GraphMed-LT: Patient-Specific Graph Memory with Latent Clinical Thought Refinement for Multi-Turn Medical Conversations

Abstract

Multi-turn medical question answering (QA) aims to model realistic clinical diagnosis, where a doctor gathers patient information across multiple turns of conversation. Existing multi-turn medical conversation systems have shown promising progress, but they often rely on accumulated conversation histories as memory, leaving clinical evidence fragmented across turns. We propose GraphMed-LT, a patient-specific graph memory approach with latent clinical thought refinement for multi-turn medical conversations. GraphMed-LT extracts patient-specific clinical triplets from patient responses, retrieves relevant knowledge triplets, and organises them into an incrementally updated graph memory. The graph memory is projected into graph-conditioned evidence tokens and refined inside a trainable doctor agent through hidden-state feedback, enabling the agent to update its internal clinical context before asking follow-up questions or producing the final answer. Experiments on three multi-turn medical QA benchmarks show that GraphMed-LT consistently outperforms existing multi-turn medical conversation baselines across multiple LLM backbones, achieving up to a 6.3 percentage-point absolute improvement over the strongest baseline. Further analyses show that GraphMed-LT asks more answerable follow-up questions and provides consistent gains across medical specialties.