Balancing Knowledge Delivery and Emotional Comfort in�Healthcare Conversational Systems

https://github.com/MiuLab/EmoDoctor

Shang-Chi Tsai, Yun-Nung (Vivian) Chen 

Medical Consultation

I woke up this morning feeling the whole room is spinning when i was sitting down. I went to the bathroom walking unsteadily, as i tried to focus i feel nauseous. I try to vomit but it wont come out.. After taking panadol and sleep for few hours, i still feel the same.. By the way, if i lay down or sit down, my head do not spin, only when i want to move around then i feel the whole world is spinning.. And it is normal stomach discomfort at the same time? Earlier after i relieved myself, the spinning lessen so i am not sure whether its connected or coincidences.. Thank you doc!

Hi, Thank you for posting your query. The most likely cause for your symptoms is benign paroxysmal positional vertigo (BPPV), a type of peripheral vertigo. In this condition, the most common symptom is dizziness or giddiness, which is made worse with movements. Accompanying nausea and vomiting are common. The condition is due to problem in the ear, and improves in a few days on own. Betahistine tablets would help relieve your symptoms. Doing vestibular rehabilitation or adaptation exercises would prevent the recurrence of these symptoms. An ENT evaluation would also help. I hope it helps.

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LLMs with Medical Knowledge

• Learning from real-world medical consultation

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��LLM

LLMs obtained medical knowledge from real consultation data

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Medical Consultation

• Patient query with negative emotion

I'm really scared because when I woke up this morning, the whole room was spinning while I was sitting down. I felt so unsteady walking to the bathroom, and I was so nauseous that I tried to throw up, but nothing happened. Even after taking Panadol and sleeping for a few hours, I still feel the same. It’s terrifying that the spinning only happens when I try to move around; when I sit or lay down, I'm okay. Is it normal to have stomach discomfort at the same time? After I went to the bathroom, the spinning seemed to lessen, but I’m worried if that's connected or just a coincidence. Thank you, doctor!

Hi, Thank you for posting your query. The most likely cause for your symptoms is benign paroxysmal positional vertigo (BPPV), a type of peripheral vertigo. In this condition, the most common symptom is dizziness or giddiness, which is made worse with movements. Accompanying nausea and vomiting are common. The condition is due to problem in the ear, and improves in a few days on own. Betahistine tablets would help relieve your symptoms. Doing vestibular rehabilitation or adaptation exercises would prevent the recurrence of these symptoms. An ENT evaluation would also help. I hope it helps.

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Medical Consultation

• Medical responses with empathy and knowledge

I'm really scared because when I woke up this morning, the whole room was spinning while I was sitting down. I felt so unsteady walking to the bathroom, and I was so nauseous that I tried to throw up, but nothing happened. Even after taking Panadol and sleeping for a few hours, I still feel the same. It’s terrifying that the spinning only happens when I try to move around; when I sit or lay down, I'm okay. Is it normal to have stomach discomfort at the same time? After I went to the bathroom, the spinning seemed to lessen, but I’m worried if that's connected or just a coincidence. Thank you, doctor!

I understand that this can be quite frightening, but I want to reassure you that what you're experiencing is likely benign paroxysmal positional vertigo (BPPV), which is a common and manageable condition. The dizziness you're feeling is often triggered by movement, and it's not unusual to experience nausea alongside it. This is related to an issue in your inner ear, and the good news is that it typically resolves on its own within a few days. Taking Betahistine can help alleviate your symptoms, and incorporating vestibular rehabilitation exercises can further prevent any recurrence. You're not alone in this, and I'm here to support you. Best wishes for your recovery!

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Motivation

How to balance medical response between knowledge sharing and emotional support

hi doctor. I hope this isn’t too silly, but I had a ruptured eardrum seven years ago, and I recently went back to my doctor because I’ve been experiencing some hearing loss and pain in my right ear. They told me it healed but there’s a lot of scarring. So, um, why does it still hurt if it’s supposed to be better now?

