Abstract
Clinical diagnostic medicine is an experimental science based on observation, hypothesis making, and testing. It is an use dynamic process that involves observation and summary, diagnostic conjectures, testing, review, observation and summary, new or revised conjectures, i.e. it is an iterative process. It can then be said that diagnostic hypotheses are also ‘observation-laden’. My aim is to enlarge on the strategies of medical diagnosis as these are meshed in training and clinical experience—that is, to describe the patterns of reasoning used by experienced clinicians under different diagnostic circumstances and how these patterns of inquiry allow further insight into the evaluation and treatment of patients. I do not aim to present a theory and illustrate it with examples; I wish rather am to let a realistic example, similar to actual clinical scenarios, direct the exposition. To this end, I introduce an account of medical diagnosis—briefly comparing and contrasting it to other accounts—in order to focus on discussing the process of diagnosis through a detailed clinical case.
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Notes
Ross Upshur has argued previously that the “dispute between the proponents of clinical common sense and evidence-based medicine can likely find common ground in the philosophy of C.S. Peirce” (1903). He advised that “circumspection must accompany the use of statistical models in clinical reasoning” and claimed that Peirce’s logic provides “a promising framework in which to develop a theory of clinical reasoning that is both rigorous and probabilistic, [while also being] able to recognize the uncertainties and particularities of day-to-day clinical practice” (1997, p. 205). He did not develop, however, a detailed account of this theory of clinical reasoning. In an article on the selective stage of diagnostic reasoning (Stanley and Campos 2015), we built on Upshur’s position, and developed one important aspect of a logical account of clinical reasoning by expounding the theory and illustrating the practice of diagnosis selection. In this diagnostic process, clinicians must have recourse to a variety of logical strategies in which clinical acumen, insight, and experience play a central role to guide statistical, economic, and other considerations.
We have discussed each of these methods in more depth, with several detailed illustrations, in (Stanley and Campos 2015).
See (Campos 2011) for one explanation and references to further relevant literature.
For the classical exposition, see (Hempel 1966).
For an exposition of how this process works semiotically—that is, by the creation of mental signs such as pictures, diagrams, schemata, and so on—see (Silveira 2005).
For a thorough presentation of prevalence and predictive value, see (Galen and Gambino 1975, pp. 167–264).
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Stanley, D.E. The Logic of Medical Diagnosis: Generating and Selecting Hypotheses. Topoi 38, 437–446 (2019). https://doi.org/10.1007/s11245-017-9516-2
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DOI: https://doi.org/10.1007/s11245-017-9516-2