MedConceal: A Benchmark for Clinical Hidden-Concern Reasoning Under Partial Observability

Patient-clinician communication is an asymmetric-information problem: patients often do not disclose fears, misconceptions, or practical barriers unless clinicians elicit them skillfully. Effective medical dialogue therefore requires reasoning under partial observability: clinicians must elicit latent concerns, confirm them through interaction, and respond in ways that guide patients toward appropriate care. However, existing medical dialogue benchmarks largely sidestep this challenge by exposing hidden patient state, collapsing elicitation into extraction, or evaluating responses without modeling what remains hidden. We present MedConceal, a benchmark with an interactive patient simulator for evaluating hidden-concern reasoning in medical dialogue, comprising 300 curated cases and 600 clinician-LLM interactions. Built from clinician-answered online health discussions, each case pairing clinician-visible context with simulator-internal hidden concerns derived from prior literature and structured using an expert-developed taxonomy. The simulator withholds these concerns from the dialogue agent, tracks whether they have been revealed and addressed via theory-grounded turn-level communication signals, and is clinician-reviewed for clinical plausibility. This enables process-aware evaluation of both task success and the interaction process that leads to it. We study two abilities: confirmation, surfacing hidden concerns through multi-turn dialogue, and intervention, addressing the primary concern and guiding the patient toward a target plan. Results show that no single system dominates: frontier models lead on different confirmation metrics, while human clinicians (N=159) remain strongest on intervention success. Together, these results identify hidden-concern reasoning under partial observability as a key unresolved challenge for medical dialogue systems.

Joint Optimization of Reasoning and Dual-Memory for Self-Learning Diagnostic Agent

Clinical expertise improves not only by acquiring medical knowledge, but by accumulating experience that yields reusable diagnostic patterns. Recent LLMs-based diagnostic agents have shown promising progress in clinical reasoning for decision support. However, most approaches treat cases independently, limiting experience reuse and continual adaptation. We propose SEA, a self-learning diagnostic agent with cognitively inspired dual-memory module. We design a reinforcement training framework tailored to our designed agent for joint optimization of reasoning and memory management. We evaluate SEA in two complementary settings. On standard evaluation with MedCaseReasoning dataset, SEA achieves 92.46% accuracy, outperforming the strongest baseline by +19.6%, demonstrating the benefit of jointly optimizing reasoning and memory. On the long-horizon with ER-Reason dataset, SEA attains the best final accuracy (0.7214) and the largest improvement (+0.35 Acc@100), while baseline methods show limited or unstable gains. Expert evaluation further indicates that rules consolidated from SEA show strong clinical correctness, usefulness and trust, suggesting that the induced rules in dual-memory module are reliable and practically meaningful. Overall, SEA improves both diagnostic reasoning ability and continual learning by effectively transforming experience into reusable knowledge.

Improving Clinical Diagnosis with Counterfactual Multi-Agent Reasoning

Clinical diagnosis is a complex reasoning process in which clinicians gather evidence, form hypotheses, and test them against alternative explanations. In medical training, this reasoning is explicitly developed through counterfactual questioning--e.g., asking how a diagnosis would change if a key symptom were absent or altered--to strengthen differential diagnosis skills. As large language model (LLM)-based systems are increasingly used for diagnostic support, ensuring the interpretability of their recommendations becomes critical. However, most existing LLM-based diagnostic agents reason over fixed clinical evidence without explicitly testing how individual findings support or weaken competing diagnoses. In this work, we propose a counterfactual multi-agent diagnostic framework inspired by clinician training that makes hypothesis testing explicit and evidence-grounded. Our framework introduces counterfactual case editing to modify clinical findings and evaluate how these changes affect competing diagnoses. We further define the Counterfactual Probability Gap, a method that quantifies how strongly individual findings support a diagnosis by measuring confidence shifts under these edits. These counterfactual signals guide multi-round specialist discussions, enabling agents to challenge unsupported hypotheses, refine differential diagnoses, and produce more interpretable reasoning trajectories. Across three diagnostic benchmarks and seven LLMs, our method consistently improves diagnostic accuracy over prompting and prior multi-agent baselines, with the largest gains observed in complex and ambiguous cases. Human evaluation further indicates that our framework produces more clinically useful, reliable, and coherent reasoning. These results suggest that incorporating counterfactual evidence verification is an important step toward building reliable AI systems for clinical decision support.