Daily Papers

In recent years, large language models have shown substantial potential in psychological support tasks. However, existing psychological counseling data mostly rely on single-turn question answering or short multi-turn dialogues, making it difficult to characterize how college students' psychological distress accumulates, interacts, and gradually evolves over long periods within campus life events. To address this issue, this paper proposes Psy-Chronicle, a structured data-generation framework for synthesizing long-horizon campus psychological counseling dialogues. We generate a semester-spanning temporal stress event graph to model the chronological order and evolutionary dependencies among campus stress events. Through interactive simulation between a student agent and a counselor agent, together with a structured memory integration mechanism, Psy-Chronicle generates long-horizon dialogues with continuity across counseling sessions. Based on Psy-Chronicle, we construct and open-source CPCD, a Chinese long-horizon dialogue dataset for college psychological counseling, containing 100 student profiles, 90,000 counseling dialogues. We further build CPCD-Bench to evaluate models' long-horizon campus counseling capabilities from three dimensions: session-level response, long-horizon memory recall, and temporal-causal reasoning. Experimental results show that CPCD effectively improves session-level response generation and long-horizon memory recall for models with the same base architecture. Meanwhile, improvements in temporal-causal reasoning remain limited, indicating that event-chain organization and causal explanation are key challenges in long-horizon psychological counseling modeling. The related code and data are available at: https://github.com/EdwinUSTB/Psy-Chronicle

Virtual counselors powered by large language models (LLMs) aim to create interactive support systems that effectively assist clients struggling with mental health challenges. To replicate counselor-client conversations, researchers have built an online mental health platform that allows professional counselors to provide clients with text-based counseling services for about an hour per session. Notwithstanding its effectiveness, challenges exist as human annotation is time-consuming, cost-intensive, privacy-protected, and not scalable. To address this issue and investigate the applicability of LLMs in psychological counseling conversation simulation, we propose a framework that employs two LLMs via role-playing for simulating counselor-client interactions. Our framework involves two LLMs, one acting as a client equipped with a specific and real-life user profile and the other playing the role of an experienced counselor, generating professional responses using integrative therapy techniques. We implement both the counselor and the client by zero-shot prompting the GPT-4 model. In order to assess the effectiveness of LLMs in simulating counselor-client interactions and understand the disparities between LLM- and human-generated conversations, we evaluate the synthetic data from various perspectives. We begin by assessing the client's performance through automatic evaluations. Next, we analyze and compare the disparities between dialogues generated by the LLM and those generated by professional counselors. Furthermore, we conduct extensive experiments to thoroughly examine the performance of our LLM-based counselor trained with synthetic interactive dialogues by benchmarking against state-of-the-art models for mental health.

Graph Retrieval Augmented Generation (GraphRAG) effectively enhances external knowledge integration capabilities by explicitly modeling knowledge relationships, thereby improving the factual accuracy and generation quality of Large Language Models (LLMs) in specialized domains. However, existing methods suffer from two inherent limitations: 1) Inefficient Information Aggregation: They rely on a single agent and fixed iterative patterns, making it difficult to adaptively capture multi-level textual, structural, and degree information within graph data. 2) Rigid Reasoning Mechanism: They employ preset reasoning schemes, which cannot dynamically adjust reasoning depth nor achieve precise semantic correction. To overcome these limitations, we propose Graph Counselor, an GraphRAG method based on multi-agent collaboration. This method uses the Adaptive Graph Information Extraction Module (AGIEM), where Planning, Thought, and Execution Agents work together to precisely model complex graph structures and dynamically adjust information extraction strategies, addressing the challenges of multi-level dependency modeling and adaptive reasoning depth. Additionally, the Self-Reflection with Multiple Perspectives (SR) module improves the accuracy and semantic consistency of reasoning results through self-reflection and backward reasoning mechanisms. Experiments demonstrate that Graph Counselor outperforms existing methods in multiple graph reasoning tasks, exhibiting higher reasoning accuracy and generalization ability. Our code is available at https://github.com/gjq100/Graph-Counselor.git.

