Clinical Question-Answering (CQA) industry systems are increasingly rely on Large Language Models (LLMs), yet their deployment is often guided by the assumption that domain-specific fine-tuning is essential. Although specialised medical LLMs such as BioBERT, BioGPT, and PubMedBERT remain popular, they face practical limitations including narrow coverage, high retraining costs, and limited adaptability. Efforts based on Supervised Fine-Tuning (SFT) have attempted to address these assumptions but continue to reinforce what we term the SPECIALISATION FALLACY—the belief that specialised medical LLMs are inherently superior for CQA. To address this assumption, we introduce MEDASSESS-X, a deployment-industry-oriented CQA framework that applies alignment at inference time rather than through SFT. MEDASSESS-X uses lightweight steering vectors to guide model activations toward medically consistent reasoning without updating model weights or requiring domain-specific retraining. This inference-time alignment layer stabilises CQA performance across both general-purpose and specialised medical LLMs, thereby resolving the SPECIALISATION FALLACY. Empirically, MEDASSESS-X delivers consistent gains across all LLM families, improving Accuracy by up to +6%, Factual Consistency by +7%, and reducing Safety Error Rate by as much as 50%.

Document Visual Question Answering (DocVQA) models often produce overconfident or ethically misaligned responses, especially under uncertainty. Existing models like LayoutLMv3, UDOP, and DONUT focus on accuracy but lack ethical calibration. We propose HonestVQA, a model-agnostic, self-supervised framework that aligns model confidence with correctness using weighted loss and contrastive learning. We introduce two new metrics—Honesty Score (H-Score) and Ethical Confidence Index (ECI)—to evaluate ethical alignment. HonestVQA improves accuracy and F1 by up to 4.3% across SpDocVQA, InfographicsVQA, and SROIE datasets, while reducing overconfidence. It also generalizes well across domains, achieving 78.9% accuracy and 76.1% F1-score.