b.cohen wrote:
>I agree that clinical diagnosis is about problem solving, although it's
>'scientific' credentials are often rather weak.
>>From a scientific point of view, one's 'confidence' in a hypothesis, e.g. a
>diagnosis, does not correspond to a quantifable 'likelihood of truth' (as
>Popper has insisted for years) but to the set of hypotheses all of which
>account for the facts observed so far.
>Scientific problem solving seeks optimal ways of making observations that could
>refute as many members of this set as possible.
>Certainty is reached when the set of valid hypotheses is singular. Note that
>this is certainty is not equivalent to truth, since the 'true' hypothesis may
>be one that one has not, yet, been able to articulate; hence Kuhn's 'paradigm
>shift'.
>In clinical medicine, 'Clinical Practice Guidelines' (CPGs) provide what
>practitioners have discovered, so far, to be optimal strategies for diagostic
>testing in certain areas.
>
>
>
so I wonder if we can reduce all uses of uncertainty qualifiers
('possible', 'probable' etc) in the EHR to just 'uncertain' as Peter has
suggested. The more important item of information than some exact
percentage would seem to be identifying a published (maybe even
computerised) guideline and possibly even the decision node in it to
which the current point in the patient investigation corresponds? Ok,
I'm not seriously suggesting that the physician work that out manually -
but software could help. Prodigy for example provides help in finding
the entry point to a guideline.
Is there any value at all in a physician putting anything more than
'uncertain' as a qualifier in the EHR? Is there any value for example in
putting "95% likelihood of influenza, 5% likelihood of viral meningitis"
rather than just "? influenza ? meningitis"? Do we ever need to care
about percentage weighting, except where included instructured
guidelines (and presumably supported by suitable studies) - where as far
as I understand, they are used to evaluate risk when there is a
combination of exacerbating and reducing factors?
- thomas
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