The growing demand for scalable psychological counseling highlights the need for high-quality, privacy-compliant data, yet such data remains scarce. Here we introduce MAGneT, a novel multi-agent framework for synthetic psychological counseling session generation that decomposes counselor response generation into coordinated sub-tasks handled by specialized LLM agents, each modeling a key psychological technique. Unlike prior single-agent approaches, MAGneT better captures the structure and nuance of real counseling. We further propose a unified evaluation framework that consolidates diverse automatic metrics and expands expert assessment from four to nine counseling dimensions, thus addressing inconsistencies in prior evaluation protocols. Empirically, MAGneT substantially outperforms existing methods: experts prefer MAGneT-generated sessions in 77.2% of cases, and sessions generated by MAGneT yield 3.2% higher general counseling skills and 4.3% higher CBT-specific skills on cognitive therapy rating scale (CTRS). A open source Llama3-8B-Instruct model fine-tuned on MAGneT-generated data also outperforms models fine-tuned using baseline synthetic datasets by 6.9% on average on CTRS.We also make our code and data public.

As mental health issues globally escalate, there is a tremendous need for advanced digital support systems. We introduce MentalAgora, a novel framework employing large language models enhanced by interaction between multiple agents for tailored mental health support. This framework operates through three stages: strategic debating, tailored counselor creation, and response generation, enabling the dynamic customization of responses based on individual user preferences and therapeutic needs. We conduct experiments utilizing a high-quality evaluation dataset TherapyTalk crafted with mental health professionals, shwoing that MentalAgora generates expert-aligned and user preference-enhanced responses. Our evaluations, including experiments and user studies, demonstrate that MentalAgora aligns with professional standards and effectively meets user preferences, setting a new benchmark for digital mental health interventions.

Large Language Models (LLMs) have demonstrated promising potential in providing empathetic support during interactions. However, their responses often become verbose or overly formulaic, failing to adequately address the diverse emotional support needs of real-world scenarios. To tackle this challenge, we propose an innovative strategy-enhanced role-playing framework, designed to simulate authentic emotional support conversations. Specifically, our approach unfolds in two steps: (1) Strategy-Enhanced Role-Playing Interactions, which involve three pivotal roles -- Seeker, Strategy Counselor, and Supporter -- engaging in diverse scenarios to emulate real-world interactions and promote a broader range of dialogues; and (2) Emotional Support Agent Training, achieved through fine-tuning LLMs using our specially constructed dataset. Within this framework, we develop the ServeForEmo dataset, comprising an extensive collection of 3.7K+ multi-turn dialogues and 62.8K+ utterances. We further present SweetieChat, an emotional support agent capable of handling diverse open-domain scenarios. Extensive experiments and human evaluations confirm the framework's effectiveness in enhancing emotional support, highlighting its unique ability to provide more nuanced and tailored assistance.

Large language models (LLMs) have demonstrated notable advancements in psychological counseling. However, existing models generally do not explicitly model seekers' emotion shifts across counseling sessions, a core focus in classical psychological schools. Moreover, how to align counselor models' responses with these emotion shifts while proactively mitigating safety risks remains underexplored. To bridge these gaps, we propose PsychēChat, which explicitly integrates emotion shift tracking and safety risk analysis for psychological counseling. Specifically, we employ interactive role-playing to synthesize counselor--seeker dialogues, incorporating two modules: Emotion Management Module, to capture seekers' current emotions and emotion shifts; and Risk Control Module, to anticipate seekers' subsequent reactions and identify potential risks. Furthermore, we introduce two modeling paradigms. The Agent Mode structures emotion management, risk control, and counselor responses into a collaborative multi-agent pipeline. The LLM Mode integrates these stages into a unified chain-of-thought for end-to-end inference, balancing efficiency and performance. Extensive experiments, including interactive scoring, dialogue-level evaluation, and human assessment, demonstrate that PsychēChat outperforms existing methods for emotional insight and safety control.

Rising demand for mental health support has increased interest in using Large Language Models (LLMs) for counseling. However, adapting LLMs to this high-risk safety-critical domain is hindered by the scarcity of real-world counseling data due to privacy constraints. Synthetic datasets provide a promising alternative, but existing approaches often rely on unstructured or semi-structured text inputs and overlook structural dependencies between a client's cognitive, emotional, and behavioral states, often producing psychologically inconsistent interactions and reducing data realism and quality. We introduce Graph2Counsel, a framework for generating synthetic counseling sessions grounded in Client Psychological Graphs (CPGs) that encode relationships among clients' thoughts, emotions, and behaviors. Graph2Counsel employs a structured prompting pipeline guided by counselor strategies and CPG, and explores prompting strategies including CoT (Wei et al., 2022) and Multi-Agent Feedback (Li et al., 2025a). Graph2Counsel produces 760 sessions from 76 CPGs across diverse client profiles. In expert evaluation, our dataset outperforms prior datasets on specificity, counselor competence, authenticity, conversational flow, and safety, with substantial inter-annotator agreement (Krippendorff's α = 0.70). Fine-tuning an open-source model on this dataset improves performance on CounselingBench (Nguyen et al., 2025) and CounselBench (Li et al., 2025b), showing downstream utility. We also make our code and data public.

