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    The Logical Structure of Clinical Medicine
    The Logical Structure of Clinical Medicine
    The Logical Structure of Clinical Medicine
    Ebook99 pages3 hours

    The Logical Structure of Clinical Medicine

    By Ulrich Müller-Kolck

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    About this ebook

    The practice of medicine basically depends on three general concepts: an individual patient image, the individual disease course of this patient, and an expectation of the future development of the disease. Physicians use heuristics for the cognitive processing of these concepts. Basic clinical heuristics are put into three algorithms: a history-based-learning algorithm, a diagnostic-inferencing algorithm, and a prognostic-planning algorithm. A proto-theory of clinical reasoning for practicing physicians is proposed.
    LanguageEnglish
    PublisherBooks on Demand
    Release dateNov 26, 2015
    ISBN9783739282459
    The Logical Structure of Clinical Medicine

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      Book preview

      The Logical Structure of Clinical Medicine - Ulrich Müller-Kolck

      REFERENCES

      Preface

      The text is the core of a knowledge-engeneering lecture in computer science (AI-working group, Technical Informatics, Universitiy Bielefeld, 1992-95) introducing master students to basic reasoning principles in clinical medicine. The very general approach to the practice of medicine oversimplifies the complexity of real clinical settings. Many of the issues would require extended discussions. The text provides a proto-theory.

      Acknowledgements

      The author is much in dept to Reinhard Flessner for reading of the text and his criticisms.

      1 Introduction

      In our professional medical language the term clinical medicine denotes all the activities of solving individual health problems under real world conditions. Clinical medicine has often been analysed under the focus of processing a nosological taxonomy for the classification of individual disease cases. From the viewpoint of medical practice cognitive processing is more than solving classification tasks.¹ In contrast the core structure of clinical reasoning is the dynamic concept of the individual disease course. Physicians use basic clinical heuristics to reconstruct idiosyncratic disease courses. Both elements, disease course and reasoning heuristics, are necessary to apply medical knowledge to the real world problems of the patients.

      My thesis is that the practice of medicine basically depends on three general concepts: an individual patient image, the individual disease course of this patient, and an expectation of the future development of the disease. I analyze the logical structures of these concepts in chapter 3 (patient image) and chapter 4 (disease course).

      Physicians use heuristics for the cognitive processing of these concepts under real world conditions. Heuristics have the advantage that they guide medical decisions within fuzzy boundaries. Heuristics are open for new information, for intuitions.² In chapter 5 basic clinical heuristics are condensed into three algorithms: a history-based-learning algorithm, a diagnostic-inferencing algorithm, and a prognostic-planning algorithm. Chapter 6 summerizes the results of my analysis.

      Although computer-based medical information processing has tremendously progressed in the last years, there is no convincing penetration of these technologies into our everyday practice of medicine. Chapter 7 enumerates possible applications of the proposed theory. A list of reasonable exercises may encourage cognitive engineers to design tools to support cognitive processing of individual patient data. These tools should realize the proposed algorithms. They should be judgment assistants or tools for thinking³ for the practicing physician.

      ¹ Braunwald E, Isselbacher KJ, Petersdorf RG, Wilson JD, Martin JB, Fauci AS (eds.). Harrison´s Principles of Internal Medicine, New York, et al.: McGraw-Hill Book Company, 11th ed. 1987. Hurst, J.W. (ed.), Medicine for the Practicing Physician, 2nd edition, Boston et. al.: Butterworth, 1988. Kahneman D, Slovic P, Tversky A (eds.). Judgement under Uncertainty: Heuristics and Biases. Cambridge, England: Cambridge University Press 1982. Macleod John (ed.). Clinical Examination. Edingburgh, London, NewYork: Churchll Livingstone, 1979. Murphy EA. Probability in Medicine. Baltimore, London: The Johns Hopkins University Press, 1979. Murphy EA. Skepsis, Dogma and Belief. Uses and Abuses in Medicine. Baltimore, London: The Johns Hopkins University Press, 1981.

      ² Gigerenzer G. Gut Feelings. New York: Viking. 2007. Gigerenzer G. Fast and Frugal heuristics: tools of bounded rationality, in: Koehler D, Harvey N (eds.): Blackwell handbook of judgement and decision making. Oxford 2004, 62-88. Schwartz S, Griffin T. Medical Thinking. The Psychology of Medical Judgment and Decision Making, Springer: New York, 1986.

      ³ Hurst, J.W. (ed.), a.a.O., p13.

      2 Method

      The author was interviewed as a medical expert during the knowledge acquisition process for the HYPERCON-project (HYPERCON 1992 – 1995: University of Bielefeld, Faculty of Technology, Knowledge Based Systems - Artificial Intelligence Research Group, Head: Ipke Wachsmuth).⁴ The reconstruction of general structures in clinical medicine is based upon the transcripts of these interviews.

      The formal approach for the reconstruction uses Patrick Suppes´s method of axiomatizing theories by defining set theoretical predicates.⁵ His informal set theoretic approach has later been extended to the so called Structuralist View of Scientific Theories.⁶ Following these ideas the basic structures in clinical medicine are reconstructed. The technique of defining set theoretical predicates.is self-explanatory, the formal representation uses naïve set theory.

      This approach has three advantages: (1) The predicates reconstruct and summarize basic structures and their functions in clinical medicine. (2) They can be used to elicit basic heuristics of medical knowledge processing. (3) During the initial phase of a knowledge engineering process this kind of intuitive representation helps to axiomatize the medical domain in a precise manner without recourse to specialized formal languages which later on are necessary to transform the modelling into computer programs.

      ⁴ Heller B, Meyer-Fujara J, Schlegelmilch S, Wachsmuth I. HYPERCON: ein Konsultationssystem zur Hypertonie auf der Basis modular organisierter Wissensbestände. University of Bielefeld ; Fakultäten. Technische Fakultät, in: G. Barth et al.: Anwendungen der künstlichen Intelligenz: KI-94, 18. Fachtagung für Künstliche Intelligenz, Saarbrücken, 22./23. September 1994, Berlin: Springer: 1994, 155-169. Heller B. Modularisierung und Fokussierung erweiterbarer komplexer Wissensbasen auf der Basis von Kompetenzeinheiten. Bielefeld, Univ., Diss., 1995. Sankt Augustin: Reihe: Dissertationen zur künstlichen Intelligenz. 1996. Heller B, Herre H, Lippoldt K, Loeffler M. Standardized Terminology for Clinical Trial Protocols Based on Top-Level Ontological Categories. In: Kaiser K et al (eds.) Computer-based Support for Clinical Guidelines and Protocols, IOS Press

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