Evidence, Logic, and Compliance: Multi-Agent Structured Graph Reasoning with Expert Arbitration for Medical Referral
Authors: Qi Peng, Yi Cai, Jialin Cui, Tong Zhu, Yujuan Ding, Qingbao Huang, Tao Wang, Jiayuan Xie, +2 more
Organizations: School of Software Engineering, South China University of Technology, Guangzhou, China · School of Computer Science and Network Engineering, Guangzhou University, Guangzhou China · Department of Computing, Hong Kong Polytechnic University, Hong Kong, China · School of Electrical Engineering, Guangxi University, Guangxi China · Department of Biostatistics & Health Informatics (BHI), King’s College London, London
Abstract
Medical referral (directing patients to the appropriate hospital department) is a complex decision-making process requiring the synthesis of multimodal data, including patient narratives, laboratory indicators, and radiology imaging. While Large Language Models (LLMs) have advanced medical dialogue systems, they struggle with real-world referral tasks due to two primary limitations: (1) Information Overload, where models fixate on high-frequency disease terms while overlooking subtle but critical urgency indicators; and (2) Unstructured Collaboration, where existing multi-agent frameworks rely on loose dialogue that leads to semantic drift and confirmation bias. To address these challenges, we introduce MASGR (Multi-Agent Structured Graph Reasoning), a framework that treats referral not as a classification task but as a structured graph construction problem. MASGR deploys specialized agents to extract evidence from distinct modalities and coordinates them through a clinical reasoning graph. This graph forces agents to establish explicit logical connections between conflicting evidence. Furthermore, we integrate a knowledge-guided arbitration mechanism that prioritizes patient safety rules over standard diagnostic classification. Extensive experiments on real-world medical records demonstrate that MASGR significantly outperforms state-of-the-art LLMs and existing multi-agent systems, particularly in complex cases requiring the balancing of chronic disease management and emergency intervention. The AI contribution lies in the Multi-Agent Structured Graph Reasoning framework that transforms unstructured multi-agent dialogue into a verifiable logical graph construction. The engineering application is demonstrated through its deployment in a complex healthcare decision-making system to optimize the precision of complex medical referrals.
Real-world clinical decision support requires reasoning over heterogeneous and longitudinal patient information rather than answering isolated medical questions. However, current medical large language models and retrieval-augmented generation systems often rely on single-step prompting or retrieval, which can be fragile when clinical evidence is distributed across long electronic health records, medical images, sensor streams, guidelines, and referral constraints. This paper proposes MedRLM, a Recursive Multimodal Health Intelligence framework for long-context clinical reasoning, sensor-guided screening, and community-to-tertiary referral support. Instead of compressing all patient information into one prompt, MedRLM treats the patient case as an external clinical environment that can be recursively inspected, decomposed, retrieved, verified, and synthesized. The framework coordinates specialized agents for clinical text, longitudinal EHR, medical imaging, physiological sensor signals, guideline retrieval, uncertainty auditing, and referral planning. It further introduces a Clinical Evidence Graph Memory to connect patient-specific observations with retrieved evidence, standardized definitions, sensor-derived biomarkers, and referral criteria. A sensor-guided recursive triggering mechanism activates deeper reasoning when abnormal physiological or behavioral patterns are detected, while uncertainty-gated refinement supports clinician review for high-risk or low-confidence cases. We also outline a real-data evaluation design using public and credentialed clinical datasets spanning EHR, radiology, ECG, ICU time series, and referral-proxy outcomes. MedRLM aims to move medical AI from static question answering toward auditable, multimodal, and workflow-aware clinical decision support.
Large language model (LLM) driven multi-agent systems have shown promise in complex clinical reasoning, yet existing approaches rely on static strategies and lack persistent clinical memory, preventing self-evolving from prior diagnostic successes and failures. We present EMR, a self-evolving medical multi-agent system via Experience Mining and Reuse. EMR introduces a hierarchical clinical experience library that organizes accumulated knowledge into three levels: clinical principles, diagnostic patterns, and representative cases. During inference, EMR emulates multidisciplinary consultation: a planner agent coordinates domain-specific department agents for specialized reasoning, while a summary agent synthesizes their analyses into a final decision. Critically, EMR automatically extracts correct diagnostic insights and failure-related warnings from multi-agent reasoning trajectories, incrementally updating the experience library to guide future cases. Experiments on medical reasoning benchmarks demonstrate that EMR consistently outperforms state-of-the-art medical multi-agent baselines. Further analysis reveals that the hierarchical experience enables cross-specialty generalization and transfer across diverse LLM backbones, offering a scalable and in
Clinical diagnosis is a gradual process of evidence integration, in which physicians move from symptoms and medical history to examinations, competing hypotheses, disease relations, and treatment decisions. Large language models have advanced medical text understanding and generation. Yet their clinical use remains limited by weak evidence grounding, opaque reasoning, and inconsistent links among differential diagnosis, final diagnosis, diagnostic basis, and treatment planning. We introduce MedCollab, a multi-agent framework for full-cycle clinical diagnosis and report generation. MedCollab coordinates specialist and examination agents according to patient records. It structures agent deliberation with an Issue-Based Information System (IBIS) protocol, so that each diagnostic position is supported by patient-specific evidence and medical knowledge. It also builds Hierarchical Disease Relation Chains (HDRC) to connect accepted hypotheses through progression, complication, and comorbidity relations. During multi-round deliberation, a verifier-guided consensus module evaluates evidence support, medical plausibility, and logical conflicts. It then adjusts agent contributions and filters unsupported reasoning. Experiments on ClinicalBench and MIMIC-IV show that MedCollab outperforms leading LLMs and medical multi-agent baselines in diagnostic accuracy, evidence consistency, and clinical reasoning quality. These results indicate that structured and auditable collaboration can produce more faithful and clinically coherent diagnostic reports.