Constrained by the cost and ethical concerns of involving real seekers in AI-driven mental health, researchers develop LLM-based conversational agents (CAs) with tailored configurations, such as profiles, symptoms, and scenarios, to simulate seekers. While these efforts advance AI in mental health, achieving more realistic seeker simulation remains hindered by two key challenges: dynamic evolution and multi-session memory. Seekers' mental states often fluctuate during counseling, which typically spans multiple sessions. To address this, we propose AnnaAgent, an emotional and cognitive dynamic agent system equipped with tertiary memory. AnnaAgent incorporates an emotion modulator and a complaint elicitor trained on real counseling dialogues, enabling dynamic control of the simulator's configurations. Additionally, its tertiary memory mechanism effectively integrates short-term and long-term memory across sessions. Evaluation results, both automated and manual, demonstrate that AnnaAgent achieves more realistic seeker simulation in psychological counseling compared to existing baselines. The ethically reviewed and screened code can be found on https://github.com/sci-m-wang/AnnaAgent.

Millions of users come to online peer counseling platforms to seek support on diverse topics ranging from relationship stress to anxiety. However, studies show that online peer support groups are not always as effective as expected largely due to users' negative experiences with unhelpful counselors. Peer counselors are key to the success of online peer counseling platforms, but most of them often do not have systematic ways to receive guidelines or supervision. In this work, we introduce CARE: an interactive AI-based tool to empower peer counselors through automatic suggestion generation. During the practical training stage, CARE helps diagnose which specific counseling strategies are most suitable in the given context and provides tailored example responses as suggestions. Counselors can choose to select, modify, or ignore any suggestion before replying to the support seeker. Building upon the Motivational Interviewing framework, CARE utilizes large-scale counseling conversation data together with advanced natural language generation techniques to achieve these functionalities. We demonstrate the efficacy of CARE by performing both quantitative evaluations and qualitative user studies through simulated chats and semi-structured interviews. We also find that CARE especially helps novice counselors respond better in challenging situations.

In mental health counseling, a variety of earlier studies have focused on dialogue modeling. However, most of these studies give limited to no emphasis on the quality of interaction between a patient and a therapist. The therapeutic bond between a patient and a therapist directly correlates with effective mental health counseling. It involves developing the patient's trust on the therapist over the course of counseling. To assess the therapeutic bond in counseling, we introduce trust as a therapist-assistive metric. Our definition of trust involves patients' willingness and openness to express themselves and, consequently, receive better care. We conceptualize it as a dynamic trajectory observable through textual interactions during the counseling. To facilitate trust modeling, we present MENTAL-TRUST, a novel counseling dataset comprising manual annotation of 212 counseling sessions with first-of-its-kind seven expert-verified ordinal trust levels. We project our problem statement as an ordinal classification task for trust quantification and propose a new benchmark, TrustBench, comprising a suite of classical and state-of-the-art language models on MENTAL-TRUST. We evaluate the performance across a suite of metrics and lay out an exhaustive set of findings. Our study aims to unfold how trust evolves in therapeutic interactions.

This technical brief introduces Deep Agent, an advanced autonomous AI system designed to manage complex multi-phase tasks through a novel hierarchical task management architecture. The system's foundation is built on our Hierarchical Task DAG (HTDAG) framework, which dynamically decomposes high-level objectives into manageable sub-tasks while rigorously maintaining dependencies and execution coherence. Deep Agent advances beyond traditional agent systems through three key innovations: First, it implements a recursive two-stage planner-executor architecture that enables continuous task refinement and adaptation as circumstances change. Second, it features an Autonomous API & Tool Creation (AATC) system that automatically generates reusable components from UI interactions, substantially reducing operational costs for similar tasks. Third, it incorporates Prompt Tweaking Engine and Autonomous Prompt Feedback Learning components that optimize Large Language Model prompts for specific scenarios, enhancing both inference accuracy and operational stability. These components are integrated to form a service infrastructure that manages user contexts, handles complex task dependencies, and orchestrates end-to-end agentic workflow execution. Through this sophisticated architecture, Deep Agent establishes a novel paradigm in self-governing AI systems, demonstrating robust capability to independently handle intricate, multi-step tasks while maintaining consistent efficiency and reliability through continuous self-optimization.

