Diagnosis: What Is the Structure of Its Reasoning?

How does the diagnosis process work? This essay traces the philosophical underpinnings of diagnosis from Hume through Kant, Peirce, and Popper, analyzing how pathologists amalgamate sensibility, intuition, and imagination to form new hypotheses that can be tested by evidence and experience.

Precision medicine and diseases as natural kinds: An epistemological dilemma.

BACKGROUND: The most important advance of precision medicine (PM) has been a specific way to define and understand disease. However, PM may fail to be therapeutically effective if diseases are natural kinds. OBJECTIVE: To attest adverse consequences of treatments suggested by PM that do not generalize well. METHODS: Conceptual analysis of PM; Epistemology of clinical reasoning; Cases that show diseases as natural kinds to clash with epistemology of PM. RESULTS: Contemplation of future research options that could clarify the position of PM under the conception of diseases as natural kinds. CONCLUSION: Need for improved design of future interventions that better acknowledge problematic epistemology of PM.

Strategies in Abduction: Generating and Selecting Diagnostic Hypotheses.

We distinguish three aspects of medical diagnosis: generating new diagnostic hypotheses, selecting hypotheses for further pursuit, and evaluating their probability in light of the available evidence. Drawing on Peirce's account of abduction, we argue that hypothesis generation is amenable to normative analysis: physicians need to make good decisions about when and how to generate new diagnostic hypothesis as well as when to stop. The intertwining relationship between the generation and selection of diagnostic hypotheses is illustrated through the analysis of a detailed clinical case study. This interaction is not adequately captured by the existing probabilistic, decision-theoretic models of the threshold approach to clinical decision-making. Instead, we propose to conceptualize medical diagnosis in terms of strategic reasoning.

Medical reasoning and doctor-patient communication.

Nineteenth-century American philosopher Charles Sanders Peirce offered a picture of the scientific method that can be fruitfully applied to the practice of medical diagnosis. Physicians can use this framework to become more self-consciously aware of what they are doing when they diagnose medical conditions, and they can also learn more about the potential pitfalls of communication between physicians and their patients.

The logic of medical diagnosis.

Establishing diagnoses is a crucial aspect of medical practice. However, this process has received comparatively little logical and pedagogical attention when compared to statistical methods for evaluating evidence. This article investigates the logic of medical diagnosis in order to fill this void. It is organized in three parts: the first attempts to explain why more attention ought to be paid to diagnosis, at least as much as to evidence; the second calls attention to the method of diagnosis by abductive reasoning developed in the 19th century by Charles Sanders Peirce (1839-1914); and the third demonstrates the use and pervasiveness of abduction by any other name in clinical diagnosis. We examine six diagnostic strategies in common use that contain most, if not all, of Peirce's structure of inquiry in science.

A philosophical analysis of the evidence-based medicine debate.

BACKGROUND: The term "evidence-based medicine" (or EBM) was introduced about ten years ago, and there has been considerable debate about the value of EBM. However, this debate has sometimes been obscured by a lack of conceptual clarity concerning the nature and status of EBM. DISCUSSION: First, we note that EBM proponents have obscured the current debate by defining EBM in an overly broad, indeed almost vacuous, manner; we offer a clearer account of EBM and its relation to the alternative approaches to medicine. Second, while EBM proponents commonly cite the philosophical work of Thomas Kuhn and claim that EBM is a Kuhnian 'paradigm shift,' we argue that such claims are seriously mistaken and unduly polarize the EBM debate. Third, we suggest that it is much more fruitful to understand the relationship between EBM and its alternatives in light of a different philosophical metaphor: W.V. Quine's metaphor of the web of belief. Seen in this way, we argue that EBM is an approach to medical practice that is indeed importantly different from the alternatives. SUMMARY: We can have a more productive debate about the value of EBM by being clearer about the nature of EBM and its relationship to alternative approaches to medicine.