Medical large language models are often judged by how many clinical questions they answer correctly. That view is useful, but it misses a practical risk. A model may know the right answer and still change its response when the same case is written in a different patient voice. This paper evaluates that risk as SDoH aware narrative anchoring bias. We use NarrativeShield SDoH MedQA, a counterfactual medical question answering dataset in which each case appears in persona based narratives while the answer key remains fixed. The dataset is reshaped from wide format into case grouped persona rows. We evaluate three open source instruction tuned LLMs from the Qwen2.5 family: 1.5B, 3B, and 7B. The final experiment uses 300 clinical cases and produces 8,100 model responses across three prompting conditions. We report persona level accuracy, counterfactual consistency, correct consistency, and narrative sensitivity error. Qwen2.5 7B achieves the best accuracy at 56.33 percent and the best correct consistency at 40.33 percent. Paired McNemar exact tests show significant accuracy gains for 7B over 3B in all prompt settings. Even so, narrative sensitivity remains, with the lowest error still at 31.67 percent. These results suggest that trustworthy clinical decision support should be evaluated by both average correctness and stability across medically equivalent patient narratives.
World Action Models (WAMs) improve planning by incorporating future world evolution into action generation, yet existing methods allocate a fixed imagination budget to every scene. We propose RISE (\textbf{R}efining \textbf{I}magination through \textbf{SE}lective Rollout), a system-level adaptive imagination framework that makes sequential \textsc{Roll}/\textsc{Stop} decisions according to the expected planning benefit of continued rollout. At each step, a Latent Evaluator estimates the risk revealed by the current prefix and how much planning could improve if imagination continues, while a Rollout Gate weighs this expected benefit against additional computation cost. Since factual driving logs expose only one realized future, we further construct \textbf{CounterDrive}, a counterfactual dataset with diverse outcomes and risk levels, to enrich future dynamics and provide localized risk supervision. Each retained sample undergoes expert verification and annotation of trajectory validity, incident onset, and causal category, providing a reusable resource for safety-critical world-modeling research. Experiments on NAVSIM and nuScenes show that RISE achieves the best overall planning performance while reducing unnecessary rollout, with additional transfer results supporting its plug-in generality across WAM architectures.