7. Conclusion
In this paper, we have outlined a general framework for analyzing
diagnostic reasoning, based on C. S. Peirce’s notion of abduction. We
have distinguished between reasoning concerned with generating, pursuing
and accepting/rejecting diagnostic hypotheses. Through our case study we
have highlighted the crucial role played by clinical experience and
judgement at each of these stages. Finally, we have critically evaluated
currently existing frameworks for conceptualizing diagnostic reasoning,
and proposed that diagnosis can be fruitfully thought of in terms of
strategic reasoning.
As illustrated in Section 6, the latter framework allows us to naturally
describe the kinds of reasons that led to successful diagnosis in our
case study. We do not claim this to be prescriptive: while we have
explicated reasons which in the concrete situation made the strategies
adopted by the physicians reasonable , we do not claim that these
represent the best possible strategies. However, we
believe that our framework can contribute to a better normative
understanding of diagnostic reasoning as it occurs in existing clinical
practice. By allowing us to identify and discuss the prescriptive
limitations of different diagnostic strategies, it provides a basis for
evaluating proposed improvements of clinical practice and for teaching
diagnostic reasoning.