Abstract
In medical diagnostic examination three main stages may be distinguished: (a) initial exploration, (b) hypothesis-directed investigation, and (c) final diagnosis making. The purpose of this work is to study some methodological problems concerning the second of the above stages of the diagnosis and to prepare a background for a mathematical model [30] of this process.
In diagnostic problem solving, the reasoning proceeds along the main lines traced by some initial suggestions and passes through various intermediate elements which are connected with one another forming ramifying chains and nets of inferences and hypotheses. Such a complex mental construction is based on laws which form medical knowledge and reflect various regularities and relations, causal, structural, functional, and others.
The main components of diagnostic reasoning may be divided into several classes according to their function and content: leading hypotheses, working hypotheses, main diagnostic hypotheses, statements accepted as certain, intermediary and reserve hypotheses, therapeutic suggestions of immediate consequence. In an example of diagnostic problem solving these types of propositions are defined and analysed.
In diagnostic reasoning, as in every other process of rational problem solving, explanation of the observed symptoms and signs and testing of the explaining hypotheses play a predominant role. These procedures form successive, frequently numerous and diversified steps and stages of the reasoning, leading to the construction of a mental model of the patient's state. Some problems relative to the scheme of explanation, especially to that which is based on causal laws, are discussed.
Similar content being viewed by others
References
Ajdukiewicz, K.,Pragmatic Logic, PWN, Warsaw, 1975.
Ajdukiewicz, K., “Classification of reasonings”,Studia Logica 2, (1955) 218–239. (In Polish).
Berlyne, D. E.,Structure and Direction of Thinking, J. Wiley, New York, 1965.
Bernard, C.,Introduction à l'étude de la médecine expérimentale, Baillière, Paris, 1865.
Biegański, W.,Logic of Medicine, Wende, Warsaw, 1908. (In Polish.)
Bleich, H. L., ‘Computer evaluation of acid-base disorders’,J. clin. Invest. 48, (1969) 1689–1696.
Bonner, R. E., Evangelisti, C. J., Steinbeck, H. D., and Cohen, L., ‘A diagnostic assistance program’,Meth. Inform. Med. 5, (1966) 115–128.
Braine, M. D. S., ‘On the relation between the natural logic of reasoning and standard logic’,Psychol. Rev. 85, (1978) 1–21.
Braithwaite, R. B.,Scientific Explanation, Cambridge University Press, Cambridge, 1955.
Brodziak, A., ‘Algorithmization of natural medical diagnosis’,Ann. Med. Sec. Pol. Ac. Sci. 15, (1970) 2–20.
Bunge, M.,Causality. The Place of the Causal Principle in Modern Science, Harvard Univ. Press, Cambridge, MA, 1959.
Bykhovskiy, M. L., Vishnevskiy, A. A., and Kharnas, S. S., ‘Problems in the development of a diagnostic process by means of mathematical machines’,Eksp. Khir. Anest. 4, (1961) 3–15. (In Russian.)
Czežowski, T.,Main Principles of Philosophical Sciences, TNT, Toruń, 1946. (In Polish.)
Czežowski, T., ‘Classification of reasonings’,Philosophical Lectures, pp. 128–155, TNT, Toruń, 1969, (In Polish.)
Doroszewski, J., ‘Probability evaluation in the process of testing of diagnostic hypotheses’,Studia Filozof. 10, (1972) 121–142. (In Polish.)
Doroszewski, J., ‘Studies on the structure of medical diagnosis’,Pol. Arch. Med. Wewn. 11, (1973) 741–754. (In Polish.)
Doroszewski, J., ‘Explanation and proving in diagnostic reasoning’,Post. Hig. Med. Dosw. 32, (1978) 405–424. (In Polish.)
Dudley, H. A. F., ‘Pay-off, heuristics, and pattern recognition in the diagnostic process’,Lancet, 1968/II, 723–726.
Edwards, D. A. W., ‘Flow charts, diagnostic keys, and algorithms in the diagnosis of dysphagia’,Scot. med. J. 15, (1970) 378–385.
Engle, R. L., Flehinger, B. J., Allen, S., et al., “HEME: a computer aid to diagnosis of hematological disease’,Bull. N. Y. Acad. Med. 52, (1976) 584–600.
Feinstein, A. R., ‘An analysis of diagnostic reasoning. I: The domain and disorders of macrobiology. II: The strategy of intermediate decisions’,Yale J. Biol. Med. 46, (1973) 212–232 and 264–283.
Gross, R.,Medizinische Diagnostik — Grundlagen und Praxis, Springer, Berlin, 1969.
Groot, A. D. de,Methodology, Mouton, The Hague, 1969.
Hempel, C. G.,Aspects of Scientific Explanation, Free Press, New York, 1965.
Hempel, C. G.,Philosophy of Natural Science, Prentice-Hall, Englewood Cliffs, 1966.
Jesdinsky, H. J., ‘Diagnose-Modelle in der Medizin’,Meth. Inform. Med. 11, (1972) 48–59.
Kayser, K., ‘Logic and diagnosis’,Meth. Inform. Med. 14, (1975) 76–80.
