# Beyond Information Seeking: Severity-Aware Question Supervision for Proactive Medical Dialogue

arXiv: https://arxiv.org/abs/2608.24521 · HTML: https://mlsanity.com/paper/2608.24521/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 24 references that are in the map.
- First posted on arXiv 25 Aug 2026.

## Builds on (most cited first, 14 of 14)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [DDXPlus: A New Dataset For Automatic Medical Diagnosis](https://mlsanity.com/paper/2205.09148/) (2022)
- [EDDI: Efficient Dynamic Discovery of High-Value Information with Partial VAE](https://mlsanity.com/paper/1809.11142/) (2018)
- [End-to-End Knowledge-Routed Relational Dialogue System for Automatic Diagnosis](https://mlsanity.com/paper/1901.10623/) (2019)
- [Active Feature Acquisition with Generative Surrogate Models](https://mlsanity.com/paper/2010.02433/) (2020)
- [Qwen Look Again: Guiding Vision-Language Reasoning Models to Re-attention Visual Information](https://mlsanity.com/paper/2505.23558/) (2025)
- [Doctor-R1: Mastering Clinical Inquiry with Experiential Agentic Reinforcement Learning](https://mlsanity.com/paper/2510.04284/) (2025)
- [ProMed: Shapley Information Gain Guided Reinforcement Learning for Proactive Medical LLMs](https://mlsanity.com/paper/2508.13514/) (2025)
- [ATPO: Adaptive Tree Policy Optimization for Multi-Turn Medical Dialogue](https://mlsanity.com/paper/2603.02216/) (2026)
- [Knowledge Grounded Conversational Symptom Detection with Graph Memory Networks](https://mlsanity.com/paper/2101.09773/) (2021)
- [Residual Decoding: Mitigating Hallucinations in Large Vision-Language Models via History-Aware Residual Guidance](https://mlsanity.com/paper/2602.01047/) (2026)
- [MedClarify: An information-seeking AI agent for medical diagnosis with case-specific follow-up questions](https://mlsanity.com/paper/2602.17308/) (2026)

## Abstract (arXiv)

Proactive medical dialogue requires an agent to decide what to ask from incomplete patient information. Existing information-seeking approaches commonly prioritize questions that most reduce diagnostic uncertainty, but this criterion overlooks an important property of medical diagnosis: different diagnostic errors can carry substantially different consequences. The most informative question may therefore differ from the one most valuable for the downstream decision. We propose Expected-Severity-Risk (ESR), a consequence-aware question-supervision objective that values each candidate by its expected reduction in severity-aware terminal risk. Because questions must be selected before their answers are observed, ESR marginalizes over possible answers using train-only population statistics. Its rankings are then distilled into a prefix-only language policy, requiring no teacher-side risk computation at deployment. Across three matched Qwen3-4B training seeds on DDxPlus, ESR reduces mean high-severity diagnostic miss from 0.0645 to 0.0455 (29.5% relative reduction) and improves mean diagnostic accuracy from 0.9123 to 0.9320 while requiring only 0.14 additional questions per dialogue. Fixed-budget analyses show that the distinction persists when question count is controlled, while a matched expected-0/1-risk student control further isolates the contribution of asymmetric severity weighting. These results support moving proactive medical dialogue beyond uncertainty reduction toward consequence-aware evidence acquisition.