Learning Reinforced Agents with Counterfactual Simulation for Medical Automatic Diagnosis

Medical automatic diagnosis (MAD) aims to learn an agent that mimics the behavior of a human doctor, i.e. inquiring symptoms and informing diseases. Due to medical ethics concerns, it is impractical to directly apply reinforcement learning techniques to solving MAD, e.g., training a reinforced agent with the human patient. Developing a patient simulator by using the collected patient-doctor dialogue records has been proposed as a promising approach to MAD. However, most of these existing works overlook the causal relationship between patient symptoms and disease diagnoses. For example, these simulators simply generate the ``not-sure'' response to the inquiry (i.e., symptom) that was not observed in one dialogue record. As a result, the MAD agent is usually trained without exploiting the counterfactual reasoning beyond the factual observations. To address this problem, this paper presents a propensity-based patient simulator (PBPS), which is capable of facilitating the training of MAD agents by generating informative counterfactual answers along with the disease diagnosis. Specifically, our PBPS estimates the propensity score of each record with the patient-doctor dialogue reasoning, and can thus generate the counterfactual answers by searching across records. That is, the unrecorded symptom for one patient can be found in the records of other patients according to the propensity score matching. A progressive assurance agent (P2A) can be thus trained with PBPS, which includes two separate yet cooperative branches accounting for the execution of symptom-inquiry and disease-diagnosis actions, respectively. The disease-diagnosis predicts the confidence of disease and drives the symptom-inquiry in terms of enhancing the confidence, and the two branches are jointly optimized with benefiting from each other.