Kohout, L., ‘Algebraic models in computer-aided medical diagnosis’, in J. Anderson and J. M. Forsythe (eds.), MEDINFO 74, pp. 575–579, North-Holland Publ. Co., Amsterdam, 1974.
Korab-Laskowska, M., ‘Algebraic framework of an optimization problem in medical diagnosis’,Int. J. Bio-med Comput. 10, (1979) 169–178.
Korab-Laskowska, M., ‘Hypothetico-nomological aspects of medical diagnosis. Part II: Formal model of the explanation and testing procedures’, in this issue.
Kotarbiński, T.,Elements of Epistemology, Formal Logic and Methodology of Sciences, Ossolineum, Wroclaw, 1961. (In Polish.)
Kotarbiński, T.,A Treatise on Good Work, Ossolineum, Wroclaw, 1973. (In Polish.)
Ledley, R. S., and Lusted, L. B., ‘Reasoning foundations of medical diagnosis’,Science 130, (1959) 9–21.
Ledley, W. M., and Lusted, L. B., ‘The use of electronic computers in medical data processing: aids in diagnosis, current information retrieval and medical record”,IRE Trans. med. Electron. ME-7, (1960) 31–47.
Lively, W. M., Szygenda, S. A., and Mize, C. E.: ‘Modelling techniques for medical diagnosis. I: Heuristic and learning programs in selected neonatal hepatic diseases’,Comput. biomed. Res. 6, (1973) 393–410.
Mathew, R. J., Kulikowski, C. A., and Kaplan, K. R., ‘A multileveled representation for knowledge acquisition in medical consultation systems’, in D. B. Shires and H. Wolf (eds.) MEDINFO 77, pp. 151–156, North-Holland Publ. Co., Amsterdam, 1977.
Mize, C. E., ‘Modeling techniques for medical diagnosis. II: Differential diagnosis of neonatal hepatitis and biliary athresis’,Comput. biomed. Res. 9, (1976) 239–245.
Nagel, E.,The Structure of Science, Harcourt, New York, 1961.
Nikitin, E.,Explanation: Function of Sciences, Nauka, Moscow, 1970. (In Russian)
Pap, A.,An Introduction to the Philosophy of Science, Glencoe, New York, 1962.
Pauker, S. G., Gorry, G. A., Kassirer, J. F., and Schwartz, W. B., ‘Towards the stimulation of clinical cognition’,Am. J. Med. 60, (1976) 981–996.
Popper, K. R.,The Logic of Scientific Discovery, Hutchinson, London, 1953.
Ras, Z.,A Mathematical Model of a Diagnostic Experiment, Columbia Univ. Press, New York, 1976.
Rescher, D., ‘Discrete state systems, Markow chains, and problems in the theory of scientific explanation and prediction’,Philosophy of Science 30, (1963) 325–345.
Rothschuh, K. E.,Prinzipien der Medizin, Urban und Schwarzenberg, München, 1965.
Shrotliffe, E. H., Axline, S. G., Buchanan, B. G., Merigan, T. C., and Cohen, S. N., ‘An artificial intelligence program to advise physicians regarding antimicrobial therapy’,Comput biomed. Res. 6, (1973) 544–560.
Stegmüller, W., ‘Explanation, prediction, scientific systematization and non-explanatory information’,Ratio 8, (1966) 1–24.
Stein, M. A., and Winter, J., ‘Theory development in medical decision-making’,Int. J. bio-med. Comput. 5, (1974) 145–159.
Thiry, S., ‘Selfs-instructing physiopathological models’, in D. B. Shires and H. Wolf (eds.), MEDINFO 77, pp. 111–113, North-Holland Publ. Co., Amsterdam, 1977.
Wardle, A., and Wardle, L., ‘Computer aided diagnosis — a review of research’,Meth. Inform. Med. 17, (1978) 15–28.
Warner, H. R., Toronto, A. F., Vaesey, L. G., and Stephenson, R., ‘A mathematical approach to medical diagnosis. Application to congenital heart disease’,J. Amer. med. Ass. 177, (1961) 177–183.
Weiss, A., Kulikowski, C. A., and Safir, A., ‘Glaucoma consultation by computer’,Comput. Biol. Med. 8, (1978) 25–40.
Weiss, S., Kulikowski, C. A., Safir, A., and Amarel, S., ‘A model-based method for computer-aided medical decision-making’, forthcoming inArtif. Intel. J., special issue on application in sciences and biomedicine.
Wiener, F., ‘Computer simulation of the diagnostic process in medicine’,Comput. biomed. Res. 8, (1975) 129–142.
Ziemski, S.: ‘Methods of diagnosis in science and practical activity’,Prakseologia 42, (1972) 113–118. (In Polish.)
Author information
Authors and Affiliations
Additional information
This work was supported by Grant No. 10.4 of the Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences.
Rights and permissions
About this article
Cite this article
Doroszewski, J. Hypothetico-nomological aspects of medical diagnosis Part I: General structure of the diagnostic process and its hypothesis-directed stage. Metamedicine 1, 177–194 (1980). https://doi.org/10.1007/BF00883113
Issue Date:
DOI: https://doi.org/10.1007/BF00883113