Complementary Vulnerabilities: Auditing and Governing Clinician-LLM Error Overlap

Overview & Synopsis

Health systems are deploying large language models (LLMs) into clinical workflows, often on the assumption that a second automated check can only reduce error. But a second reasoner reduces error only insofar as it fails differently from the first. We say that a clinician and a model have complementary vulnerabilities to the extent that they break down through different mechanisms and on different cases. The two reasoners' failure substrates differ: they are embodied and cognitive in the clinician, and statistical and generative in the model - so their weak points need not line up. That divergence is plausible rather than guaranteed, and the independence it creates is fragile, eroding when clinicians defer to the model or the model conforms to the clinician. We therefore propose a predeployment audit in which each site measures error overlap on its own cases. We also propose a governance model with which the site keeps those errors independent over time. Health systems should then judge a clinical artificial intelligence (AI) tool by whether its failures overlap with their clinicians' failures, as well as by its accuracy.