Diagnostic Consultations: a Speech-Act Theoretical Reconstruction for the Design of Consultation Systems

Abstract:

In this paper the theory of speech acts is applied for a structural reconstruction of medical diagnostic consultations. The reconstruction provides the conceptual model for a research prototype of a consultation tool which is expected to play a mediating role between the participants in the professional diagnostic discourse. Preliminary results of the design will be outlined.

Key-Words

Diagnostic Consultation Systems - Medical Diagnosis - Speech Acts - Application Modeling

• REFERENCES

• 1 Ledley R, Lusted L. Reasoning foundations of medical diagnosis. Science 1959; 130: 9-21.
• 2 Kingsland LC. The evaluation of medical expert systems: Experience with the AI/ Rheum knowledge-based consultation system in rheumatology. In: Proceedings of the 9th Annual Symposium in Medical Care. New York: 1985: 292-5.
• 3 Barnett GO, Cimino JJ, Hupp JA, Hoffer EP. DX pIain: An evolving diagnostic decision support system. JAMA 1987; 258: 67-74.
• 4 Blois MS, Tuttle MS, Sheretz DD. RECONSIDER: A program for generating differential diagnoses. In: Proceedings of the Fifth Annual Symposium on Computer Application in Health Care. Washington DC: 1981: 263-8.
• 5 DeDombal FT, Leaper DJ, Staniland JR, McCann AP, Horrocks JC. Computer-aided diagnosis of acute abdominal pain. Br Med J 1972; 02: 9-13.
• 6 Miller RA, Pople HE, Myers JD. INTER-NIST-1. An experimental computer-based diagnostic consultant for general internal medicine. N Engl J Med 1982; 307: 468-76.
• 7 Adlassnig K-P, Kolarz G, Scheithauer W. Present state of the medical expert system CARDIAG-2. Meth Inf Med 1985; 24: 13-20.
• 8 Buchanan B, Shortliffe E. eds. Rule-Based Expert Systems: The MYCIN Experiments of the Stanford Heuristic Programming Project. Reading MA: 1984
• 9 Aikins JS, Kunz JC, Shortliffe EH, Fallat RJ. PUFF: an expert system for the interpretation of pulmonary lung function data. Comput Biomed Res 1983; 16: 199-208.
• 10 Bankowitz RA, McNeil MA, Challinor SM, Parker RC, Kapoor WN, Miller RA. A Computer-assisted medical diagnosis consultation service. Ann Intern Med 1989; 110: 824-32.
• 11 Szlolovitz P, Patil RS, Schwartz WB. Artificial intelligence in medical diagnosis. Ann Intern Med 1988; 108: 80-7.
• 12 McDonald CJ, Tierney WM. Computer-stored medical records: Their future role in medical practice. JAMA 1988; 259: 3433-40.
• 13 Waxman HS, Worley WE. Computer-assisted adult medical diagnosis: Subject review and evaluation of a new microcomputer-based system. Medicine 1990; 69: 125-36.
• 14 Feinstein AR. Clinical Judgment. New York: 1967
• 15 Feinstein AR. Clinical Biostatistics. St. Louis; Mosby: 1977
• 16 Blois MS. Clinical judgment and computers. N Engl J Med 1980; 303: 192-7.
• 17 Blois MS. Medicine and the nature of vertical reasoning. N Engl J Med 1988; 318: 847-51.
• 18 Murphy EA. The Logic of Medicine. Baltimore: Johns Hopkins Univ Press; 1976
• 19 Murphy EA. The diagnostic process, the diagnosis and homeostasis. Theoretical Medicine 1988; 09: 151-66.
• 20 Pellegrino ED. The anatomy of clinical judgment. In: Clinical Judgment: A Critical Appraisal. Engelhard HT, Spicker SF, Towers B. eds. Dordrecht; 1979: 169-94.
• 21 Miller RA, Schaffner KF, Meisel A. Ethical and legal issues related to the use of computer programs in clinical medicine. Ann Intern Med 1985; 102: 529-36.
• 22 Miller RA, Masarie FE. The demise of the “Greek Oracle” model for medical diagnostic systems. Meth Inform Med 1990; 29: 1-2.
• 23 Weed LL. New premises and new tools for medical care and medical education. Meth Inform Med 1989; 28: 207-14.
• 24 Shortliffe EH. Testing reality: The introduction of decision-support technologies for physicians. Meth Inform Med 1989; 28: 1-5.
• 25 Austin JL. How to Do Things with Words. Oxford: Clarendon Press; 1962
• 26 Searle JR. Speech Acts. Cambridge: Cambridge Univ Press; 1969
• 27 Searle JR, Vandervenken D. Foundations of Illocutionary Logic. Cambridge: Cambridge Univ Press; 1985
• 28 Winograd T, Flores F. Understanding Computers and Cognition. A New Foundation for Design.. Norwood NJ: Ablex Publ Comp; 1986
• 29 Lee RM. Automating red tape: the performative vs. informative roles of bureaucratic documents. Office 1978; 05: 203-8.
• 30 Flores F, Ludlow JJ. Doing and speaking in the office. In: Fick G, Sprague RH. eds. Decision Support Systems, Issues and Challenges. London: Pergamon Press; 1981
• 31 Kimbrough SO, Lee RM, Ness D. Performative, informative and emotive systems: The first piece of PIE. In: Maggi L, King JL, Kraemer KL. eds. Proceedings of the Fifth Conference on Information Systems.. Tucson: 1984: 141-8.
• 32 Lethinen E, Lyytinen K. Action based model of information system. Inform Systems 1986; 11: 299-317.
• 33 Sadegh-Zadeh K. Foundations of clinical praxiology. Part I: The relativity of medical diagnosis. Metamedicine 1981; 02: 183-96.
• 34 Mueller-Kolck U. Expert system support for the therapeutic management of cerebrovascular disease. Artif Intell Med 1990; 02: 35-42.
• 35 Bankowitz RA, McNeil MA, Challinor SM, Miller RA. Effect of a computer-assisted general medicine diagnostic consultation service on housestaff diagnostic strategy. Meth Inform Med 1989; 28: 352-6.
• 36 Kirwan JR, Barnes CG, Davies PG, Currey HLF. Analysis of clinical judgment helps to improve agreement in the assessment of rheumatoid arthritis. Ann Rheum Dis 1988; 47: 138-43.