Online medical consultation (OMC) restricts doctors to gathering patient information solely through inquiries, making the already complex sequential decision-making process of diagnosis even more challenging. Recently, the rapid advancement of large language models has demonstrated a significant potential to transform OMC. However, most studies have primarily focused on improving diagnostic accuracy under conditions of relatively sufficient information, while paying limited attention to the "inquiry" phase of the consultation process. This lack of focus has left the relationship between "inquiry" and "diagnosis" insufficiently explored. In this paper, we first extract real patient interaction strategies from authentic doctor-patient conversations and use these strategies to guide the training of a patient simulator that closely mirrors real-world behavior. By inputting medical records into our patient simulator to simulate patient responses, we conduct extensive experiments to explore the relationship between "inquiry" and "diagnosis" in the consultation process. Experimental results demonstrate that inquiry and diagnosis adhere to the Liebig's law: poor inquiry quality limits the effectiveness of diagnosis, regardless of diagnostic capability, and vice versa. Furthermore, the experiments reveal significant differences in the inquiry performance of various models. To investigate this phenomenon, we categorize the inquiry process into four types: (1) chief complaint inquiry; (2) specification of known symptoms; (3) inquiry about accompanying symptoms; and (4) gathering family or medical history. We analyze the distribution of inquiries across the four types for different models to explore the reasons behind their significant performance differences. We plan to open-source the weights and related code of our patient simulator at https://github.com/LIO-H-ZEN/PatientSimulator.

The application of the Multi-modal Large Language Models (MLLMs) in medical clinical scenarios remains underexplored. Previous benchmarks only focus on the capacity of the MLLMs in medical visual question-answering (VQA) or report generation and fail to assess the performance of the MLLMs on complex clinical multi-modal tasks. In this paper, we propose a novel Medical Personalized Multi-modal Consultation (Med-PMC) paradigm to evaluate the clinical capacity of the MLLMs. Med-PMC builds a simulated clinical environment where the MLLMs are required to interact with a patient simulator to complete the multi-modal information-gathering and decision-making task. Specifically, the patient simulator is decorated with personalized actors to simulate diverse patients in real scenarios. We conduct extensive experiments to access 12 types of MLLMs, providing a comprehensive view of the MLLMs' clinical performance. We found that current MLLMs fail to gather multimodal information and show potential bias in the decision-making task when consulted with the personalized patient simulators. Further analysis demonstrates the effectiveness of Med-PMC, showing the potential to guide the development of robust and reliable clinical MLLMs. Code and data are available at https://github.com/LiuHC0428/Med-PMC.

Data are often labeled by many different experts with each expert only labeling a small fraction of the data and each data point being labeled by several experts. This reduces the workload on individual experts and also gives a better estimate of the unobserved ground truth. When experts disagree, the standard approaches are to treat the majority opinion as the correct label or to model the correct label as a distribution. These approaches, however, do not make any use of potentially valuable information about which expert produced which label. To make use of this extra information, we propose modeling the experts individually and then learning averaging weights for combining them, possibly in sample-specific ways. This allows us to give more weight to more reliable experts and take advantage of the unique strengths of individual experts at classifying certain types of data. Here we show that our approach leads to improvements in computer-aided diagnosis of diabetic retinopathy. We also show that our method performs better than competing algorithms by Welinder and Perona (2010); Mnih and Hinton (2012). Our work offers an innovative approach for dealing with the myriad real-world settings that use expert opinions to define labels for training.