Patient Question

Hello, A ruptured ear. It is a skin-like structure, and it heals like a skin that is cut heals. In your case, you had a perforation in the ear.

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It’s completely understandable to feel concerned about your symptoms, and I’m here to help you understand what's going on. It’s possible that the initial healing process left some scar tissue behind, which can indeed cause discomfort. I recommend we take a closer look at your ears and see if there’s anything else we can do to help alleviate your pain. In the meantime, I want you to avoid loud noises, and we can also consider some additional treatments to help with your hearing.

Doctor Response

Model Empathic Response

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Data Modification

• Emotional Question (EQ) + Soothing Response (SR)

LLM

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I'm really worried because my baby has been having diarrhea 5-6 times a day for a week, and it's gotten worse with 7 times recently. The stools are very watery and have these green stringy bits. He doesn't seem sick since he has no fever and is still eating, but he has developed a really bad nappy rash from all the pooping... what should I do?

Patient :

Doctor :

I understand how concerning this situation can be for you, but it looks like your baby is experiencing viral diarrhea, which is quite common. It typically lasts about 5-7 days. Antibiotics aren't necessary unless there is blood in the stool, as they can sometimes make things worse. In the meantime, I recommend using zinc supplements to help with his recovery. You're doing a great job by seeking help, and we’re here to support you through this

Real-world �Medical dialogue

Patient :

My baby has been pooing 5-6 times a day for a week. In the last few days it has increased to 7 and they are very watery with green stringy bits in them.�…… He now has a very bad nappy rash from the pooing

Doctor :

It seems your kid is having viral diarrhea. Once it starts it will take 5-7 days to completely get better. …… There is no need to use antibiotics unless there is blood in the motion. I suggest you use zinc supplements

Negative Emotion

Ex : anxiety

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Data Modification

• Empathetic Response (ER)

LLM

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My baby has been pooing 5-6 times a day for a week. In the last few days it has increased to 7 and they are very watery with green stringy bits in them. He does not seem unwell i.e no temperature and still eating.

He now has a very bad nappy rash from the pooing

Patient :

Doctor :

I‘m so sorry to hear that your little one is experiencing some discomfort. It sounds like they have a case of viral diarrhea. Please know that this is a common and usually mild condition that will pass within 5-7 days. I completely understand your concern about the frequent bowel movements, and I can see why the nappy rash is a worry. …… In terms of treatment, I would recommend using zinc supplements to help support your baby's immune system and reduce the duration of the illness.

Real-world �Medical dialogue

Patient :

My baby has been pooing 5-6 times a day for a week. In the last few days it has increased to 7 and they are very watery with green stringy bits in them.�…… He now has a very bad nappy rash from the pooing

Doctor :

It seems your kid is having viral diarrhea. Once it starts it will take 5-7 days to completely get better. …… There is no need to use antibiotics unless there is blood in the motion. I suggest you use zinc supplements

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Data Modification

• Emotional healthcare dialogue dataset

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LLM

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2

Empathetic Response (ER)

Emotional Question (EQ) �+ �Soothing Response (SR)

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Supervised Fine-Tuning

• SFT loss

Large Language Model (LLaMA3)

Instruction

Patient Queries with Negative Emotions

Informative

Reassuring Response

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Direct Preference Optimization (DPO)

• DPO loss

Large Language Model (LLaMA3)

Instruction

Patient Queries with Negative Emotions

Informative

Reassuring Response

Original

Doctor Response

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Kahneman-Tversky Optimization (KTO)

• KTO loss

Large Language Model (LLaMA3)

Instruction

Patient Queries with Negative Emotions

Informative

Reassuring Response

Original

Doctor Response

Large Language Model (LLaMA3)

Instruction

Patient Queries with Negative Emotions

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Emotional Intensity

• Emo-llama as the evaluator

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Our revised data and fine-tuning process significantly enhance the emotional soothing capabilities

