Large Language Models (LLMs) are increasingly applied to medicine, yet their adoption is limited by concerns over reliability and safety. Existing evaluations either test factual medical knowledge in isolation or assess patient-level reasoning without verifying correctness, leaving a critical gap. We introduce MediEval, a benchmark that links MIMIC-IV electronic health records (EHRs) to a unified knowledge base built from UMLS and other biomedical vocabularies. MediEval generates diverse factual and counterfactual medical statements within real patient contexts, enabling systematic evaluation across a 4-quadrant framework that jointly considers knowledge grounding and contextual consistency. Using this framework, we identify critical failure modes, including hallucinated support and truth inversion, that current proprietary, open-source, and domain-specific LLMs frequently exhibit. To address these risks, we propose Counterfactual Risk-Aware Fine-tuning (CoRFu), a DPO-based method with an asymmetric penalty targeting unsafe confusions. CoRFu improves by +16.4 macro-F1 points over the base model and eliminates truth inversion errors, demonstrating both higher accuracy and substantially greater safety.

Large Language Models (LLMs) exhibit strong linguistic capabilities, but little is known about how they encode psycholinguistic knowledge across languages. We investigate whether and how LLMs exhibit human-like psycholinguistic responses under different linguistic identities using two tasks: sound symbolism and word valence. We evaluate two models, Llama-3.3-70B-Instruct and Qwen2.5-72B-Instruct, under monolingual and bilingual prompting in English, Dutch, and Chinese. Behaviorally, both models adjust their outputs based on prompted language identity, with Qwen showing greater sensitivity and sharper distinctions between Dutch and Chinese. Probing analysis reveals that psycholinguistic signals become more decodable in deeper layers, with Chinese prompts yielding stronger and more stable valence representations than Dutch. Our results demonstrate that language identity conditions both output behavior and internal representations in LLMs, providing new insights into their application as models of cross-linguistic cognition.