Utkarsh Desai

Author directory

2026

Large Language Models (LLMs) are increasingly deployed in high-stakes clinical applications in India. Speakers of Indian languages frequently communicate using romanized text rather than native scripts, yet existing research rarely quantifies or evaluates this orthographic variation in real-world applications. We investigate how romanization impacts the reliability of LLMs in a critical domain: maternal and newborn healthcare triage. We benchmark leading LLMs on a real-world dataset of user-generated health queries spanning five Indian languages and Nepali. Our results reveal consistent degradation in performance for romanized messages, with gap reaching up to 24 points across languages and models. We propose and evaluate an Uncertainty-based Selective Routing method to narrow this script gap. Our findings highlight a critical safety blind spot in deploying LLMs for health systems: models that appear to understand romanized input may still fail to act on it reliably.