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Metamedicine

, Volume 1, Issue 3, pp 277–303 | Cite as

Effort and demand logic in medical decision making

  • G. William Moore
  • Grover M. Hutchins
Article

Abstract

Medical decisions, including diagnosis, prognosis, and disease classification, must often be made on the basis of incomplete or unsatisfactory information. Data which are essential to the care of one patient may be unobtainable for technical or ethical reasons in another patient. For this reason the principles of controlled experimentation may be impossible to satisfy in human studies. In this paper, some formal aspects of medical decision making are discussed. Special operators for the intuitive concepts of ‘certainty’, ‘demand’, and ‘effort’, akin to the operators of modal logic, are used to accommodate the technical and ethical limitations on human studies. Theorems are stated and proved which show how this system handles incomplete information. The embryogenesis of the human heart is presented as a sample problem in classification.

Key words

Medical decision making Computer diagnosis Symbolic logic Modal logic Sutton's Law Embryogenesis Congenital heart disease 

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References

  1. [1]
    Bauer, F. W., and Robbins, S. L.: ‘An autopsy study of cancer patients. I: Accuracy of the clinical diagnoses (1955–1965) Boston City Hospital’,JAMA 221, (1972) 1471–1474.Google Scholar
  2. [2]
    Boolos, G.:The Unprovability of Consistency. An Essay in Modal Logic, Cambridge University Press, Cambridge, 1979.Google Scholar
  3. [3]
    Borkowski, L.:Formale Logik, C. H. Beck, Munich, 1977.Google Scholar
  4. [4]
    Britton, M.: ‘Diagnostic errors discovered at autopsy’,Acta med. Scand. 196, (1974) 203–210.Google Scholar
  5. [5]
    Congdon, E. D.: ‘Transformation of the aortic-arch system during the development of the human embryo’,Contrib. Embryol. Carnegie Inst. Wash., Pub. No. 277, pp. 47–110.Google Scholar
  6. [6]
    Davis, C. L.: ‘Development of the human heart from its first appearance to the stage found in embryos of twenty paired somites’,Contrib. Embryol. Carnegie Inst. Wash. 19, (1927) 245–284.Google Scholar
  7. [7]
    Doerr, W., and Schipperges, H.:Was ist Theoretische Pathologie? Springer-Verlag, Berlin, 1979.Google Scholar
  8. [8]
    Engelhardt, H. T.: ‘Introduction’, in H. T. Engelhardt, Jr., S. F. Spicker, and B. Towers (eds.),Clinical Judgment: A Critical Appraisal, D. Reidel, Dordrecht, 1979, pp. xi-xxiv.Google Scholar
  9. [9]
    Feinstein, A. R.:Clinical Judgment, Williams and Wilkins, Baltimore, 1967, pp. 156–228.Google Scholar
  10. [10]
    Gross, R.: ‘Der Prozess der Diagnose’,Dtsch. med. Wschr. 98, (1973) 783–787.Google Scholar
  11. [11]
    Heuser, C. H. and Corner, G. W.: ‘Developmental horizons in human embryos. Description of age group X, 4 to 12 somites’,Contrib. Embryol. Carnegie Inst. Wash. 36, (1957) 29–39.Google Scholar
  12. [12]
    Hutchins, G. M., Moore, G. W., and Lipford, E. H.: ‘Asplenia and polysplenia malformation complexes explained by abnormal embryonic body curvature’, (Abstract),Fed. Proc. 38, (1979) 1208.Google Scholar
  13. [13]
    Ledley, R. S., and Lusted, L. B.: ‘Reasoning foundations of medical diagnosis’,Science 130, (1959) 9–21.Google Scholar
  14. [14]
    Lewis, C. I., and Langford, C. H.:Symbolic Logic, 2nd Edition, Dover Publications, Inc., 1959.Google Scholar
  15. [15]
    Mall, F. P.: ‘On the development of the human heart’,Amer. J. Anat. 13, (1912) 249–298.Google Scholar
  16. [16]
    Maron, B., and Hutchins, G. M.: ‘The development of the semilunar valves of the human heart’,Amer. J. Pathol. 74, (1974) 331–344.Google Scholar
  17. [17]
    Metamed, Volume 0.Google Scholar
  18. [18]
    Moore, G. W., Riede, U. N., and Sandritter, W.: ‘Application of Quine's nullities to a quantitative organelle pathology’,J. theor. Biol. 65, (1977) 633–651.Google Scholar
  19. [19]
    Moore, G. W., Hutchins, G. M., and Bulkley, B. H.: ‘Certainty levels in the nullity method of symbolic logic: Application to the pathogenesis of congenital heart malformations’,J. theor. Biol. 76, (1979) 53–81.Google Scholar
  20. [20]
    Moore, G. W., and Hutchins, G. M.: ‘Certainty levels in symbolic logic: Two necessary conditions for Sutton's Law’,Archiv für Medizinforschung 3, (1980), in press.Google Scholar
  21. [21]
    O'Rahilly, R.:Developmental Stages in Human Embryos. Part A: Embryos of the First Three Weeks (Stages 1 to 9), Carnegie Institution of Washington, Publication 631 (1973).Google Scholar
  22. [22]
    Quine, W. V.:Theory of Deduction, Harvard Cooperative Society, Cambridge, 1948, pp. 65–81.Google Scholar
  23. [23]
    Roberts, W. C.: ‘The autopsy. Its decline and its suggestion for its retrieval’,New Engl. J. Med. 299, (1978) 332–338.Google Scholar
  24. [24]
    Sadegh-zadeh, K.: ‘Grundlagenprobleme einer Theorie der klinischen Praxis. Teil I: Explikation des medizinschen Diagnosebegriffs’,Metamed 1, (1977) 76–102.Google Scholar
  25. [25]
    Snyder D. P.:Modal Logic and Its Applications, Van Nostrand Reinhold Company, New York, 1971.Google Scholar
  26. [26]
    Streeter, G. L.:Developmental Horizons in Human Embryos. Age Groups XI to XXIII, Carnegie Institution of Washington, Embryology Reprint Vol. II, The Lord Baltimore Press, Baltimore, 1951.Google Scholar
  27. [27]
    Suppes, P.:Axiomatic Set Theory, D. Van Nostrand Company, Inc., Princeton, 1960.Google Scholar
  28. [28]
    Wieland, W.:Diagnose, Überlegungen zur Medizintheorie, Walter de Gruyter, Berlin, 1975, pp. 13–40.Google Scholar
  29. [29]
    Zeman, J. J.:Modal Logic. The Lewis-Modal Systems, Oxford at the Clarendon Press, 1973.Google Scholar

Copyright information

© D. Reidel Publishing Company 1980

Authors and Affiliations

  • G. William Moore
    • 1
  • Grover M. Hutchins
    • 1
  1. 1.Department of PathologyThe Johns Hopkins HospitalBaltimoreU.S.A.

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