The rocketing prosperity of large language models (LLMs) in recent years has boosted the prevalence of vision-language models (VLMs) in the medical sector. In our online medical consultation scenario, a doctor responds to the texts and images provided by a patient in multiple rounds to diagnose her/his health condition, forming a multi-turn multimodal medical dialogue format. Unlike high-quality images captured by professional equipment in traditional medical visual question answering (Med-VQA), the images in our case are taken by patients' mobile phones. These images have poor quality control, with issues such as excessive background elements and the lesion area being significantly off-center, leading to degradation of vision-language alignment in the model training phase. In this paper, we propose ZALM3, a Zero-shot strategy to improve vision-language ALignment in Multi-turn Multimodal Medical dialogue. Since we observe that the preceding text conversations before an image can infer the regions of interest (RoIs) in the image, ZALM3 employs an LLM to summarize the keywords from the preceding context and a visual grounding model to extract the RoIs. The updated images eliminate unnecessary background noise and provide more effective vision-language alignment. To better evaluate our proposed method, we design a new subjective assessment metric for multi-turn unimodal/multimodal medical dialogue to provide a fine-grained performance comparison. Our experiments across three different clinical departments remarkably demonstrate the efficacy of ZALM3 with statistical significance.

Scientific research indicates that for every hour spent in direct patient care, physicians spend nearly two additional hours on administrative tasks, particularly on electronic health records (EHRs) and desk work. This excessive administrative burden not only reduces the time available for patient care but also contributes to physician burnout and inefficiencies in healthcare delivery. To address these challenges, this study introduces MediGen, a fine-tuned large language model (LLM) designed to automate the generation of medical reports from medical dialogues. By leveraging state-of-the-art methodologies for fine-tuning open-source pretrained models, including LLaMA3-8B, MediGen achieves high accuracy in transcribing and summarizing clinical interactions. The fine-tuned LLaMA3-8B model demonstrated promising results, achieving a ROUGE score of 58% and a BERTScore-F1 of 72%, indicating its effectiveness in generating accurate and clinically relevant medical reports. These findings suggest that MediGen has the potential to significantly reduce the administrative workload on physicians, improving both healthcare efficiency and physician well-being.

Recent advances in Large Language Models (LLMs) have achieved remarkable breakthroughs in understanding and responding to user intents. However, their performance lag behind general use cases in some expertise domains, such as Chinese medicine. Existing efforts to incorporate Chinese medicine into LLMs rely on Supervised Fine-Tuning (SFT) with single-turn and distilled dialogue data. These models lack the ability for doctor-like proactive inquiry and multi-turn comprehension and cannot align responses with experts' intentions. In this work, we introduce Zhongjing, the first Chinese medical LLaMA-based LLM that implements an entire training pipeline from continuous pre-training, SFT, to Reinforcement Learning from Human Feedback (RLHF). Additionally, we construct a Chinese multi-turn medical dialogue dataset of 70,000 authentic doctor-patient dialogues, CMtMedQA, which significantly enhances the model's capability for complex dialogue and proactive inquiry initiation. We also define a refined annotation rule and evaluation criteria given the unique characteristics of the biomedical domain. Extensive experimental results show that Zhongjing outperforms baselines in various capacities and matches the performance of ChatGPT in some abilities, despite the 100x parameters. Ablation studies also demonstrate the contributions of each component: pre-training enhances medical knowledge, and RLHF further improves instruction-following ability and safety. Our code, datasets, and models are available at https://github.com/SupritYoung/Zhongjing.

This paper focuses on term-status pair extraction from medical dialogues (MD-TSPE), which is essential in diagnosis dialogue systems and the automatic scribe of electronic medical records (EMRs). In the past few years, works on MD-TSPE have attracted increasing research attention, especially after the remarkable progress made by generative methods. However, these generative methods output a whole sequence consisting of term-status pairs in one stage and ignore integrating prior knowledge, which demands a deeper understanding to model the relationship between terms and infer the status of each term. This paper presents a knowledge-enhanced two-stage generative framework (KTGF) to address the above challenges. Using task-specific prompts, we employ a single model to complete the MD-TSPE through two phases in a unified generative form: we generate all terms the first and then generate the status of each generated term. In this way, the relationship between terms can be learned more effectively from the sequence containing only terms in the first phase, and our designed knowledge-enhanced prompt in the second phase can leverage the category and status candidates of the generated term for status generation. Furthermore, our proposed special status "not mentioned" makes more terms available and enriches the training data in the second phase, which is critical in the low-resource setting. The experiments on the Chunyu and CMDD datasets show that the proposed method achieves superior results compared to the state-of-the-art models in the full training and low-resource settings.