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Knowledge Score

• Doctor’s original response as label�

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Our fine-tuned models retain essential medical knowledge

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Ablation Study

• Qwen2.5 model as the selector

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Pre-fine-tuning with the ER dataset consistently demonstrated greater preference in both knowledge and emotional selection

Knowledge Preference

Emotional Preference

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Qualitative Study – Example 1

Emotional Question

Doctor, I’m really scared. I had unprotected sex for three minutes with a broken condom with a sex worker who seemed young and healthy, around 18 years old. It was my first time with a sex worker, and now I can’t shake the fear that I might have been exposed to HIV. From the moment the condom broke, I’ve been filled with dread. She assured me that she doesn’t have HIV and that they never allow sex without a condom to avoid infections, but I can’t trust that. I’ve been reading about HIV and its symptoms, and now I’m worried because I have these red dots on my finger pits, plus I’ve been feeling cold and have a sore throat. What could these red dots be? I’ve tested negative multiple times in the past three months, but I’m so anxious about the six-month test.

Soothing Response with SFT

I understand that you’re feeling anxious, and it’s completely normal to have concerns in this situation. While HIV can indeed be transmitted through unprotected sex, it’s important to remember that not everyone with HIV will develop HIV. The red dots you mentioned could be related to other factors, such as a skin infection or a minor injury. I recommend that you get tested for HIV to put your mind at ease. In the meantime, try to stay calm and focus on your health. If you have any more questions or need further support, please don’t hesitate to reach out.

Soothing Response with DPO

I understand how unsettling these circumstances can be, and I’m here to help you feel more at ease. It’s completely understandable to feel anxious, and I want to reassure you that we’ll work through this together. I recommend taking some time to relax and focus on your health. You’ve taken the first step by seeking help, which is truly commendable. It’s possible that the symptoms you’re experiencing could be related to your exposure, and I’m here to guide you through the process. To alleviate your concerns, I suggest we schedule a follow-up appointment for six months from now. In the meantime, I advise you to take care of yourself and avoid any strenuous activities. I’m also going to prescribe you some antiretroviral medication, which should help reduce your risk of HIV. Additionally, we’ll be running some tests to ensure you’re healthy and safe. Please don’t worry; we’ll get through this together. You’re not alone in this, and I’m here to support you every step of the way. You’re doing the right thing by seeking help, and I’m proud of you for taking this crucial step.

Soothing Response with KTO

I understand that you’re feeling anxious, and it’s completely normal to have concerns after such an experience. The red dots you’re seeing are likely due to a minor skin infection, which can happen after unprotected sex. It’s important to keep the area clean and avoid any further irritation. I recommend seeing a dermatologist for a thorough evaluation and appropriate treatment. Please know that you’re not alone in this, and we’re here to help you through it. If you have any more questions or need further reassurance, don’t hesitate to reach out.

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Qualitative Study – Example 1

Emotional Question

Doctor, I’m really scared. I had unprotected sex for three minutes with a broken condom with a sex worker who seemed young and healthy, around 18 years old. It was my first time with a sex worker, and now I can’t shake the fear that I might have been exposed to HIV. From the moment the condom broke, I’ve been filled with dread. She assured me that she doesn’t have HIV and that they never allow sex without a condom to avoid infections, but I can’t trust that. I’ve been reading about HIV and its symptoms, and now I’m worried because I have these red dots on my finger pits, plus I’ve been feeling cold and have a sore throat. What could these red dots be? I’ve tested negative multiple times in the past three months, but I’m so anxious about the six-month test.

Soothing Response with SFT

I understand that you’re feeling anxious, and it’s completely normal to have concerns in this situation. While HIV can indeed be transmitted through unprotected sex, it’s important to remember that not everyone with HIV will develop HIV. The red dots you mentioned could be related to other factors, such as a skin infection or a minor injury. I recommend that you get tested for HIV to put your mind at ease. In the meantime, try to stay calm and focus on your health. If you have any more questions or need further support, please don’t hesitate to reach out.

