arXiv:2603.11413v5 Announce Type: replace Abstract: A recent Nature Medicine study reported that ChatGPT Health under-triages 51.6% of emergencies and concluded that consumer-facing AI triage poses safety risks. Its protocol, however, was an exam-style scaffold (forced A/B/C/D output, knowledge suppression, no clarifying questions) unlike how consumers use health chatbots. We ask how much of the headline error rate is a property of the measurement rather than of the models. In a first, mechanistic study, five frontier LLMs on a 17-scenario bank scored 6.4 points higher under naturalistic patient-style messages than under the constrained scaffold (p=0.015). In a second, faithful replication we ran the authors' own 60 released vignettes through six frontier models under four matched formats, with clinician validation of the rewrites and a blinded clinician audit of the LLM adjudicators. Here the direction reversed: free-text rewrites scored slightly below the exact prompt (78.7% vs 81.8%, p=0.020), removing only the answer scaffold changed little (80.6% vs 81.4%, p=0.81), and naturalistic input with a forced categorical answer beat both the exact prompt (84.4%, p=0.023) and free text (p=0.0001). On the four vignettes defining the original emergency rate, under-triage was 17% with the exact scaffold, 50% in free text, and 21% with a forced letter on the same message; every free-text "under-triage" was a same-day recommendation scored C rather than D, and 60% made escalation conditional on information the patient was asked to check, behavior a single-turn benchmark cannot score. The headline rate did not reproduce as a stable cross-model finding; much of it depends on output format and on mapping prose onto a four-point scale. Each format elicits a separate response, so the design measures format sensitivity, not format versus capability. Safety claims should report sensitivity to input wording, output format and adjudication.