Though Large Vision-Language Models (LVLMs) are being actively explored in medicine, their ability to conduct complex real-world telemedicine consultations combining accurate diagnosis with professional dialogue remains underexplored. This paper presents 3MDBench (Medical Multimodal Multi-agent Dialogue Benchmark), an open-source framework for simulating and evaluating LVLM-driven telemedical consultations. 3MDBench simulates patient variability through temperament-based Patient Agent and evaluates diagnostic accuracy and dialogue quality via Assessor Agent. It includes 2996 cases across 34 diagnoses from real-world telemedicine interactions, combining textual and image-based data. The experimental study compares diagnostic strategies for widely used open and closed-source LVLMs. We demonstrate that multimodal dialogue with internal reasoning improves F1 score by 6.5% over non-dialogue settings, highlighting the importance of context-aware, information-seeking questioning. Moreover, injecting predictions from a diagnostic convolutional neural network into the LVLM's context boosts F1 by up to 20%. Source code is available at https://github.com/univanxx/3mdbench.

Rare diseases represent the long tail of medical imaging, where AI models often fail due to the scarcity of representative training data. In clinical workflows, radiologists frequently consult case reports and literature when confronted with unfamiliar findings. Following this line of reasoning, we introduce RADAR, Retrieval Augmented Diagnostic Reasoning Agents, an agentic system for rare disease detection in brain MRI. Our approach uses AI agents with access to external medical knowledge by embedding both case reports and literature using sentence transformers and indexing them with FAISS to enable efficient similarity search. The agent retrieves clinically relevant evidence to guide diagnostic decision making on unseen diseases, without the need of additional training. Designed as a model-agnostic reasoning module, RADAR can be seamlessly integrated with diverse large language models, consistently improving their rare pathology recognition and interpretability. On the NOVA dataset comprising 280 distinct rare diseases, RADAR achieves up to a 10.2% performance gain, with the strongest improvements observed for open source models such as DeepSeek. Beyond accuracy, the retrieved examples provide interpretable, literature grounded explanations, highlighting retrieval-augmented reasoning as a powerful paradigm for low-prevalence conditions in medical imaging.

An effective physician should possess a combination of empathy, expertise, patience, and clear communication when treating a patient. Recent advances have successfully endowed AI doctors with expert diagnostic skills, particularly the ability to actively seek information through inquiry. However, other essential qualities of a good doctor remain overlooked. It features 3,000 realistically simulated patient agents that exhibit diverse linguistic patterns, cognitive limitations, emotional responses, and tendencies for passive disclosure. We also introduce a multi-faceted evaluation framework, covering task success, inquiry proficiency, dialogue competence, inquiry efficiency, and patient experience. Experiments on different LLMs reveal substantial challenges across the evaluation aspects. Even state-of-the-art models show significant room for improvement in their inquiry capabilities. These models are highly sensitive to variations in realistic patient behavior, which considerably impacts diagnostic accuracy. Furthermore, our fine-grained metrics expose trade-offs between different evaluation perspectives, highlighting the challenge of balancing performance and practicality in real-world clinical settings.Figure 1: Comparison between MAQ E enables more realistic patient simulation by integrating diverse behaviors and evaluates doctor inquiries from more comprehensive and fine-grained perspectives. A medical career is among the most demanding professions to master. A physician's role extends far beyond treating diseases; it also involves employing nuanced conversational skills to understand a patient's condition and guide them through moments of vulnerability. Current Large Language Models (LLMs) have reached the initial stage of this journey by grasping extensive medical knowledge and expertise in clinical examinations (Nori et al., 2023; Wang et al., 2023; Saab et al., 2024; Singhal et al., 2025; Dou et al., 2025). However, their passive, response-driven nature (Li et al., 2024)--an inherent tendency to answer user queries directly rather than to engage in goal-oriented dialogue--limits their practical utility. This shortcoming is particularly critical in clinical consultation, the focus of this work, where an LLM must proactively converse with patients to gather information through thoughtful and compassionate inquiry. Existing studies (Liao et al., 2023; Li et al., 2024; Schmidgall et al., 2024; Nori et al., 2025) have proposed several benchmarks to evaluate the inquiry capabilities of LLMs. A prevalent method is to develop a virtual interaction environment in which a patient is simulated by an LLM based on a synthesized profile.

Large language models (LLMs) have demonstrated excellent capabilities in the field of biomedical question answering, but their application in real-world clinical consultations still faces core challenges. Single-round consultation systems require patients to describe all symptoms upfront, leading to vague diagnosis with unclear complaints. Traditional multi-turn dialogue models, constrained by static supervised learning, lack flexibility and fail to intelligently extract key clinical information. To address these limitations, we propose \Ours{}, a reinforcement learning (RL)-based multi-agent collaborative framework that models medical consultations as a dynamic decision-making process under uncertainty. The doctor agent continuously optimizes its questioning strategy within the RL framework through multi-turn interactions with the patient agent, dynamically adjusting its information-gathering path based on comprehensive rewards from the Consultation Evaluator. This RL fine-tuning mechanism enables LLMs to autonomously develop interaction strategies aligned with clinical reasoning logic, rather than superficially imitating patterns in existing dialogue data. Notably, we constructed MTMedDialog, the first English multi-turn medical consultation dataset capable of simulating patient interactions. Experiments demonstrate that \Ours{} outperforms existing models in both multi-turn reasoning capability and final diagnostic performance. This approach shows immense practical value by reducing misdiagnosis risks in time-pressured settings, freeing clinicians for complex cases, and pioneering a strategy to optimize medical resource allocation and alleviate workforce shortages. Code and data are available at https://github.com/JarvisUSTC/DoctorAgent-RL

