Fear of knowledge: Clinical hypotheses in diagnostic and prognostic reasoning

• Published in: Journal of evaluation in clinical practice Vol. 23; no. 5; pp. 928 - 934
• Main Authors: Chiffi, Daniele, Zanotti, Renzo
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-10-2017
• Subjects: abduction; Clinical Decision-Making; clinical reasoning; Diagnosis; Diagnostic Errors; Humans; hypothesis; Judgment; Knowledge; Medical diagnosis; Medical prognosis; philosophy of science; Problem Solving; Prognosis; Thinking; Uncertainty; diagnosis; clinical reasoning; philosophy of science; abduction; hypothesis; prognosis
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/jep.12664

Patients are interested in receiving accurate diagnostic and prognostic information. Models and reasoning about diagnoses have been extensively investigated from a foundational perspective; however, for all its importance, prognosis has yet to receive a comparable degree of philosophical and methodological attention, and this may be due to the difficulties inherent in accurate prognostics. In the light of these considerations, we discuss a considerable body of critical thinking on the topic of prognostication and its strict relations with diagnostic reasoning, pointing out the distinction between nosographic and pathophysiological types of diagnosis and prognosis, underlying the importance of the explication and explanation processes. We then distinguish between various forms of hypothetical reasoning applied to reach diagnostic and prognostic judgments, comparing them with specific forms of abductive reasoning. The main thesis is that creative abduction regarding clinical hypotheses in diagnostic process is very unlikely to occur, whereas this seems to be often the case for prognostic judgments. The reasons behind this distinction are due to the different types of uncertainty involved in diagnostic and prognostic judgments.