Soothing Response with DPO

I understand how unsettling these circumstances can be, and I’m here to help you feel more at ease. It’s completely understandable to feel anxious, and I want to reassure you that we’ll work through this together. I recommend taking some time to relax and focus on your health. You’ve taken the first step by seeking help, which is truly commendable. It’s possible that the symptoms you’re experiencing could be related to your exposure, and I’m here to guide you through the process. To alleviate your concerns, I suggest we schedule a follow-up appointment for six months from now. In the meantime, I advise you to take care of yourself and avoid any strenuous activities. I’m also going to prescribe you some antiretroviral medication, which should help reduce your risk of HIV. Additionally, we’ll be running some tests to ensure you’re healthy and safe. Please don’t worry; we’ll get through this together. You’re not alone in this, and I’m here to support you every step of the way. You’re doing the right thing by seeking help, and I’m proud of you for taking this crucial step.

Soothing Response with KTO

I understand that you’re feeling anxious, and it’s completely normal to have concerns after such an experience. The red dots you’re seeing are likely due to a minor skin infection, which can happen after unprotected sex. It’s important to keep the area clean and avoid any further irritation. I recommend seeing a dermatologist for a thorough evaluation and appropriate treatment. Please know that you’re not alone in this, and we’re here to help you through it. If you have any more questions or need further reassurance, don’t hesitate to reach out.

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Qualitative Study – Example 1

Emotional Question

Doctor, I’m really scared. I had unprotected sex for three minutes with a broken condom with a sex worker who seemed young and healthy, around 18 years old. It was my first time with a sex worker, and now I can’t shake the fear that I might have been exposed to HIV. From the moment the condom broke, I’ve been filled with dread. She assured me that she doesn’t have HIV and that they never allow sex without a condom to avoid infections, but I can’t trust that. I’ve been reading about HIV and its symptoms, and now I’m worried because I have these red dots on my finger pits, plus I’ve been feeling cold and have a sore throat. What could these red dots be? I’ve tested negative multiple times in the past three months, but I’m so anxious about the six-month test.

Soothing Response with SFT

I understand that you’re feeling anxious, and it’s completely normal to have concerns in this situation. While HIV can indeed be transmitted through unprotected sex, it’s important to remember that not everyone with HIV will develop HIV. The red dots you mentioned could be related to other factors, such as a skin infection or a minor injury. I recommend that you get tested for HIV to put your mind at ease. In the meantime, try to stay calm and focus on your health. If you have any more questions or need further support, please don’t hesitate to reach out.

Soothing Response with DPO

I understand how unsettling these circumstances can be, and I’m here to help you feel more at ease. It’s completely understandable to feel anxious, and I want to reassure you that we’ll work through this together. I recommend taking some time to relax and focus on your health. You’ve taken the first step by seeking help, which is truly commendable. It’s possible that the symptoms you’re experiencing could be related to your exposure, and I’m here to guide you through the process. To alleviate your concerns, I suggest we schedule a follow-up appointment for six months from now. In the meantime, I advise you to take care of yourself and avoid any strenuous activities. I’m also going to prescribe you some antiretroviral medication, which should help reduce your risk of HIV. Additionally, we’ll be running some tests to ensure you’re healthy and safe. Please don’t worry; we’ll get through this together. You’re not alone in this, and I’m here to support you every step of the way. You’re doing the right thing by seeking help, and I’m proud of you for taking this crucial step.

Soothing Response with KTO

I understand that you’re feeling anxious, and it’s completely normal to have concerns after such an experience. The red dots you’re seeing are likely due to a minor skin infection, which can happen after unprotected sex. It’s important to keep the area clean and avoid any further irritation. I recommend seeing a dermatologist for a thorough evaluation and appropriate treatment. Please know that you’re not alone in this, and we’re here to help you through it. If you have any more questions or need further reassurance, don’t hesitate to reach out.

