CLIN-LLM: A safety-constrained hybrid framework for clinical diagnosis and treatment generation

Vollständiger Abstract

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Accurate symptom-to-disease classification and clinically-grounded treatment recommendations remain challenging, particularly in heterogeneous patient settings with high diagnostic risk. Existing large language model (LLM)-based systems often lack medical grounding and fail to quantify uncertainty, resulting in unsafe outputs. We propose CLIN-LLM, a safety-constrained hybrid pipeline that integrates multimodal patient encoding, uncertainty-calibrated disease classification, and retrieval-augmented treatment generation. Our framework fine-tunes BioBERT on 1,200 clinical cases from the Symptom2Disease dataset and incorporates Focal Loss with Monte Carlo Dropout to generate confidence-aware predictions from free-text symptoms and structured vital signs. Low-certainty cases (18%) are automatically flagged for expert review, ensuring human oversight. For treatment generation, CLIN-LLM employs Biomedical Sentence-BERT to retrieve top-k relevant dialogues from the 260,000-sample MedDialog corpus. The retrieved evidence and patient context are fed into a fine-tuned FLAN-T5 model for personalized treatment generation, followed by post-processing with RxNorm for antibiotic stewardship and drug–drug interaction (DDI) screening. CLIN-LLM achieves 98% accuracy and F1 score, outperforming ClinicalBERT by 7.1% (p < 0.001), with 78% top-5 retrieval precision and a clinician-rated validity of 4.2/5. Reduces unsafe antibiotic suggestions by 67% compared to GPT-5. These results demonstrate CLIN-LLM’s robustness, interpretability, and clinical safety alignment. The proposed system provides a deployable, human-in-the-loop decision support framework for resource-limited healthcare environments.