Multimodal large language models (MLLMs) have shown great potential in medical applications, yet existing benchmarks inadequately capture real-world clinical complexity. We introduce MEDSYN, a multilingual, multimodal benchmark of highly complex clinical cases with up to 7 distinct visual clinical evidence (CE) types per case. Mirroring clinical workflow, we evaluate 18 MLLMs on differential diagnosis (DDx) generation and final diagnosis (FDx) selection. While frontier models often match or even outperform human experts on DDx generation, all MLLMs exhibit a much larger DDx–FDx performance gap compared to expert clinicians, indicating a failure mode in synthesis of heterogeneous CE types. Ablations attribute this failure to (i) overreliance on less discriminative textual CE (e.g., medical history) and (ii) a cross-modal CE utilization gap. We introduce Evidence Sensitivity to quantify the latter and show that a smaller gap correlates with higher diagnostic accuracy. Finally, we demonstrate how it can be used to guide interventions to improve model performance. https://github.com/jianing-lab/MEDSYN.

We study object hallucination in Multimodal Large Language Models (MLLMs) and improve visual contrastive decoding (VCD) by constructing an object-aligned auxiliary view. We leverage object-centric attention in self-supervised Vision Transformers. In particular, we remove the most salient visual evidence to construct an auxiliary view that disrupts unsupported tokens and produces a stronger contrast signal. Our method is prompt-agnostic, model-agnostic, and can be seamlessly plugged into the existing VCD pipeline with little computation overhead, i.e., a single cacheable forward pass. Empirically, our method demonstrates consistent gains on two popular object hallucination benchmarks across two MLLMs.