Beyond overconfidence: Embedding curiosity and humility for ethical medical AI

Journal article

Contemporary medical AI systems exhibit a critical vulnerability: they deliver confident predictions without mechanisms to express uncertainty or acknowledge limitations, leading to dangerous overreliance in clinical settings. This paper introduces the BODHI (Bridging, Open, Discerning, Humble, Inquiring) framework, a dual-reflective architecture grounded in two essential epistemic virtues: curiosity and humility, as foundational design principles for healthcare AI. Curiosity drives systems to actively explore diagnostic uncertainty, seek additional information when faced with ambiguous presentations, and recognize when training distributions fail to match clinical reality. Humility provides complementary restraint, enabling uncertainty quantification, boundary recognition, and appropriate deference to human expertise. We demonstrate how these virtues function synergistically in a dynamic feedback loop, preventing both reckless exploration and excessive caution while supporting collaborative clinical decision-making. Drawing from psychological theories of curiosity and cross-species evidence of epistemic humility, we argue that these capacities represent fundamental biological design principles essential for systems operating in high-stakes, uncertain environments. The BODHI framework addresses systemic failures in medical AI deployment, from biased training data to institutional workflow pressures, by embedding uncertainty awareness and collaborative restraint into foundational system architecture. Key implementation features include calibrated confidence measures, out-of-distribution detection, curiosity-driven escalation protocols, and transparency mechanisms that adapt to clinical context. Rather than pursuing algorithmic perfection through pure optimization, we advocate for human-AI partnerships that enhance clinical reasoning through mutual accountability and calibrated trust. This approach represents a paradigm shift from overconfident automation toward collaborative systems that embody the wisdom to pause, reflect, and defer when appropriate.

Authors: Cajas Ordóñez, SA; Castro, R; Celi, LA; Delos Reyes, R; Engelmann, J

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Public Library of Science
• Journal: PLOS Digital Health
• Volume: 5
• Issue: 1
• Pages: e0001013-e0001013
• Publication date: 2026-01-05
• DOI: 10.1371/journal.pdig.0001013
• EISSN: 2767-3170
• ISSN: 2767-3170
• Language: English
• Keywords: Adversarial system; Function (biology); Humility; Curiosity; Workflow; Transparency (behavior); Deference; Accountability