In this paper, we introduce S-MedQA, an English medical question-answering (QA) dataset designed for benchmarking large language models (LLMs) in fine-grained clinical specialties. S-MedQA consists of over 24k examples, covering 15 medical specialties, with QA pairs that can have multiple specialty annotations, such as when a question is cross-disciplinary. The dataset is constructed using both machine and expert verification to maximize data availability and reliability. We use S-MedQA to investigate the role of clinical specialties in the knowledge-intensive scenario of medical QA. Our results show that training on data from a clinical specialty does not necessarily lead to the best performance on that specialty. Additionally, regardless of the specialty the LLM was fine-tuned on, token probabilities of clinically relevant terms consistently increase across all specialties. Based on these findings, we hypothesize that improvement gains, at least in our settings, are derived primarily from domain shifting (e.g., general to medical) rather than from injecting specialty-specific knowledge. This suggests a need to rethink the role of fine-tuning data in the medical domain. To encourage further advancements in the clinical NLP field, we release S-MedQA along with all the code required to reproduce our experiments for the research community.

Protecting patient privacy in clinical narratives is essential for enabling secondary use of healthcare data under regulations such as GDPR and HIPAA. While manual de-identification remains the gold standard, it is costly and slow, motivating the need for automated methods that combine privacy guarantees with high utility. Historically, most automated text de-identification pipelines employed named entity recognition (NER) to identify protected entities for redaction. Although methods based on differential privacy (DP) provide formal privacy guarantees, more recently also large language models (LLMs) are increasingly used for text de-identification in the clinical domain. In this work, we present the first comparative study of DP, NER, and LLMs for Dutch clinical text de-identification. We investigate these methods separately as well as hybrid strategies that apply NER or LLM preprocessing prior to DP, and assess performance in terms of privacy leakage and extrinsic evaluation (entity and relation classification). We show that DP mechanisms alone degrade utility substantially, but combining them with linguistic preprocessing, especially LLM-based redaction, significantly improves the privacy–utility trade-off.