Medical consultation (MC) is an interactive decision-making process that requires dynamically adapting inquiry directions according to evolving patient feedback. Although large language models (LLMs) have demonstrated strong planning capabilities in medical applications, existing LLM-based MC methods typically make turn-level independent inquiry decisions without adaptive control over global inquiry directions, making them prone to inefficient local exploration. To address this limitation, we propose MCPlanner, a hierarchical adaptive planning-based MC framework in which a high-level planner adaptively controls the inquiry direction, while a low-level planner executes inquiry actions under the selected direction. Additionally, MCPlanner introduces expert-guided distillation and a smoothed confidence calibration strategy to improve high-level planning efficiency and diagnostic accuracy. Experimental results on DXY, GMD, and CMD show that MCPlanner achieves best diagnostic accuracies of 95.2%, 90.8%, and 76.1%, respectively. Notably, on CMD, MCPlanner outperforms the strongest baseline by 5.0 percentage points. Code is publicly available at https://github.com/zh-jia/MCPlanner.

Large Language Models (LLMs) demonstrate strong generalization and reasoning abilities, making them well-suited for complex decision-making tasks such as medical consultation (MC). However, existing LLM-based methods often fail to capture the dual nature of MC, which entails two distinct sub-tasks: symptom inquiry, a sequential decision-making process, and disease diagnosis, a classification problem. This mismatch often results in ineffective symptom inquiry and unreliable disease diagnosis. To address this, we propose DDO, a novel LLM-based framework that performs Dual-Decision Optimization by decoupling the two sub-tasks and optimizing them with distinct objectives through a collaborative multi-agent workflow. Experiments on three real-world MC datasets show that DDO consistently outperforms existing LLM-based approaches and achieves competitive performance with state-of-the-art generation-based methods, demonstrating its effectiveness in the MC task. The code is available at https://github.com/zh-jia/DDO.

Finetuning large language models (LLMs) has been empirically effective on a variety of downstream tasks. Existing approaches to finetuning an LLM either focus on parameter-efficient finetuning, which only updates a small number of trainable parameters, or attempt to reduce the memory footprint during the training phase of the finetuning. Typically, the memory footprint during finetuning stems from three contributors: model weights, optimizer states, and intermediate activations. However, existing works still require considerable memory, and none can simultaneously mitigate the memory footprint of all three sources. In this paper, we present quantized side tuing (QST), which enables memory-efficient and fast finetuning of LLMs by operating through a dual-stage process. First, QST quantizes an LLM’s model weights into 4-bit to reduce the memory footprint of the LLM’s original weights. Second, QST introduces a side network separated from the LLM, which utilizes the hidden states of the LLM to make task-specific predictions. Using a separate side network avoids performing back-propagation through the LLM, thus reducing the memory requirement of the intermediate activations. Finally, QST leverages several low-rank adaptors and gradient-free downsample modules to significantly reduce the trainable parameters, so as to save the memory footprint of the optimizer states. Experiments show that QST can reduce the total memory footprint by up to 2.3× and speed up the finetuning process by up to 3× while achieving competent performance compared with the state-of-the-art. When it comes to full finetuning, QST can reduce the total memory footprint up to 7×.