Statistics, Not Scale: Modular Medical Dialogue with Bayesian Belief Engine

Abstract

Large language models are increasingly deployed as autonomous diagnostic agents, yet they conflate two fundamentally different capabilities: natural-language communication and probabilistic reasoning. We argue that this conflation is an architectural flaw, not an engineering shortcoming. We introduce BMBE (Bayesian Medical Belief Engine), a modular diagnostic dialogue framework that enforces a strict separation between language and reasoning: an LLM serves only as a sensor, parsing patient utterances into structured evidence and verbalising questions, while all diagnostic inference resides in a deterministic, auditable Bayesian engine. Because patient data never enters the LLM, the architecture is private by construction; because the statistical backend is a standalone module, it can be replaced per target population without retraining. This separation yields three properties no autonomous LLM can offer: calibrated selective diagnosis with a continuously adjustable accuracy-coverage tradeoff, a statistical separation gap where even a cheap sensor paired with the engine outperforms a frontier standalone model from the same family at a fraction of the cost, and robustness to adversarial patient communication styles that cause standalone doctors to collapse. We validate across empirical and LLM-generated knowledge bases against frontier LLMs, confirming the advantage is architectural, not informational.