Most language-based assistants follow a reactive ask-and-respond paradigm, requiring users to explicitly state their needs. As a result, relevant but unexpressed needs often go unmet. Existing proactive agents attempt to address this gap either by eliciting further clarification, preserving this burden, or by extrapolating future needs from context, often leading to unnecessary or mistimed interventions. We introduce ProPer, Proactivity-driven Personalized agents, a novel two-agent architecture consisting of a Dimension Generating Agent (DGA) and a Response Generating Agent (RGA). DGA, a fine-tuned LLM agent, leverages explicit user data to generate multiple implicit dimensions (latent aspects relevant to the user's task but not considered by the user) or knowledge gaps. These dimensions are selectively filtered using a reranker based on quality, diversity, and task relevance. RGA then balances explicit and implicit dimensions to tailor personalized responses with timely and proactive interventions. We evaluate ProPer across multiple domains using a structured, gap-aware rubric that measures coverage, initiative appropriateness, and intent alignment. Our results show that ProPer improves quality scores and win rates across all domains, achieving up to 84% gains in single-turn evaluation and consistent dominance in multi-turn interactions.

Simulating human clients in mental health counseling is crucial for training and evaluating counselors (both human or simulated) in a scalable manner. Nevertheless, past research on client simulation did not focus on complex conversation tasks such as mental health counseling. In these tasks, the challenge is to ensure that the client's actions (i.e., interactions with the counselor) are consistent with with its stipulated profiles and negative behavior settings. In this paper, we propose a novel framework that supports consistent client simulation for mental health counseling. Our framework tracks the mental state of a simulated client, controls its state transitions, and generates for each state behaviors consistent with the client's motivation, beliefs, preferred plan to change, and receptivity. By varying the client profile and receptivity, we demonstrate that consistent simulated clients for different counseling scenarios can be effectively created. Both our automatic and expert evaluations on the generated counseling sessions also show that our client simulation method achieves higher consistency than previous methods.

Empathy is fundamental to human interactions, yet it remains unclear whether embodied agents can provide human-like empathetic support. Existing works have studied agents' tasks solving and social interactions abilities, but whether agents can understand empathetic needs and conduct empathetic behaviors remains overlooked. To address this, we introduce EmpathyAgent, the first benchmark to evaluate and enhance agents' empathetic actions across diverse scenarios. EmpathyAgent contains 10,000 multimodal samples with corresponding empathetic task plans and three different challenges. To systematically evaluate the agents' empathetic actions, we propose an empathy-specific evaluation suite that evaluates the agents' empathy process. We benchmark current models and found that exhibiting empathetic actions remains a significant challenge. Meanwhile, we train Llama3-8B using EmpathyAgent and find it can potentially enhance empathetic behavior. By establishing a standard benchmark for evaluating empathetic actions, we hope to advance research in empathetic embodied agents. Our code and data are publicly available at https://github.com/xinyan-cxy/EmpathyAgent.

To develop a reliable AI for psychological assessment, we introduce PsychEval, a multi-session, multi-therapy, and highly realistic benchmark designed to address three key challenges: 1) Can we train a highly realistic AI counselor? Realistic counseling is a longitudinal task requiring sustained memory and dynamic goal tracking. We propose a multi-session benchmark (spanning 6-10 sessions across three distinct stages) that demands critical capabilities such as memory continuity, adaptive reasoning, and longitudinal planning. The dataset is annotated with extensive professional skills, comprising over 677 meta-skills and 4577 atomic skills. 2) How to train a multi-therapy AI counselor? While existing models often focus on a single therapy, complex cases frequently require flexible strategies among various therapies. We construct a diverse dataset covering five therapeutic modalities (Psychodynamic, Behaviorism, CBT, Humanistic Existentialist, and Postmodernist) alongside an integrative therapy with a unified three-stage clinical framework across six core psychological topics. 3) How to systematically evaluate an AI counselor? We establish a holistic evaluation framework with 18 therapy-specific and therapy-shared metrics across Client-Level and Counselor-Level dimensions. To support this, we also construct over 2,000 diverse client profiles. Extensive experimental analysis fully validates the superior quality and clinical fidelity of our dataset. Crucially, PsychEval transcends static benchmarking to serve as a high-fidelity reinforcement learning environment that enables the self-evolutionary training of clinically responsible and adaptive AI counselors.

