MedGraph: Maintaining Patient State with Graph Memory for Long-Term Medical Dialogue

Large Language Models (LLMs) are increasingly expected to interact with users over long time horizons. However, due to their finite context window, LLMs cannot retain all past interactions, making long-term memory management essential for storing, updating, and retrieving historical information beyond the context limit. Although recent memory systems attempt to address this issue by storing historical information externally, existing approaches suffer from three key limitations: flat text-based memory organizations fail to capture explicit relations among memories, structured memory systems often destructively overwrite evolving facts, and current retrieval mechanisms remain query-agnostic and passive when evidence is incomplete. REAL constructs long-term conversational memory as a temporal and confidence-aware directed property graph, where each atomic fact is represented with entities, relations, valid-time intervals, confidence scores, and exploration intent labels. During memory construction, REAL adopts a non-destructive temporal update strategy that preserves parallel fact versions and their validity intervals, enabling faithful tracking of fact evolution. During retrieval, REAL anchors query-relevant root entities, decouples their exploration intents, and performs semantic evaluator-guided hybrid beam search to extract compact memory subgraphs. It further incorporates counterfactual inference to repair unreliable retrieval states and recover missing memory evidence through implicit logical relations. Comprehensive experiments demonstrate that REAL substantially improves long-term memory performance over flat-text, graph-based, and existing memory baselines, achieving an average improvement of 22.72%.

Clinical decision-making agents can benefit from reusing prior decision experience. However, many memory-augmented methods store experiences as independent records without explicit relational structure, which may introduce noisy retrieval, unreliable reuse, and in some cases even hurt performance compared to direct LLM inference. We propose GSEM (Graph-based Self-Evolving Memory), a clinical memory framework that organizes clinical experiences into a dual-layer memory graph, capturing both the decision structure within each experience and the relational dependencies across experiences, and supporting applicability-aware retrieval and online feedback-driven calibration of node quality and edge weights. Across MedR-Bench and MedAgentsBench with two LLM backbones, GSEM achieves the highest average accuracy among all baselines, reaching 70.90% and 69.24% with DeepSeek-V3.2 and Qwen3.5-35B, respectively. Code is available at https://github.com/xhan1022/gsem.

Entity-Memory graph retrieval keeps dialogue turns as verbatim Memory nodes, links repeated mentions through shared Entities, and connects adjacent Memories with directed chronological edges. At query time the retriever moves from Entity gating through semantic fusion and one-hop chronological recovery to dense backfill. The path can keep a neighboring Memory that dense cosine ranking would otherwise omit. A matched dense control shares the Memory and query vectors, context budget, requested answer protocol, and evaluator, isolating graph structure from changes to the reader. On 1,986 questions from ten LoCoMo conversations, graph retrieval raises official evidence recall at top-k 25 from 79.7468% to 84.4842%. The recall advantage is supported from top-k 5 to 50, while no matched cutoff supports an overall final-answer F1 difference. Four paper-eligible requested configurations support empirical robustness across the tested GPT-3.5 and DeepSeek extractors on both outcomes. Embedding robustness is mixed: F1 has no supported contrast, but recall is sensitive to the embedding artifact. The comparison isolates a retrieval-coverage gain from graph structure. It does not establish a final-answer F1 gain, model or embedding equivalence, or cross-dataset generalization.