From Uncertainty to Clinical Risk: Severity-Aware Conformal Planning for Interactive Medical Diagnosis

Abstract

Interactive medical diagnosis dynamically acquires patient information through multiple rounds of questioning, supporting accurate, efficient, and safe clinical decisions under incomplete evidence. Existing methods commonly guide information acquisition with predictive uncertainty or label ambiguity, but overlook the asymmetric clinical risk of missing severe diseases and lack unified long-horizon planning over whether to continue asking questions or commit to a diagnosis. To address these limitations, we propose Severity-Aware Conformal Clinical Planning, which formulates interactive diagnosis as a risk-sensitive sequential decision problem. The framework maintains complementary diagnostic, safety, and masked-evidence beliefs; calibrates turn-specific diagnostic prediction sets and severity-weighted differential-diagnosis risk on held-out diagnostic trajectories; and introduces the calibrated clinical risk into Monte Carlo Tree Search to jointly evaluate long-horizon Ask and Commit trajectories. Experiments on DDXPlus and MediQ show that our method achieves more accurate diagnoses with fewer questions across multiple large language models, while improving differential-diagnosis quality and reducing high-risk errors in severe cases. These findings validate the value of using clinical risk, rather than predictive uncertainty alone, as a planning signal and demonstrate the effectiveness of the proposed framework for information acquisition and risk-aware diagnostic decision making. They also motivate future work on clinical-risk-oriented interactive diagnosis and information-acquisition methods.