ABSTRACT
This chapter presents a conceptual framework for characterizing the essential nature of the diagnostic reasoning process. It addresses the nature of the clinical reasoning process and offers a description, critique, and a status report of the internist development. Designers of computer-based diagnosis programs often view the physician's primary decision-making task as one of "differential diagnosis." The physician's concept of a diagnostic task establishes a context for a number of clinical decisions. Perhaps the most important consequence of the physician's conceptualization of a diagnostic problem is the role that such a problem solving context plays in determining the strategy to be used for information acquisition. The great majority of diagnostic programs fall into a degenerate category, in that the entire computer-based procedure consists of the single module labeled "problem solver." Any diagnostic program that permits narrowing of the problem solver's focus on the basis of purely heuristic maneuvers must make provision for those maneuvers to be undone.
