On Apr 27, 2005, at 8:19 AM, Arild Faxvaag wrote: > We could say that physicians _infer_ diagnostic hypotheses based on > - knowledge of the tentative underlying disease, > - the patients subjective experiences > - phenomena registered in the patients body
In any case it is a subjective statement and is a professional opinion based on more (lab results, x-rays) or less (patient history) objective data. > > Phrases such as "cannot be exluded" might be due to", "probably", > "definitely", "beyond doubt" are statements of probability of the > inferrence being correct (and what to do next). Inferrences expressed in the subjective statements documenting the treatment of the patient. > > Can one say that diagnoses belong to the class of statements > whereas the disease itself belong to the class of natural phenomena? Disease is an abstraction of reality that for the moment, for the next decision is considered to represent the reality about the health of the patient. Diagnosis is the professional but subjective opinion about a disease of a patient. There is a continuum: Real pathological, fysiologiscal phenomena in a patient. Certain manifestations of these phenomena. That are (or are not) experienecd by the patient of an other person. The arrousal of distress, anxiety, etc, triggering a visit to a physisian. What is said (or not) about the manifestations of the phenomena during the visit. And how it is said. How it is measured and documented. What is understood of what was said or measured about the manifestations of the phenomena. How all this was mached to the state-of-the art knowledge, or interpreted in the context of a limited amount of available knowledge. What was recorded about all these steps above. How the same person (or others) interpret the recorded 'facts' at a later stage???? So what do we record in an EHR? And what do we interpret readingan EHR? Then ... What is certain? And what is uncertain? Certain or uncertain in what domain, in what line above, at what level of the whole described continuum? In ?25% of the extremely wel researched patients in one University Hospital we not diagnosed correctly during their life time. As could be concluded after an autopsy. So what do we really know about disease and complaints? What is certainty? What is it refering to? Do we understand this mine field well enough? > > The diagnosis establishes a relation between the subjective > experiences / phenomena and the disease that induces those symptoms > and findings. > Example: > Experiences and phenomena: Pain in the wrist joints, feeling of > joint stiffness, joint tenderness, joint swelling, elevated > sedimentation rate. > Diagnostic inferrence: Rheumatoid arthritis. > Relation: Might be induced by/due to > > Can statements of probability be considered statements regarding > the strength of these relations?? This is what they are at best. > > Comments on this? -------------- next part -------------- An HTML attachment was scrubbed... URL: <http://lists.openehr.org/mailman/private/openehr-technical_lists.openehr.org/attachments/20050528/26059551/attachment.html>
