# PRISMATIC : Prescription Risk Inspection System for Multi-Agent Treatment Interaction in Clinical Decision-Making

arXiv: https://arxiv.org/abs/2610.19762 · HTML: https://mlsanity.com/paper/2610.19762/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 6 of its 28 references that are in the map.
- First posted on arXiv 14 Oct 2026.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 6 of 6)

- [Language Models are Few-Shot Learners](https://mlsanity.com/paper/2005.14165/) (2020)
- [ReAct: Synergizing Reasoning and Acting in Language Models](https://mlsanity.com/paper/2210.03629/) (2022)
- [Med42-v2: A Suite of Clinical LLMs](https://mlsanity.com/paper/2408.06142/) (2024)
- [PMC-LLaMA: Towards Building Open-source Language Models for Medicine](https://mlsanity.com/paper/2304.14454/) (2023)
- [MAP: Evaluation and Multi-Agent Enhancement of Large Language Models for Inpatient Pathways](https://mlsanity.com/paper/2503.13205/) (2025)
- [Integrating Large Language Models with Human Expertise for Disease Detection in Electronic Health Records](https://mlsanity.com/paper/2504.00053/) (2025)

## Abstract (arXiv)

Medical prescribing errors for multimorbid patients, who require complex drug regimens, are a major patient safety concern. These errors often stem from fragmented decision-making across medical specialties, a critical coordination failure that leads to adverse drug events and rehospitalizations. To address this coordination challenge, we introduce PRISMATIC, a multi-agent architecture where specialized agents, each representing a workflow role, collaboratively generate and refine treatment plans. Operating on a blackboard architecture, the system first structures patient information from clinical notes, then iteratively develops safe, rational, and interpretable drug regimens. The agents' collaboration is governed by two novel adaptive coordination mechanisms: (1) Dynamic Self-Updating Weight Adjustment (DSWA), a long-term mechanism that adjusts the influence weights of agents based on historical case outcomes, enabling the system to adapt and trust more reliable specialists over time. (2) Discrepancy Feedback Precise Calibration (DFPC), a short-term mechanism where agents provide iterative feedback to resolve disagreements and eliminate prescription conflicts for the current patient. Experiments on patient records from the MIMIC-IV database show that PRISMATIC significantly reduces drug conflicts, improves prescription coverage, and enhances treatment consistency compared to strong LLM baselines. Our work demonstrates that structuring clinical co-treatment as a multi-agent coordination problem offers a promising path toward safer and more coherent multidisease management.