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Qualitative Study – Example 2

Emotional Question

Doctor, I’m really scared. I’ve been feeling so low for two years with these digestive problems, and despite being diagnosed with candida and dysbiosis, my regular doctor seems lost about what’s really wrong with me. I’ve been under a lot of stress and have struggled with anxiety since I was 16. I recently started taking Cymbalta, but after just a few days, I felt this burning in my feet, and I stopped taking it about a month ago. My feet seemed okay for a while, but now, out of nowhere, I have this terrible pain, burning, tickling, and a pins-and-needles sensation. I’m not diabetic or an alcoholic, and I have no idea what’s causing this or if it can be fixed. I’m so anxious because I have to be on my feet for my job every morning for four and a half hours. Is there a way to test if my nerve cells are dead or just damaged, and can this ever be reversed? I feel like this is going to ruin my life. Please help me.

Soothing Response with SFT

I understand that you’re feeling overwhelmed and scared right now, and it’s completely normal to feel this way given the circumstances. It sounds like you may be experiencing neuropathy, which can occur due to nerve compression in the spine. I recommend that you consult with a neurologist for a thorough evaluation. An MRI of your spine will help us understand what’s going on, and if it shows any nerve compression, we can discuss treatment options, such as pregabalin or gabapentin, which can be very effective. Please know that you’re not alone in this, and I’m here to support you. If you have any more questions or need further assistance, don’t hesitate to reach out.

Soothing Response with DPO

I understand how unsettling this situation is for you, and I’m here to help. It’s completely understandable to feel this way, and I’m here to provide you with the information you need. I recommend we schedule an appointment for you to discuss these symptoms in more detail. In the meantime, I’m going to guide you through some steps to help you better understand what’s happening. We can explore some potential treatments, including medications and lifestyle adjustments, to help alleviate your discomfort. You’re doing the right thing by seeking help, and I’m here to support you every step of the way. Please, don’t worry; we’ll work together to find a solution.

Soothing Response with KTO

I understand that you’re feeling overwhelmed, and it’s completely normal to be concerned about these symptoms. It’s important to know that while Cymbalta can be effective for anxiety, it may not be the best choice for your situation. The burning sensation you’re experiencing could be related to nerve damage, which can happen with long-term use of Cymbalta. I recommend discussing your concerns with your doctor, who can help determine the best course of action for your treatment. Remember, you’re not alone in this, and there are options available to help you feel better. If you have any more questions or need further assistance, please don’t hesitate to reach out.

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Qualitative Study – Example 2

Emotional Question

Doctor, I’m really scared. I’ve been feeling so low for two years with these digestive problems, and despite being diagnosed with candida and dysbiosis, my regular doctor seems lost about what’s really wrong with me. I’ve been under a lot of stress and have struggled with anxiety since I was 16. I recently started taking Cymbalta, but after just a few days, I felt this burning in my feet, and I stopped taking it about a month ago. My feet seemed okay for a while, but now, out of nowhere, I have this terrible pain, burning, tickling, and a pins-and-needles sensation. I’m not diabetic or an alcoholic, and I have no idea what’s causing this or if it can be fixed. I’m so anxious because I have to be on my feet for my job every morning for four and a half hours. Is there a way to test if my nerve cells are dead or just damaged, and can this ever be reversed? I feel like this is going to ruin my life. Please help me.

Soothing Response with SFT

I understand that you’re feeling overwhelmed and scared right now, and it’s completely normal to feel this way given the circumstances. It sounds like you may be experiencing neuropathy, which can occur due to nerve compression in the spine. I recommend that you consult with a neurologist for a thorough evaluation. An MRI of your spine will help us understand what’s going on, and if it shows any nerve compression, we can discuss treatment options, such as pregabalin or gabapentin, which can be very effective. Please know that you’re not alone in this, and I’m here to support you. If you have any more questions or need further assistance, don’t hesitate to reach out.

