# More Reasoning Is Not Always Better: Executing Clinical Guidelines with LLMs and Rules

arXiv: https://arxiv.org/abs/2610.15912 · HTML: https://mlsanity.com/paper/2610.15912/

## 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 21 of its 43 references that are in the map.
- First posted on arXiv 11 Oct 2026.

## Placed in

- LLM reasoning / [Clinical and biomedical applications](https://mlsanity.com/lr/clinical-and-biomedical-applications/)

## Builds on (most cited first, 21 of 21)

- [The Llama 3 Herd of Models](https://mlsanity.com/paper/2407.21783/) (2024)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Qwen3 Technical Report](https://mlsanity.com/paper/2505.09388/) (2025)
- [ReAct: Synergizing Reasoning and Acting in Language Models](https://mlsanity.com/paper/2210.03629/) (2022)
- [Efficient Memory Management for Large Language Model Serving with PagedAttention](https://mlsanity.com/paper/2309.06180/) (2023)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Improving Factuality and Reasoning in Language Models through Multiagent Debate](https://mlsanity.com/paper/2305.14325/) (2023)
- [Logic-LM: Empowering Large Language Models with Symbolic Solvers for Faithful Logical Reasoning](https://mlsanity.com/paper/2305.12295/) (2023)
- [Benchmarking Retrieval-Augmented Generation for Medicine](https://mlsanity.com/paper/2402.13178/) (2024)
- [MedAgents: Large Language Models as Collaborators for Zero-shot Medical Reasoning](https://mlsanity.com/paper/2311.10537/) (2023)
- [AgentClinic: a multimodal agent benchmark to evaluate AI in simulated clinical environments](https://mlsanity.com/paper/2405.07960/) (2024)
- [Structured Outputs Enable General-Purpose LLMs to be Medical Experts](https://mlsanity.com/paper/2503.03194/) (2025)
- [From Conflict to Consensus: Boosting Medical Reasoning via Multi-Round Agentic RAG](https://mlsanity.com/paper/2603.03292/) (2026)
- [DRS: Deep Question Reformulation With Structured Output](https://mlsanity.com/paper/2411.17993/) (2024)
- [MedGuideX: Internalizing Decision Logic from Executable Guidelines into Large Language Models for Clinical Reasoning](https://mlsanity.com/paper/2605.26567/) (2026)
- [The Consistency Illusion: How Multi-Agent Debate Hides Reasoning Misalignment](https://mlsanity.com/paper/2606.08457/) (2026)
- [DeltaFlow: Noise-Adaptive Bidirectional Gated Delta Networks for Embedded Language Flows](https://mlsanity.com/paper/2608.01240/) (2026)
- [CDR-Agent: Intelligent Selection and Execution of Clinical Decision Rules Using Large Language Model Agents](https://mlsanity.com/paper/2505.23055/) (2025)
- [Guideline2Graph: Profile-Aware Multimodal Parsing for Executable Clinical Decision Graphs](https://mlsanity.com/paper/2604.02477/) (2026)
- [Neuro-Symbolic Resolution of Recommendation Conflicts in Multimorbidity Clinical Guidelines](https://mlsanity.com/paper/2604.17340/) (2026)
- [Benchmarking Clinical Decision Pathway Adherence in Large Language Models](https://mlsanity.com/paper/2608.26592/) (2026)

## Abstract (arXiv)

Large language models (LLMs) have shown considerable promise in clinical decision support. However, existing approaches often rely on multi-step reasoning or multi-agent collaboration to execute clinical guidelines, introducing substantial computational overhead without reliably preventing decision errors. To address these limitations, we propose a framework for Medical Decision Execution (MedDEx) that integrates structured patient states with deterministic rule execution to support guideline-based treatment planning. MedDEx separates clinical record interpretation from guideline execution, leveraging LLMs to extract patient information and generate treatment plans while assigning guideline-defined decision logic to a rule executor. Experiments across multiple clinical guideline benchmarks demonstrate that MedDEx improves decision accuracy while reducing inference costs. Further analyses highlight the critical roles of structured patient representations and deterministic rule execution, suggesting that additional LLM reasoning does not necessarily translate into better guideline adherence.