How Reliable Are System-One Decisions in Medicine? A Comparative Study of Jev, Jev-like Models, and LLMs

Jev has attracted considerable attention for its rapid, generalizable decision-making, yet its medical reliability remains under explored. To address this gap, our study compares various types of system-one decision models across 15 medical datasets comprising 8,742 instances under a unified protocol. Beyond accuracy, we assess decision stability and the ability to recognize unreliable decisions. Our results show that Jev rivals leading models on primarily text-driven tasks but is less effective on numerically driven tasks, revealing a distinct capability boundary. Under question-format variations, Jev demonstrates strong robustness, achieving the lowest decision reversal rate and relatively small accuracy fluctuations. Among evaluated open-source alternatives, only StartLux exhibits comparable robustness. But these strengths do not extend to reliable abstention awareness: most evaluated models show limitations in both recognizing missing correct answers and using optional abstention. Moreover, we find that Jev's probability-based answer selection can be improved by changing how decisions are scored: normalizing option-wise binary scores yields higher retained accuracy than choice scoring. Taken together, our findings provide early guidance for improving and applying decision models in medicine.