ABSTRACT
The problem of diagnostic error has not improved much since its severity was identified around the turn of the century. This, the author argues, is partly because of a persistent misunderstanding in the medical literature regarding what diagnostic reasoning is—a misunderstanding that focuses exclusively on things like performing tests, pattern recognition, and probabilistic calculus. The chapter argues that, instead, diagnostic reasoning is best described as abduction (i.e., “inference to the best explanation”), a method of reasoning that uses the above methods, but focuses on the comparison of multiple hypotheses according to the criteria of adequacy. If the author is right, efforts to combat diagnostic error should include the development and appreciation of abductive skills in physicians; textbooks should be revised and new research projects should be opened. To establish this, the chapter describes the abductive method, uses discoveries in the philosophy of science to establish that diagnostic reasoning is abduction, and then shows how the development of abductive skills could help reduce diagnostic error.