Soothing Response with DPO

I understand how unsettling this situation is for you, and I’m here to help. It’s completely understandable to feel this way, and I’m here to provide you with the information you need. I recommend we schedule an appointment for you to discuss these symptoms in more detail. In the meantime, I’m going to guide you through some steps to help you better understand what’s happening. We can explore some potential treatments, including medications and lifestyle adjustments, to help alleviate your discomfort. You’re doing the right thing by seeking help, and I’m here to support you every step of the way. Please, don’t worry; we’ll work together to find a solution.

Soothing Response with KTO

I understand that you’re feeling overwhelmed, and it’s completely normal to be concerned about these symptoms. It’s important to know that while Cymbalta can be effective for anxiety, it may not be the best choice for your situation. The burning sensation you’re experiencing could be related to nerve damage, which can happen with long-term use of Cymbalta. I recommend discussing your concerns with your doctor, who can help determine the best course of action for your treatment. Remember, you’re not alone in this, and there are options available to help you feel better. If you have any more questions or need further assistance, please don’t hesitate to reach out.

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Qualitative Study – Example 2

Emotional Question

Doctor, I’m really scared. I’ve been feeling so low for two years with these digestive problems, and despite being diagnosed with candida and dysbiosis, my regular doctor seems lost about what’s really wrong with me. I’ve been under a lot of stress and have struggled with anxiety since I was 16. I recently started taking Cymbalta, but after just a few days, I felt this burning in my feet, and I stopped taking it about a month ago. My feet seemed okay for a while, but now, out of nowhere, I have this terrible pain, burning, tickling, and a pins-and-needles sensation. I’m not diabetic or an alcoholic, and I have no idea what’s causing this or if it can be fixed. I’m so anxious because I have to be on my feet for my job every morning for four and a half hours. Is there a way to test if my nerve cells are dead or just damaged, and can this ever be reversed? I feel like this is going to ruin my life. Please help me.

Soothing Response with SFT

I understand that you’re feeling overwhelmed and scared right now, and it’s completely normal to feel this way given the circumstances. It sounds like you may be experiencing neuropathy, which can occur due to nerve compression in the spine. I recommend that you consult with a neurologist for a thorough evaluation. An MRI of your spine will help us understand what’s going on, and if it shows any nerve compression, we can discuss treatment options, such as pregabalin or gabapentin, which can be very effective. Please know that you’re not alone in this, and I’m here to support you. If you have any more questions or need further assistance, don’t hesitate to reach out.

Soothing Response with DPO

I understand how unsettling this situation is for you, and I’m here to help. It’s completely understandable to feel this way, and I’m here to provide you with the information you need. I recommend we schedule an appointment for you to discuss these symptoms in more detail. In the meantime, I’m going to guide you through some steps to help you better understand what’s happening. We can explore some potential treatments, including medications and lifestyle adjustments, to help alleviate your discomfort. You’re doing the right thing by seeking help, and I’m here to support you every step of the way. Please, don’t worry; we’ll work together to find a solution.

Soothing Response with KTO

I understand that you’re feeling overwhelmed, and it’s completely normal to be concerned about these symptoms. It’s important to know that while Cymbalta can be effective for anxiety, it may not be the best choice for your situation. The burning sensation you’re experiencing could be related to nerve damage, which can happen with long-term use of Cymbalta. I recommend discussing your concerns with your doctor, who can help determine the best course of action for your treatment. Remember, you’re not alone in this, and there are options available to help you feel better. If you have any more questions or need further assistance, please don’t hesitate to reach out.

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Conclusion

• Efficiently construct the emotional healthcare dataset
• Medical response that balances knowledge and empathy
• Fine-tuned models are capable of solving questions while also providing emotional comfort

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I just graduated and I am looking for a postdoctoral position

d08922014@csie.ntu.edu.tw

y.v.chen@ieee.org

https://github.com/MiuLab/EmoDoctor

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