Some Aspects of Medical Diagnosis

Since mid July Steve Pauker, Jerome Kassirer, and I (Gerald Jay Sussman) have been observing the diagnostic process of expert physicians with the goal of abstracting the underlying procedures being followed. One purpose of this position paper is to summarize our preliminary conclusions. I will attempt to pinpoint those aspects of the process we feel we understand, and where we are confused or unsure. I will also attempt to indicate some possible theoretical underpinnings of our ideas. Finally, I will propose what I consider to be a coherent research protocol for the development of these ideas. Work reported herein was conducted at the Artificial Intelligence Laboratory, a Massachusetts Institute of Technology research program supported in part by the Advanced Research Projects Agency of the Department of Defense and monitored by the Office of Naval Research under Contract Number NOO014-70-A-0362-0005. Working Papers are informal papers intended for internal use. Some Aspects of Medical Diagnosis Since mid July Steve Pauker, Jerome Kassirer, and I (Gerald Jay Sussman) have been observing the diagnostic process of expert physicians with the goal of abstracting the underlying procedures being followed. One purpose of this position paper is to summarize our preliminary conclusions. I will attempt to pinpoint those aspects of the process we feel we understand, and where we are confused or unsure. I will also attempt to indicate some possible theoretical underpinnings of our ideas. Finall , I will propose what I consider to be a coherent research protocol for the development of these ideas. Specificall, we have observed the behavior of several physicians, of varying degrees of expertise, when presented with an unknown CPC. The CPC was read to the subject, one fact at a time, and he was encouraged to introspect verbally on his state of mind. Informal protocols were taken and the subject was encouraged to participate in the analusis. Thus, the subject picked up the language and beliefs of the experimenters and was usually enthusiastic about the application of the budding theory. This is perhaps a terrible way to do psychological research as the subject's behavior is modified by the experiment; but we are more interested in a good way to perform diagnosis than in precisely how any particular physician operates. In any case, the subjects felt that, rather than their methods being modified by the experiment, they had acquired a language for describing the previously indescribable processes going on