Though Large Vision-Language Models (LVLMs) are being actively explored in medicine, their ability to conduct complex real-world telemedicine consultations combining accurate diagnosis with professional dialogue remains underexplored. This paper presents **3MDBench** (**M**edical **M**ultimodal **M**ulti-agent **D**ialogue **Bench**mark), an open-source framework for simulating and evaluating LVLM-driven telemedical consultations. 3MDBench simulates patient variability through temperament-based Patient Agent and evaluates diagnostic accuracy and dialogue quality via Assessor Agent. It includes 2996 cases across 34 diagnoses from real-world telemedicine interactions, combining textual and image-based data. The experimental study compares diagnostic strategies for widely used open and closed-source LVLMs. We demonstrate that multimodal dialogue with internal reasoning improves F1 score by 6.5% over non-dialogue settings, highlighting the importance of context-aware, information-seeking questioning. Moreover, injecting predictions from a diagnostic convolutional neural network into the LVLM’s context boosts F1 by up to 20%. Source code is available at https://github.com/univanxx/3mdbench.