, Volume 1, Issue 2, pp 177–194 | Cite as

Hypothetico-nomological aspects of medical diagnosis Part I: General structure of the diagnostic process and its hypothesis-directed stage

  • Jan Doroszewski


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.

Key words

Methodology of diagnosis Logical structure of diagnosis Stages of diagnosis Explanation of symptoms Verification of diagnostic hypotheses 


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  1. [1]
    Ajdukiewicz, K.,Pragmatic Logic, PWN, Warsaw, 1975.Google Scholar
  2. [2]
    Ajdukiewicz, K., “Classification of reasonings”,Studia Logica 2, (1955) 218–239. (In Polish).Google Scholar
  3. [3]
    Berlyne, D. E.,Structure and Direction of Thinking, J. Wiley, New York, 1965.Google Scholar
  4. [4]
    Bernard, C.,Introduction à l'étude de la médecine expérimentale, Baillière, Paris, 1865.Google Scholar
  5. [5]
    Biegański, W.,Logic of Medicine, Wende, Warsaw, 1908. (In Polish.)Google Scholar
  6. [6]
    Bleich, H. L., ‘Computer evaluation of acid-base disorders’,J. clin. Invest. 48, (1969) 1689–1696.Google Scholar
  7. [7]
    Bonner, R. E., Evangelisti, C. J., Steinbeck, H. D., and Cohen, L., ‘A diagnostic assistance program’,Meth. Inform. Med. 5, (1966) 115–128.Google Scholar
  8. [8]
    Braine, M. D. S., ‘On the relation between the natural logic of reasoning and standard logic’,Psychol. Rev. 85, (1978) 1–21.Google Scholar
  9. [9]
    Braithwaite, R. B.,Scientific Explanation, Cambridge University Press, Cambridge, 1955.Google Scholar
  10. [10]
    Brodziak, A., ‘Algorithmization of natural medical diagnosis’,Ann. Med. Sec. Pol. Ac. Sci. 15, (1970) 2–20.Google Scholar
  11. [11]
    Bunge, M.,Causality. The Place of the Causal Principle in Modern Science, Harvard Univ. Press, Cambridge, MA, 1959.Google Scholar
  12. [12]
    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.)Google Scholar
  13. [13]
    Czežowski, T.,Main Principles of Philosophical Sciences, TNT, Toruń, 1946. (In Polish.)Google Scholar
  14. [14]
    Czežowski, T., ‘Classification of reasonings’,Philosophical Lectures, pp. 128–155, TNT, Toruń, 1969, (In Polish.)Google Scholar
  15. [15]
    Doroszewski, J., ‘Probability evaluation in the process of testing of diagnostic hypotheses’,Studia Filozof. 10, (1972) 121–142. (In Polish.)Google Scholar
  16. [16]
    Doroszewski, J., ‘Studies on the structure of medical diagnosis’,Pol. Arch. Med. Wewn. 11, (1973) 741–754. (In Polish.)Google Scholar
  17. [17]
    Doroszewski, J., ‘Explanation and proving in diagnostic reasoning’,Post. Hig. Med. Dosw. 32, (1978) 405–424. (In Polish.)Google Scholar
  18. [18]
    Dudley, H. A. F., ‘Pay-off, heuristics, and pattern recognition in the diagnostic process’,Lancet, 1968/II, 723–726.Google Scholar
  19. [19]
    Edwards, D. A. W., ‘Flow charts, diagnostic keys, and algorithms in the diagnosis of dysphagia’,Scot. med. J. 15, (1970) 378–385.Google Scholar
  20. [20]
    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.Google Scholar
  21. [21]
    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.Google Scholar
  22. [22]
    Gross, R.,Medizinische Diagnostik — Grundlagen und Praxis, Springer, Berlin, 1969.Google Scholar
  23. [23]
    Groot, A. D. de,Methodology, Mouton, The Hague, 1969.Google Scholar
  24. [24]
    Hempel, C. G.,Aspects of Scientific Explanation, Free Press, New York, 1965.Google Scholar
  25. [25]
    Hempel, C. G.,Philosophy of Natural Science, Prentice-Hall, Englewood Cliffs, 1966.Google Scholar
  26. [26]
    Jesdinsky, H. J., ‘Diagnose-Modelle in der Medizin’,Meth. Inform. Med. 11, (1972) 48–59.Google Scholar
  27. [27]
    Kayser, K., ‘Logic and diagnosis’,Meth. Inform. Med. 14, (1975) 76–80.Google Scholar
