Abductive Reasoning in Clinical Diagnostics

Abstract

In this chapter, we look at the reasoning process called abduction as it happens in clinical reasoning, specifically, in diagnostics. Abduction is recognized as one of the most important forms of reasoning in studying relations between causes and effects, and often attributed to reasoning processes in scientific discoveries. Interestingly, abduction does not only play a role in scientific reasoning, but it is believed that people apply it in common everyday scenarios, for example, by detectives and judges. Yet there have been few attempts to document this form of reasoning in clinical interactions. Doctors apply abduction daily in their clinical practice, that is, in the attempt to diagnose their patients, and, as it will be seen, patients themselves use abductive reasoning to understand and explain their own symptoms. This chapter provides empirical evidence of the use of abductive inferential reasoning in clinical medicine, focusing on diagnosis as it happens in the moment of interaction between a doctor and their patient. The goal is not to document in a structured way the extent to which abductive inferential patterns appear in a typical doctor-patient interaction, but rather to illustrate that kind of interaction and mode of reasoning using real dialogues.

Appendix: Note on Data

The data was collected between July 2021 and January 2022. An assistant recorded the interaction between patients and doctors. All dialogues have been completely anonymized due to the sensitivity of the data collected. All doctor-patient recordings were assigned a letter initial, in alphabetical order, and all patients are named in this chapter with the corresponding letter. Doctors are not named or identified in any way. All patients have given consent to the recordings and their use for research purposes, and the protocol was approved by the San Raffaele Hospital Ethical Committee. A copy of the authorization can be obtained from the author.