# Evidence, Logic, and Compliance: Multi-Agent Structured Graph Reasoning with Expert Arbitration for Medical Referral

arXiv: https://arxiv.org/abs/2608.30938 · HTML: https://mlsanity.com/paper/2608.30938/

## 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 13 of its 41 references that are in the map.
- First posted on arXiv 31 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, 13 of 13)

- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [DeepSeek-R1: Incentivizing Reasoning Capability in LLMs via Reinforcement Learning](https://mlsanity.com/paper/2501.12948/) (2025)
- [Self-Consistency Improves Chain of Thought Reasoning in Language Models](https://mlsanity.com/paper/2203.11171/) (2022)
- [Qwen2 Technical Report](https://mlsanity.com/paper/2407.10671/) (2024)
- [MetaGPT: Meta Programming for A Multi-Agent Collaborative Framework](https://mlsanity.com/paper/2308.00352/) (2023)
- [ChatGLM: A Family of Large Language Models from GLM-130B to GLM-4 All Tools](https://mlsanity.com/paper/2406.12793/) (2024)
- [DeepSeek-V3 Technical Report](https://mlsanity.com/paper/2412.19437/) (2024)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [ChatCAD: Interactive Computer-Aided Diagnosis on Medical Image using Large Language Models](https://mlsanity.com/paper/2302.07257/) (2023)
- [Clinical Camel: An Open Expert-Level Medical Language Model with Dialogue-Based Knowledge Encoding](https://mlsanity.com/paper/2305.12031/) (2023)
- [ClinicalLab: Aligning Agents for Multi-Departmental Clinical Diagnostics in the Real World](https://mlsanity.com/paper/2406.13890/) (2024)
- [Medical large language models are easily distracted](https://mlsanity.com/paper/2504.01201/) (2025)
- [MedLA: A Logic-Driven Multi-Agent Framework for Complex Medical Reasoning with Large Language Models](https://mlsanity.com/paper/2509.23725/) (2025)

## Abstract (arXiv)

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.