让大模型像医生一样问诊,有依据、能透明、更懂病人。
Ask Patients with Patience: Enabling LLMs for Human-Centric Medical Dialogue with Grounded Reasoning
- 通过共情对话收集症状,结合贝叶斯主动学习诊断。
- 诊断准确率提升,不确定性降低,用户体验更好。
- 适合医疗AI研发者和临床辅助系统设计者参考。
医疗资源严重短缺限制了及时可靠的医疗服务,使数百万人无法获得帮助。大型语言模型(LLMs)虽具潜力,但在真实临床对话中表现不佳:缺乏权威医学指南支撑,难以透明处理诊断不确定性,语言机械僵硬,缺乏建立患者信任所需的人性化特质。为此,我们提出「问病人,有耐心」(Ask Patients with Patience, APP),一种基于多轮对话的医学助手框架,具备可解释的推理能力、透明的诊断过程与以人为本的交互设计。APP通过共情式提问获取症状信息,显著提升可及性与用户参与度;采用贝叶斯主动学习实现动态自适应诊断;整体基于经验证的医学指南,确保临床合理性和循证推理。为评估性能,我们构建了一个新基准,使用从真实诊疗案例中提取的患者画像生成模拟对话。对比SOTA单轮与多轮基线模型,结果表明,APP在诊断准确性、不确定性控制和用户体验方面均有显著提升。该框架将医学专业知识与透明、类人互动相结合,弥合了AI医疗辅助与真实临床实践之间的鸿沟。
原文摘要 · Abstract (English)
The severe shortage of medical doctors limits access to timely and reliable healthcare, leaving millions underserved. Large language models (LLMs) offer a potential solution but struggle in real-world clinical interactions. Many LLMs are not grounded in authoritative medical guidelines and fail to transparently manage diagnostic uncertainty. Their language is often rigid and mechanical, lacking the human-like qualities essential for patient trust. To address these challenges, we propose Ask Patients with Patience (APP), a multi-turn LLM-based medical assistant designed for grounded reasoning, transparent diagnoses, and human-centric interaction. APP enhances communication by eliciting user symptoms through empathetic dialogue, significantly improving accessibility and user engagement. It also incorporates Bayesian active learning to support transparent and adaptive diagnoses. The framework is built on verified medical guidelines, ensuring clinically grounded and evidence-based reasoning. To evaluate its performance, we develop a new benchmark that simulates realistic medical conversations using patient agents driven by profiles extracted from real-world consultation cases. We compare APP against SOTA one-shot and multi-turn LLM baselines. The results show that APP improves diagnostic accuracy, reduces uncertainty, and enhances user experience. By integrating medical expertise with transparent, human-like interaction, APP bridges the gap between AI-driven medical assistance and real-world clinical practice.
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