advanced prompting brings little improvement. These findings highlight the central role of abstention mechanisms for trustworthy LLM deployment and offer practical guidance for improving safety in high-stakes applications.

Uncertainty awareness is essential for large language models (LLMs), particularly in safety-critical domains such as medicine where erroneous or hallucinatory outputs can cause harm. Yet most evaluations remain centered on accuracy, offering limited insight into model confidence and its relation to abstention. In this work, we present preliminary experiments that combine conformal prediction with abstention-augmented and perturbed variants of medical QA datasets. Our early results suggest a positive link between uncertainty estimates and abstention decisions, with this effect amplified under higher difficulty and adversarial perturbations. These findings highlight abstention as a practical handle for probing model reliability in medical QA.