Managing uncertainty in diagnostic practice.

In spite of the large medical literature devoted to a discussion of the topic, uncertainty, particularly in diagnostic practice, is sometimes mishandled by clinicians. This, I will argue, can in turn lead to medical and ethical problems in patient care. Via the analysis of two recent case studies, I will propose an explanation for why this kind of uncertainty is sometimes not appropriately dealt with during the process of differential diagnosis in the clinic. Furthermore, I will also give recommendations for improving diagnostic practice by highlighting some representative elements of diagnostic uncertainty and reminding clinicians to be aware of the tendency to overlook this uncertainty in routine clinical cases.

Evaluating diagnostic tests.

Although much has been written on the role of randomized controlled trials and mechanistic reasoning in the evaluation of therapeutic treatments, philosophers of medicine have not yet turned their attention to the question of how diagnostic tests and procedures should be evaluated. I aim to begin to fill this gap by examining each of the following questions: What is the best way to determine the accuracy of a diagnostic test? What is the best way to determine the clinical effectiveness of a diagnostic test? Can an accurate diagnostic test be considered medically valuable even if it is not clinically effective? I argue that while diagnostic accuracy is a minimum requirement for both clinical effectiveness and medical value, accuracy and effectiveness are not sufficient for determining the value of a diagnostic test, because diagnostic value extends beyond patient outcomes.

Causal explanatory pluralism and medically unexplained physical symptoms.

In this paper, we propose a methodology for investigating medically unexplained physical symptoms (MUPSs). These symptoms are common in both primary and specialist medical practices, but are poorly understood. Currently, MUPSs are diagnosed via non-explanatory labels. However, we show that explanatory diagnoses are preferable to non-explanatory syndromic diagnoses because they bring both epistemic and therapeutic benefits to patients and their providers. Thus, we advocate a methodology of causal explanatory pluralism in the diagnostic workup and clinical management of MUPSs.

Differential diagnosis and the suspension of judgment.

In this paper I argue that ethics and evidence are intricately intertwined within the clinical practice of differential diagnosis. Too often, when a disease is difficult to diagnose, a physician will dismiss it as being "not real" or "all in the patient's head." This is both an ethical and an evidential problem. In the paper my aim is two-fold. First, via the examination of two case studies (late-stage Lyme disease and Addison's disease), I try to elucidate why this kind of dismissal takes place. Then, I propose a potential solution to the problem. I argue that instead of dismissing a patient's illness as "not real," physicians ought to exercise a compassionate suspension of judgment when a diagnosis cannot be immediately made. I argue that suspending judgment has methodological, epistemic, and ethical virtues and therefore should always be preferred to patient dismissal in the clinical setting.

Ageing gametes and embryonic death: a response to Bovens.

Luc Bovens, in his 2006 article, argues that it can be shown that the 'rhythm' method of birth control results in a larger number of embryonic deaths than the IUD, the morning after pill or the combination oral contraceptive pill, just so long as one accepts his three 'plausible' assumptions. In this brief response I will argue that Boven's third assumption is not plausible when one takes into account a basic knowledge of human reproductive biology. Thus, his argument, in both of its possible reconstructions, fails.