7. Conclusion
In this paper, we have outlined a general framework for analyzing diagnostic reasoning, based on C. S. Peirce’s notion of abduction. We have distinguished between reasoning concerned with generating, pursuing and accepting/rejecting diagnostic hypotheses. Through our case study we have highlighted the crucial role played by clinical experience and judgement at each of these stages. Finally, we have critically evaluated currently existing frameworks for conceptualizing diagnostic reasoning, and proposed that diagnosis can be fruitfully thought of in terms of strategic reasoning.
As illustrated in Section 6, the latter framework allows us to naturally describe the kinds of reasons that led to successful diagnosis in our case study. We do not claim this to be prescriptive: while we have explicated reasons which in the concrete situation made the strategies adopted by the physicians reasonable , we do not claim that these represent the best possible strategies. However, we believe that our framework can contribute to a better normative understanding of diagnostic reasoning as it occurs in existing clinical practice. By allowing us to identify and discuss the prescriptive limitations of different diagnostic strategies, it provides a basis for evaluating proposed improvements of clinical practice and for teaching diagnostic reasoning.