  28. [28]
    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.Google Scholar
  29. [29]
    Korab-Laskowska, M., ‘Algebraic framework of an optimization problem in medical diagnosis’,Int. J. Bio-med Comput. 10, (1979) 169–178.Google Scholar
  30. [30]
    Korab-Laskowska, M., ‘Hypothetico-nomological aspects of medical diagnosis. Part II: Formal model of the explanation and testing procedures’, in this issue.Google Scholar
  31. [31]
    Kotarbiński, T.,Elements of Epistemology, Formal Logic and Methodology of Sciences, Ossolineum, Wroclaw, 1961. (In Polish.)Google Scholar
  32. [32]
    Kotarbiński, T.,A Treatise on Good Work, Ossolineum, Wroclaw, 1973. (In Polish.)Google Scholar
  33. [33]
    Ledley, R. S., and Lusted, L. B., ‘Reasoning foundations of medical diagnosis’,Science 130, (1959) 9–21.Google Scholar
  34. [34]
    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.Google Scholar
  35. [35]
    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.Google Scholar
  36. [36]
    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.Google Scholar
  37. [37]
    Mize, C. E., ‘Modeling techniques for medical diagnosis. II: Differential diagnosis of neonatal hepatitis and biliary athresis’,Comput. biomed. Res. 9, (1976) 239–245.Google Scholar
  38. [38]
    Nagel, E.,The Structure of Science, Harcourt, New York, 1961.Google Scholar
  39. [39]
    Nikitin, E.,Explanation: Function of Sciences, Nauka, Moscow, 1970. (In Russian)Google Scholar
  40. [40]
    Pap, A.,An Introduction to the Philosophy of Science, Glencoe, New York, 1962.Google Scholar
  41. [41]
    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.Google Scholar
  42. [42]
    Popper, K. R.,The Logic of Scientific Discovery, Hutchinson, London, 1953.Google Scholar
  43. [43]
    Ras, Z.,A Mathematical Model of a Diagnostic Experiment, Columbia Univ. Press, New York, 1976.Google Scholar
  44. [44]
    Rescher, D., ‘Discrete state systems, Markow chains, and problems in the theory of scientific explanation and prediction’,Philosophy of Science 30, (1963) 325–345.Google Scholar
  45. [45]
    Rothschuh, K. E.,Prinzipien der Medizin, Urban und Schwarzenberg, München, 1965.Google Scholar
  46. [46]
    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.Google Scholar
  47. [47]
    Stegmüller, W., ‘Explanation, prediction, scientific systematization and non-explanatory information’,Ratio 8, (1966) 1–24.Google Scholar
  48. [48]
    Stein, M. A., and Winter, J., ‘Theory development in medical decision-making’,Int. J. bio-med. Comput. 5, (1974) 145–159.Google Scholar
  49. [49]
    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.Google Scholar
  50. [50]
    Wardle, A., and Wardle, L., ‘Computer aided diagnosis — a review of research’,Meth. Inform. Med. 17, (1978) 15–28.Google Scholar
  51. [51]
    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.Google Scholar
  52. [52]
    Weiss, A., Kulikowski, C. A., and Safir, A., ‘Glaucoma consultation by computer’,Comput. Biol. Med. 8, (1978) 25–40.Google Scholar
  53. [53]
    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.Google Scholar
  54. [54]
    Wiener, F., ‘Computer simulation of the diagnostic process in medicine’,Comput. biomed. Res. 8, (1975) 129–142.Google Scholar
  55. [55]
    Ziemski, S.: ‘Methods of diagnosis in science and practical activity’,Prakseologia 42, (1972) 113–118. (In Polish.)Google Scholar

Copyright information

© D. Reidel Publishing Company 1980

Authors and Affiliations

  • Jan Doroszewski
    • 1
  1. 1.Dept. of Biophysics and BiomathematicsMedical Centre of Postgraduate EducationWarsawPoland

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