Improving Medical Communication using Rubric-Guided Counterfactual Recommendations

Text-based telemedicine increasingly relies on lightweight patient feedback, however, such feedback primarily reflects perceived communication quality rather than medical accuracy. We introduce an LM-guided counterfactual recommendation pipeline that discovers and refines interpretable communication features such as tone, personalization, actionability and completeness in addressing patient concerns, without interfering with the medical content. These features are used together with patient-doctor interaction metadata to estimate positive feedback. At inference time, the system searches over low-cost ordinal feature changes and recommends minimal communication changes predicted to increase the probability of positive feedback, while independent auditor models test whether these gains generalize beyond the selection model. Across interactions, recommendations yield a mean +6.41% gain in predicted positive feedback probability under independent auditors, and are non-negative for 93.31% of recommendations. These results suggest that small, interpretable communication changes can capture most predicted gains while preserving the doctor's control over medical reasoning and final wording.

What Makes a Good Doctor Response? An Analysis on a Romanian Telemedicine Platform

Text-based telemedicine has become a common mode of care, requiring clinicians to deliver medical advice clearly and effectively in writing. As platforms increasingly rely on patient ratings and feedback, clinicians face growing pressure to maintain satisfaction scores, even though these evaluations often reflect communication quality more than clinical accuracy. We analyse patient satisfaction signals in Romanian text-based telemedicine. Using a sample of 77,334 anonymised patient question--doctor response pairs, we model feedback as a binary outcome, treating thumbs-up responses as positive and grouping negative or absent feedback into the other class. We extract interpretable, predominantly language-agnostic features (e.g., length, structural characteristics, readability proxies), along with Romanian LIWC psycholinguistic features and politeness/hedging markers where available. We train a classifier with a time-based split and perform SHAP-based analyses, which indicate that patient and clinician history features dominate prediction, functioning as strong priors, while characteristics of the response text provide a smaller but, crucially, actionable signal. In subgroup correlation analyses, politeness and hedging are consistently positively associated with patient feedback, whereas lexical diversity shows a negative association.