Empathy by Design: Aligning Large Language Models for Healthcare Dialogue

Abstract

General-purpose large language models (LLMs) have demonstrated remarkable generative and reasoning capabilities but remain limited in healthcare and caregiving applications due to two key deficiencies: factual unreliability and a lack of empathetic communication. These shortcomings pose significant risks in sensitive contexts where users, particularly non-professionals and caregivers, seek medically relevant guidance or emotional reassurance. To address these challenges, we introduce a Direct Preference Optimization (DPO)-based alignment framework designed to improve factual correctness, semantic coherence, and human-centric qualities such as empathy, politeness, and simplicity in caregiver-patient dialogues. Our approach fine-tunes domain-adapted LLMs using pairwise preference data, where preferred responses reflect supportive and accessible communication styles while rejected ones represent prescriptive or overly technical tones. This direct optimization method aligns model outputs with human preferences more efficiently than traditional reinforcement-learning-based alignment. Empirical evaluations across multiple open and proprietary LLMs show that our DPO-tuned models achieve higher semantic alignment, improved factual accuracy, and stronger human-centric evaluation scores compared to baseline and commercial alternatives such as Google medical dialogue systems. These improvements demonstrate that preference-based alignment offers a scalable and transparent pathway toward developing trustworthy, empathetic, and clinically informed AI assistants for caregiver and healthcare communication. Our open-source code is available at: https://github.com/LeonG19/Empathy-by-Design