Donald E. Stanley and Rune Nyrup
Charles Darwin: “I think that I have become a little more skillful in
guessing right explanations and in devising experimental tests; but this
may probably be the result of mere practice, and of a large store of
knowledge” (Darwin 1958, 136).
Abstract: We distinguish three aspects of medical diagnosis:
Generating new diagnostic hypotheses, selecting hypotheses for further
pursuit and evaluating their likelihood 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.
Keywords: Clinical diagnosis; C. S. Peirce; Abduction;
Threshold Approach; Strategic Reasoning.