As humans delegate more tasks and decisions to artificial intelligence (AI), we risk losing control of our individual and collective futures. Relatively simple algorithmic systems already steer human decision-making, such as social media feed algorithms that lead people to unintentionally and absent-mindedly scroll through engagement-optimized content. In this paper, we develop the idea of human agency by integrating philosophical and scientific theories of agency with AI-assisted evaluation methods: using large language models (LLMs) to simulate and validate user queries and to evaluate AI responses. We develop HumanAgencyBench (HAB), a scalable and adaptive benchmark with six dimensions of human agency based on typical AI use cases. HAB measures the tendency of an AI assistant or agent to Ask Clarifying Questions, Avoid Value Manipulation, Correct Misinformation, Defer Important Decisions, Encourage Learning, and Maintain Social Boundaries. We find low-to-moderate agency support in contemporary LLM-based assistants and substantial variation across system developers and dimensions. For example, while Anthropic LLMs most support human agency overall, they are the least supportive LLMs in terms of Avoid Value Manipulation. Agency support does not appear to consistently result from increasing LLM capabilities or instruction-following behavior (e.g., RLHF), and we encourage a shift towards more robust safety and alignment targets.

The growing demand for mental health support has highlighted the importance of conversational agents as human supporters worldwide and in China. These agents could increase availability and reduce the relative costs of mental health support. The provided support can be divided into two main types: cognitive and emotional support. Existing work on this topic mainly focuses on constructing agents that adopt Cognitive Behavioral Therapy (CBT) principles. Such agents operate based on pre-defined templates and exercises to provide cognitive support. However, research on emotional support using such agents is limited. In addition, most of the constructed agents operate in English, highlighting the importance of conducting such studies in China. In this study, we analyze the effectiveness of Emohaa in reducing symptoms of mental distress. Emohaa is a conversational agent that provides cognitive support through CBT-based exercises and guided conversations. It also emotionally supports users by enabling them to vent their desired emotional problems. The study included 134 participants, split into three groups: Emohaa (CBT-based), Emohaa (Full), and control. Experimental results demonstrated that compared to the control group, participants who used Emohaa experienced considerably more significant improvements in symptoms of mental distress. We also found that adding the emotional support agent had a complementary effect on such improvements, mainly depression and insomnia. Based on the obtained results and participants' satisfaction with the platform, we concluded that Emohaa is a practical and effective tool for reducing mental distress.

Large language models (LLMs) in psychological counseling have attracted increasing attention. However, existing approaches often lack emotional understanding, adaptive strategies, and the use of therapeutic methods across multiple sessions with long-term memory, leaving them far from real clinical practice. To address these critical gaps, we introduce TheraMind, a strategic and adaptive agent for longitudinal psychological counseling. The cornerstone of TheraMind is a novel dual-loop architecture that decouples the complex counseling process into an Intra-Session Loop for tactical dialogue management and a Cross-Session Loop for strategic therapeutic planning. The Intra-Session Loop perceives the patient's emotional state to dynamically select response strategies while leveraging cross-session memory to ensure continuity. Crucially, the Cross-Session Loop empowers the agent with long-term adaptability by evaluating the efficacy of the applied therapy after each session and adjusting the method for subsequent interactions. We validate our approach in a high-fidelity simulation environment grounded in real clinical cases. Extensive evaluations show that TheraMind outperforms other methods, especially on multi-session metrics like Coherence, Flexibility, and Therapeutic Attunement, validating the effectiveness of its dual-loop design in emulating strategic, adaptive, and longitudinal therapeutic behavior. The code is publicly available at https://0mwwm0.github.io/TheraMind/.

Due to the lack of human resources for mental health support, there is an increasing demand for employing conversational agents for support. Recent work has demonstrated the effectiveness of dialogue models in providing emotional support. As previous studies have demonstrated that seekers' persona is an important factor for effective support, we investigate whether there are benefits to modeling such information in dialogue models for support. In this paper, our empirical analysis verifies that persona has an important impact on emotional support. Therefore, we propose a framework for dynamically inferring and modeling seekers' persona. We first train a model for inferring the seeker's persona from the conversation history. Accordingly, we propose PAL, a model that leverages persona information and, in conjunction with our strategy-based controllable generation method, provides personalized emotional support. Automatic and manual evaluations demonstrate that PAL achieves state-of-the-art results, outperforming the baselines on the studied benchmark. Our code and data are publicly available at https://github.com/chengjl19/PAL.

