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We ask whether output format changes the model's \\emph{clinical representation} or only the mapping from a preserved representation to an answer. Using sparse-autoencoder (SAE) features in Gemma 3 4B/12B IT and Qwen3-8B, we find the same medical features fire on the shared clinical narrative under both formats but go {silent} at the multiple-choice decision token in all the cases at every model. Three independent methods (natural-language autoencoder verbalization, decision-token logit attribution, and top-feature characterization) agree that scaffold and format features, but not medical features, drive the decision logits. Behaviorally, the multiple-choice penalty inverts under both structured and natural-language input, option-order shuffle rules out po","title":"Internal Representation, Not Clinical Knowledge: Where Apparent LLM Triage Failures Originate","url":"https://arxiv.org/abs/2605.29889","vendor":"arxiv_cs_ai"},"summary":"arXiv:2605.29889v1 Announce Type: cross \nAbstract: Patient-voiced clinical-triage benchmarks report high under-triage rates for consumer LLMs for constrained multiple-choice output, yet the same cases score differently with free-text. We ask whether output format changes the model's \\emph{clinical representation} or only the mapping from a preserved representation to an answer. Using sparse-autoencoder (SAE) features in Gemma 3 4B/12B IT and Qwen3-8B, we find the same medical features fire on the shared clinical narrative under both formats but go {silent} at the multiple-choice decision token in all the cases at every model. 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