Integrating Physician Diagnostic Logic into Large Language Models: Preference Learning from Process Feedback
Open accessAbstract
The utilization of large language models for medical dialogue generation has attracted considerable attention due to its potential to enhance response richness and coherence.While previous studies have made strides in optimizing model performance, there is a pressing need to bolster the model's capacity for diagnostic logic to ensure patient safety.In response to this need, we propose an approach termed preference learning from process feedback (PLPF), which involves integrating the doctor's diagnostic logic into LLMs.PLPF encompasses three key components: rule modeling, preference data generation, and preference alignment.These components collectively serve to train the model to adhere to the diagnostic process.Our experimental results, utilizing Standardized Patient Testing, demonstrate that PLPF enhances the diagnostic accuracy of the baseline model in medical conversations by 17.6%, surpassing the performance of traditional approaches.Moreover, PLPF exhibits effectiveness in both multi-round and single-round dialogue tasks, thereby highlighting its potential in improving medical dialogue generation.Our dataset is available at https://github. com/Chengfeng-Dou/SpTesting D. Doctors are obliged to give a reasonable explanation of their diagnosis and proposed treatment.E. Doctors should not evade a patient's questions without providing a reasonable explanation.F. Doctors should actively seek relevant information from patients for their diagnosis.A. Before diagnosing and guiding the patient, doctors needs to carefully verify the patient's condition.B. Doctors should inform patients about their disease or the tests needed for diagnosis.C. Doctors should inform patients of treatment options for the disease. Goal-oriented rulesConstraint-oriented rules F. Be proactive in collecting patient information E. Answer patient questions in a positive way A.Collecting patient information B. Making a diagnosis C. Informing about treatment B. Recommending for medical testing Yes No B. Can a diagnosis be made?Start End D. Explaining
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RLHF can improve model responses to be more accurate and aligned with human-like diagnostic reasoning.
“Additionally, one study showed that RLHF can improve model responses to be more accurate and aligned with human-like diagnostic reasoning36.”
From Enhancing diagnostic capability with multi-agents conversational large language models (2025) · cites this paper as [36]
The Abstract and Conclusion report that PLPF integrates physicians’ diagnostic logic and improves diagnostic accuracy by 17.6% in standardized patient testing. But §2.4 says the study trains on preference data using direct preference optimization (DPO), not RLHF; the Introduction distinguishes PLPF from traditional approaches. The result supports the claimed improvement, but not its attribution to RLHF. (LLM, conf=0.88)
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Research works printed but not linked: 2
- Zhengxiao Du, Yujie Qian, Xiao Liu, Ming Ding, Jiezhong Qiu, Zhilin Yang, and Jie Tang. 2022. Glm: General language model pretraining with autoregres- sive blank infilling. In Proceedings of the 60th An- nual Meeting of the Association for Computational Linguistics (Volume 1: Long Papers), pages 320-335.
- Junqing He, Mingming Fu, and Manshu Tu. 2019. Ap- plying deep matching networks to chinese medical question answering: a study and a dataset. BMC med- ical informatics and decision making, 19(2):91-100.
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Self-citationXiang, L., Liu, S., Zhang, W., Wang, J., Chen, G., Lian, Y., He, Z., Li, G., Ou, Y., & Lu, W. (2026) · Communications in computer and information science · doi:10.1007/978-981-95-7299-1_22
- Authors
- Dou, C., Zhang, Y., Jin, Z., Jiao, W., Zhao, H., Zhao, Y., & Tao, Z.
- Affiliations
- Peking University (CN)
- Beijing Jiaotong University (CN)
- Venue
- Findings of the Association for Computational Linguistics ACL 2024
- Published
- 2024
- Pages
- 2453-2473
- OpenAlex
- W4402670852
- Cited by
- 4
- References
- 0
- Citations by year
- 2026: 1 · 2025: 3
- FWCI
- 1.08
- Type
- conference paper
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Findings of the Association for Computational Linguistics: ACL (Findings of ACL) (publishedVersion, cc-by)
- arXiv (Cornell University) (submittedVersion)
- arXiv (Cornell University)
- Funders
- National Natural Science Foundation of China (62192731)
- Topics
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Physical Sciences › Computer Science › Artificial Intelligence › Speech and dialogue systems
- Health Sciences › Health Professions › Health Information Management › Artificial Intelligence in Healthcare
- Keywords
- large language models, diagnostic logic, rule modeling, preference alignment, patient safety, multi-turn dialogue
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