In this work, we introduce MedAgentSim, an open-source simulated clinical environment with doctor, patient, and measurement agents designed to evaluate and enhance LLM performance in dynamic diagnostic settings. Unlike prior approaches, our framework requires doctor agents to actively engage with patients through multi-turn conversations, requesting relevant medical examinations (e.g., temperature, blood pressure, ECG) and imaging results (e.g., MRI, X-ray) from a measurement agent to mimic the real-world diagnostic process. Additionally, we incorporate self improvement mechanisms that allow models to iteratively refine their diagnostic strategies. We enhance LLM performance in our simulated setting by integrating multi-agent discussions, chain-of-thought reasoning, and experience-based knowledge retrieval, facilitating progressive learning as doctor agents interact with more patients. We also introduce an evaluation benchmark for assessing the LLM's ability to engage in dynamic, context-aware diagnostic interactions. While MedAgentSim is fully automated, it also supports a user-controlled mode, enabling human interaction with either the doctor or patient agent. Comprehensive evaluations in various simulated diagnostic scenarios demonstrate the effectiveness of our approach. Our code, simulation tool, and benchmark are available at https://medagentsim.netlify.app/.

Recently, the demand for psychological counseling has significantly increased as more individuals express concerns about their mental health. This surge has accelerated efforts to improve the accessibility of counseling by using large language models (LLMs) as counselors. To ensure client privacy, training open-source LLMs faces a key challenge: the absence of realistic counseling datasets. To address this, we introduce Cactus, a multi-turn dialogue dataset that emulates real-life interactions using the goal-oriented and structured approach of Cognitive Behavioral Therapy (CBT). We create a diverse and realistic dataset by designing clients with varied, specific personas, and having counselors systematically apply CBT techniques in their interactions. To assess the quality of our data, we benchmark against established psychological criteria used to evaluate real counseling sessions, ensuring alignment with expert evaluations. Experimental results demonstrate that Camel, a model trained with Cactus, outperforms other models in counseling skills, highlighting its effectiveness and potential as a counseling agent. We make our data, model, and code publicly available.

Recent progress in Large Language Models (LLMs) has drawn attention to their potential for accelerating drug discovery. However, a central problem remains: translating theoretical ideas into robust implementations in the highly specialized context of pharmaceutical research. This limitation prevents practitioners from making full use of the latest AI developments in drug discovery. To address this challenge, we introduce DrugAgent, a multi-agent framework that automates machine learning (ML) programming for drug discovery tasks. DrugAgent employs an LLM Planner that formulates high-level ideas and an LLM Instructor that identifies and integrates domain knowledge when implementing those ideas. We present case studies on three representative drug discovery tasks. Our results show that DrugAgent consistently outperforms leading baselines, including a relative improvement of 4.92% in ROC-AUC compared to ReAct for drug-target interaction (DTI). DrugAgent is publicly available at https://anonymous.4open.science/r/drugagent-5C42/.

Real-world clinical diagnosis is a complex process in which the doctor is required to obtain information from both interaction with the patient and conducting medical exams. Additionally, the doctor needs to adapt to different patient personas, as well as noisy and incomplete information that can happen at any time during the process. However, existing benchmarks for medical LLMs and methods for automatic diagnosis largely simplify this process by reducing it to single-turn question answering, noise-free conversations, or sequential exam making, etc., ignoring the interactive and uncertain nature of clinical diagnosis. In this paper, we aim to address this gap by formalizing clinical diagnosis as a Partially Observable Markov Decision Process (POMDP) with three action types: questioning the patient, ordering medical exams as tool calls, and issuing a diagnosis. We also introduce a systematic noise model comprising seven patient noise types and three exam noise types. Using our proposed environment, we train an effective diagnosis agent, MedExAgent, through a two-stage pipeline that first performs supervised finetuning on synthetic conversations structured after the Calgary-Cambridge model for clinical interviews, and then applies DAPO to optimize a composite reward capturing diagnostic accuracy, tool call quality, and exam cost including financial cost and patient discomfort. Through extensive experiments and ablation studies, we demonstrate that MedExAgent achieves diagnostic performance comparable to larger models while maintaining cost-efficient examination strategies.