The professionalism of a human doctor in outpatient service depends on two core abilities: the ability to make accurate medical decisions and the medical consultation skill to conduct strategic, empathetic patient inquiry. Existing Large Language Models (LLMs) have achieved remarkable accuracy on medical decision-making benchmarks. However, they often lack the ability to conduct the strategic and empathetic consultation, which is essential for real-world clinical scenarios. To address this gap, we propose Doctor-R1, an AI doctor agent trained to master both of the capabilities by ask high-yield questions and conduct strategic multi-turn inquiry to guide decision-making. Our framework introduces three key components: a multi-agent interactive environment, a two-tiered reward architecture that separately optimizes clinical decision-making and communicative inquiry skills, and an experience repository to ground policy learning in high-quality prior trajectories. We evaluate Doctor-R1 on OpenAI's HealthBench and MAQuE, assessed across multi-facet metrics, such as communication quality, user experience, and task accuracy. Remarkably, Doctor-R1 surpasses state-of-the-art open-source specialized LLMs by a substantial margin with higher parameter efficiency and outperforms powerful proprietary models. Furthermore, the human evaluations show a strong preference for Doctor-R1 to generate human-preferred clinical dialogue, demonstrating the effectiveness of the framework.

In this work, we introduce MedAgentSim, an open-source simulated clinical environment with doctor, patient, and measurement agents designed to evaluate and enhance LLM performance in dynamic diagnostic settings. Unlike prior approaches, our framework requires doctor agents to actively engage with patients through multi-turn conversations, requesting relevant medical examinations (e.g., temperature, blood pressure, ECG) and imaging results (e.g., MRI, X-ray) from a measurement agent to mimic the real-world diagnostic process. Additionally, we incorporate self improvement mechanisms that allow models to iteratively refine their diagnostic strategies. We enhance LLM performance in our simulated setting by integrating multi-agent discussions, chain-of-thought reasoning, and experience-based knowledge retrieval, facilitating progressive learning as doctor agents interact with more patients. We also introduce an evaluation benchmark for assessing the LLM's ability to engage in dynamic, context-aware diagnostic interactions. While MedAgentSim is fully automated, it also supports a user-controlled mode, enabling human interaction with either the doctor or patient agent. Comprehensive evaluations in various simulated diagnostic scenarios demonstrate the effectiveness of our approach. Our code, simulation tool, and benchmark are available at \href{https://medagentsim.netlify.app/}.

Traditional AI-based healthcare systems often rely on singlemodal data, limiting diagnostic accuracy due to incomplete information. However, recent advancements in foundation models show promising potential for enhancing diagnosis combining multi-modal information. While these models excel in static tasks, they struggle with dynamic diagnosis, failing to manage multi-turn interactions and often making premature diagnostic decisions due to insufficient persistence in information collection. To address this, we propose a multi-agent framework inspired by consultation flow and reinforcement learning (RL) to simulate the entire consultation process, integrating multiple clinical information for effective diagnosis. Our approach incorporates a hierarchical action set, structured from clinic consultation flow and medical textbook, to effectively guide the decision-making process. This strategy improves agent interactions, enabling them to adapt and optimize actions based on the dynamic state. We evaluated our framework on a public dynamic diagnosis benchmark. The proposed framework evidentially improves the baseline methods and achieves state-of-the-art performance compared to existing foundation model-based methods.

Training medical personnel using standardized patients (SPs) remains a complex challenge, requiring extensive domain expertise and role-specific practice. Most research on Large Language Model (LLM)-based simulated patients focuses on improving data retrieval accuracy or adjusting prompts through human feedback. However, this focus has overlooked the critical need for patient agents to learn a standardized presentation pattern that transforms data into human-like patient responses through unsupervised simulations. To address this gap, we propose EvoPatient, a novel simulated patient framework in which a patient agent and doctor agents simulate the diagnostic process through multi-turn dialogues, simultaneously gathering experience to improve the quality of both questions and answers, ultimately enabling human doctor training. Extensive experiments on various cases demonstrate that, by providing only overall SP requirements, our framework improves over existing reasoning methods by more than 10% in requirement alignment and better human preference, while achieving an optimal balance of resource consumption after evolving over 200 cases for 10 hours, with excellent generalizability. The code will be available at https://github.com/ZJUMAI/EvoPatient.

This paper presents an innovative large language model (LLM) agent framework for enhancing diagnostic accuracy in simulated clinical environments using the AgentClinic benchmark. The proposed automatic correction enables doctor agents to iteratively refine their reasoning and actions following incorrect diagnoses, fostering improved decision-making over time. Experiments show that the implementation of the adaptive LLM-based doctor agents achieve correct diagnoses through dynamic interactions with simulated patients. The evaluations highlight the capacity of autonomous agents to adapt and improve in complex medical scenarios. Future enhancements will focus on refining the algorithm and expanding its applicability across a wider range of tasks and different large language models.

Efficient patient-doctor interaction is among the key factors for a successful disease diagnosis. During the conversation, the doctor could query complementary diagnostic information, such as the patient's symptoms, previous surgery, and other related information that goes beyond medical evidence data (test results) to enhance disease diagnosis. However, this procedure is usually time-consuming and less-efficient, which can be potentially optimized through computer-assisted systems. As such, we propose a diagnostic dialogue system to automate the patient information collection procedure. By exploiting medical history and conversation logic, our conversation agents, particularly the doctor agent, can pose multi-round clinical queries to effectively collect the most relevant disease diagnostic information. Moreover, benefiting from our two-stage recommendation structure, carefully designed ranking criteria, and interactive patient agent, our model is able to overcome the under-exploration and non-flexible challenges in dialogue generation. Our experimental results on a real-world medical conversation dataset show that our model can generate clinical queries that mimic the conversation style of real doctors, with efficient fluency, professionalism, and safety, while effectively collecting relevant disease diagnostic information.