# Social Chain of Thought: A Multi-Agent Architecture Grounded in Medical Differential Diagnosis Methodology

arXiv: https://arxiv.org/abs/2608.11420 · HTML: https://mlsanity.com/paper/2608.11420/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Clinical and biomedical applications, one of 17 directions in LLM reasoning.
- Builds on 22 of its 38 references that are in the map.
- First posted on arXiv 11 Aug 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)
- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 22 of 22)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Qwen2.5 Technical Report](https://mlsanity.com/paper/2412.15115/) (2024)
- [Improving Factuality and Reasoning in Language Models through Multiagent Debate](https://mlsanity.com/paper/2305.14325/) (2023)
- [CAMEL: Communicative Agents for "Mind" Exploration of Large Language Model Society](https://mlsanity.com/paper/2303.17760/) (2023)
- [Large Language Models Cannot Self-Correct Reasoning Yet](https://mlsanity.com/paper/2310.01798/) (2023)
- [Large Language Monkeys: Scaling Inference Compute with Repeated Sampling](https://mlsanity.com/paper/2407.21787/) (2024)
- [Large Language Model based Multi-Agents: A Survey of Progress and Challenges](https://mlsanity.com/paper/2402.01680/) (2024)
- [ChatEval: Towards Better LLM-based Evaluators through Multi-Agent Debate](https://mlsanity.com/paper/2308.07201/) (2023)
- [Why Do Multi-Agent LLM Systems Fail?](https://mlsanity.com/paper/2503.13657/) (2025)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [Chain-of-Verification Reduces Hallucination in Large Language Models](https://mlsanity.com/paper/2309.11495/) (2023)
- [ReConcile: Round-Table Conference Improves Reasoning via Consensus among Diverse LLMs](https://mlsanity.com/paper/2309.13007/) (2023)
- [MEDITRON-70B: Scaling Medical Pretraining for Large Language Models](https://mlsanity.com/paper/2311.16079/) (2023)
- [When Can LLMs Actually Correct Their Own Mistakes? A Critical Survey of Self-Correction of LLMs](https://mlsanity.com/paper/2406.01297/) (2024)
- [Chain of Agents: Large Language Models Collaborating on Long-Context Tasks](https://mlsanity.com/paper/2406.02818/) (2024)
- [Multi-Agent Collaboration via Evolving Orchestration](https://mlsanity.com/paper/2505.19591/) (2025)
- [Examining Inter-Consistency of Large Language Models Collaboration: An In-depth Analysis via Debate](https://mlsanity.com/paper/2305.11595/) (2023)
- [Is Best-of-N the Best of Them? Coverage, Scaling, and Optimality in Inference-Time Alignment](https://mlsanity.com/paper/2503.21878/) (2025)
- [Towards Conversational Diagnostic AI](https://mlsanity.com/paper/2401.05654/) (2024)
- [Revisiting Multi-Agent Debate as Test-Time Scaling: A Systematic Study of Conditional Effectiveness](https://mlsanity.com/paper/2505.22960/) (2025)
- [On the Fundamental Limits of LLMs at Scale](https://mlsanity.com/paper/2511.12869/) (2025)
- [MACD: Multi-Agent Clinical Diagnosis with Self-Learned Knowledge for LLM](https://mlsanity.com/paper/2509.20067/) (2025)

## Abstract (arXiv)

Medical diagnostic reasoning is a high-impact use case for LLMs that carries significant implications for the health and wellbeing of users. When OpenAI (2026) reports that more than 5% of ChatGPT messages globally are healthcare-related, the transparency of these systems becomes a serious design concern. This is especially true for complex cases, where differential diagnosis often requires integrating multiple forms of specialist reasoning. Existing work has proposed multi-agent approaches to medical diagnosis, but it remains unclear when such systems are needed, why they help, and where they outperform monolithic inference. We introduce Social Chain of Thought (SCoT),a multi-round pipeline for medical differential diagnosis that structures multi-agent interaction as a deliberative framework for collabora. tive LLM reasoning. Evaluating SCoT against single-agent baselines, one-agent pipeline ablations, and best-of-n scaling, we show that its recall advantage is not reproduced by monolithic inference alone. SCoT is most successful in the hardest diagnostic cases, where multiple rounds of specialist conversation help recover ground-truth diagnoses and converge on a higher-recall differential.