Symptom diagnosis in medical conversations aims to correctly extract both symptom entities and their status from the doctor-patient dialogue. In this paper, we propose a novel framework called KNSE for symptom status recognition (SSR), where the SSR is formulated as a natural language inference (NLI) task. For each mentioned symptom in a dialogue window, we first generate knowledge about the symptom and hypothesis about status of the symptom, to form a (premise, knowledge, hypothesis) triplet. The BERT model is then used to encode the triplet, which is further processed by modules including utterance aggregation, self-attention, cross-attention, and GRU to predict the symptom status. Benefiting from the NLI formalization, the proposed framework can encode more informative prior knowledge to better localize and track symptom status, which can effectively improve the performance of symptom status recognition. Preliminary experiments on Chinese medical dialogue datasets show that KNSE outperforms previous competitive baselines and has advantages in cross-disease and cross-symptom scenarios.

The recent progress of large language models (LLMs), including ChatGPT and GPT-4, in comprehending and responding to human instructions has been remarkable. Nevertheless, these models typically perform better in English and have not been explicitly trained for the medical domain, resulting in suboptimal precision in diagnoses, drug recommendations, and other medical advice. Additionally, training and deploying a dialogue model is still believed to be impossible for hospitals, hindering the promotion of LLMs. To tackle these challenges, we have collected databases of medical dialogues in Chinese with ChatGPT's help and adopted several techniques to train an easy-deploy LLM. Remarkably, we were able to fine-tune the ChatGLM-6B on a single A100 80G in 13 hours, which means having a healthcare-purpose LLM can be very affordable. DoctorGLM is currently an early-stage engineering attempt and contain various mistakes. We are sharing it with the broader community to invite feedback and suggestions to improve its healthcare-focused capabilities: https://github.com/xionghonglin/DoctorGLM.

Medical dialogue information extraction is becoming an increasingly significant problem in modern medical care. It is difficult to extract key information from electronic medical records (EMRs) due to their large numbers. Previously, researchers proposed attention-based models for retrieving features from EMRs, but their limitations were reflected in their inability to recognize different categories in medical dialogues. In this paper, we propose a novel model, Expert System and Attention for Labelling (ESAL). We use mixture of experts and pre-trained BERT to retrieve the semantics of different categories, enabling the model to fuse the differences between them. In our experiment, ESAL was applied to a public dataset and the experimental results indicated that ESAL significantly improved the performance of Medical Information Classification.

Medical Slot Filling (MSF) task aims to convert medical queries into structured information, playing an essential role in diagnosis dialogue systems. However, the lack of sufficient term semantics learning makes existing approaches hard to capture semantically identical but colloquial expressions of terms in medical conversations. In this work, we formalize MSF into a matching problem and propose a Term Semantics Pre-trained Matching Network (TSPMN) that takes both terms and queries as input to model their semantic interaction. To learn term semantics better, we further design two self-supervised objectives, including Contrastive Term Discrimination (CTD) and Matching-based Mask Term Modeling (MMTM). CTD determines whether it is the masked term in the dialogue for each given term, while MMTM directly predicts the masked ones. Experimental results on two Chinese benchmarks show that TSPMN outperforms strong baselines, especially in few-shot settings.

USA: In a diagnostic study published in JAMA Network Open, an artificial intelligence (AI) algorithm may improve the diagnostic performance of …

Medical dialogue systems (MDSs) aim to assist doctors and patients with a range of professional medical services, i.e., diagnosis, consultation, and treatment. However, one-stop MDS is still unexplored because: (1) no dataset has so large-scale dialogues contains both multiple medical services and fine-grained medical labels (i.e., intents, slots, values); (2) no model has addressed a MDS based on multiple-service conversations in a unified framework. In this work, we first build a Multiple-domain Multiple-service medical dialogue (M^2-MedDialog)dataset, which contains 1,557 conversations between doctors and patients, covering 276 types of diseases, 2,468 medical entities, and 3 specialties of medical services. To the best of our knowledge, it is the only medical dialogue dataset that includes both multiple medical services and fine-grained medical labels. Then, we formulate a one-stop MDS as a sequence-to-sequence generation problem. We unify a MDS with causal language modeling and conditional causal language modeling, respectively. Specifically, we employ several pretrained models (i.e., BERT-WWM, BERT-MED, GPT2, and MT5) and their variants to get benchmarks on M^2-MedDialog dataset. We also propose pseudo labeling and natural perturbation methods to expand M2-MedDialog dataset and enhance the state-of-the-art pretrained models. We demonstrate the results achieved by the benchmarks so far through extensive experiments on M2-MedDialog. We release the dataset, the code, as well as the evaluation scripts to facilitate future research in this important research direction.