Medical image segmentation remains challenging when targets exhibit limited visual distinction, irregular structure, or substantial variation across imaging modalities. Medical text can reduce this ambiguity, but indiscriminate fusion may introduce unreliable guidance. We present RELiF, a vision--language framework that integrates text through reliability-guided decoding. Its Reliability-guided Fusion Gate (RFG) adaptively controls cross-modal updates, while the Text-guided Skip Refinement Adapter (TSRA) refines high-resolution features using text guidance. RELiF is evaluated on radiographic, CT, and endoscopic segmentation tasks, where it shows competitive performance across diverse imaging characteristics and target appearances. Additional analyses examine efficiency and stability. The complementary uncertainty representation derived from the reliability response also shows an association with prediction difficulty, with higher uncertainty values occurring more frequently in pixels associated with segmentation errors. Code: https://github.com/SeivanTalaie/RELiF.

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