EXCISE: Locating and Excising Distracting Sentences in Medical Question Answering

Overview & Synopsis

Language models are increasingly considered for clinical decision support, where their answers should be grounded in clinical evidence and remain robust to irrelevant information. Prior work shows that a single irrelevant sentence can lower the accuracy of medical models, but not where inside the model its effect can be removed, or how to do so without knowing which sentence it is. We find that blocking attention to a known distractor restores the answer, whereas head masking can suppress correct answers. We also show that the model's hidden states mark the distractor as the sentence that least fits the case even when the model follows it. To remove a distractor's effect without knowing which sentence it is, we propose EXCISE, an inference-time method that blocks the sentence most influencing the answer, but only if the model's hidden states mark it as inconsistent with the case. On MedQA-TD (MedQA with Targeted Distractors), a benchmark we construct in which each distractor targets a specific wrong option, EXCISE gains 16.7-22.8 accuracy points at a 1.5-2.1-point cost on the same questions without distractors, outperforming prompting, rewriting, and steering baselines for all three models. Its gains extend to MedDistractQA and BiasMedQA, as well as chain-of-thought generation.