MedDDC-Eval: Diagnosis-Decoupled Evaluation of Multi-Turn Medical Consultation Agents

Abstract

Multi-turn medical consultation agents must decide what to ask, adapt to patient responses, and determine when the collected evidence is sufficient. However, coupled evaluation conflates the quality of the policy-elicited history with policy-specific terminal diagnosis generation: strong generation can compensate for a thin history, while weaker generation can obscure a rich one. We introduce MedDDC-Eval, a diagnosis-decoupled testbed that treats elicited history as the comparison object and holds the history-to-diagnosis mapping constant through a shared frozen reader. Across two held-out sources, a grounded interface and an auditable diagnosis-trajectory-efficiency (D/T/E) harness measure diagnostic usefulness, information acquisition, and efficiency. Directional semantic coverage followed by deterministic one-to-one assignment yields coherent precision-recall counts for open-ended items, with at most one credited match per prediction or reference. Holding histories fixed, changing only the diagnostic reader shifts diagnosis F1 by 2.2-19.0 points and reverses 18% and 36% of pairwise policy orderings on the Record and Dialogue splits. We further apply standard Group Relative Policy Optimization (GRPO) over interactive multi-turn rollouts to post-train Qwen3-32B using diagnosis-result and trajectory feedback. On the 100-case Record and 70-case Dialogue splits, the trained policy improves over its initialization by 9.7 and 4.6 total-score points; removing either primary signal lowers held-out joint performance. These results show that MedDDC-Eval supports controlled attribution, interpretable elicited-history measurement, and evaluation-guided evidence-acquisition policy development.