Triage by Token: When Context Clues Quietly Override Clinical Judgment
Opening — Why this matters now Large language models are quietly moving from clerical assistance to clinical suggestion. In emergency departments (EDs), where seconds matter and triage decisions shape outcomes, LLM-based decision support tools are increasingly tempting: fast, consistent, and seemingly neutral. Yet neutrality in language does not guarantee neutrality in judgment. This paper interrogates a subtle but consequential failure mode: latent bias introduced through proxy variables. Not overt racism. Not explicit socioeconomic labeling. Instead, ordinary contextual cues—how a patient arrives, where they live, how often they visit the ED—nudging model outputs in clinically unjustified ways. ...