The increasingly frequent application of formal methods, including algorithms and computer programs, to processes that are ordinarily viewed as judgmental seems to be a source of both promise and unease for physicians. A consideration of some of these methods suggests that it may be helpful to attempt to distinguish carefully between judgment and computation. Medical care involves a complex of inferential processes, any of which may be performed as judgments, and some of which may be carried out as a computation. My purpose here is to identify the latter cases. The empirical evidence suggests that such a demarcation is feasible. The most important question appears not to be "Where can we use computers?" but "Where must we use human beings?" Until this matter is more thoroughly explored, tension between physicians and computer advocates will persist.

Clinical Judgment and Computers

The present bibliography aims at informing and stimulating researchers when studying the multiple facets of medical diagnosis. The complexity of investigation in this domain can be judged by the fact that papers dealing with medical diagnosis do not appear in medical journals only. Clearly, medical diagnosis is no longer a strictly medical problem. Mathematical and statistical models and analyses must be created and improved before computer programs for diagnostics can be elaborated.

Problems of medical diagnosis--a bibliography.

The predictive values of total thyroxine, thyrotropin, and total triiodothyronine concentrations in serum for clinically apparent and subclinical hypothyroidism and hyperthyroidism were determined by retrospective analysis of clinical cases chosen from the frequency distributions of hormone test results. Very low total thyroxine concentrations, less than 25 microgram/L, were specific for hypothyroidism. Most subclinical hypothyroid cases had intermediate or low total thyroxine concentrations, 35-60 microgram/L, with moderately increased thyrotropin concentrations, greater than 12 milli-int. units/L. Thyrotropin cut-off concentrations were identified that had predictive values greater than 90% for classifying untreated and hormone-treated hypothyroid cases. Above-normal total thyroxine concentrations, regardless of absolute value, were not specific for hyperthyroidism, because binding-protein alterations related to estrogen taking were prevalent and produced occasional marked increases in serum total thyroxine. Nevertheless, cut-off concentrations for serum total thyroxine and total triiodothyronine were identified that had a predictive value greater than 90% for hyperthyroidism, without necessitating measurement of the capacities or concentrations of hormone-binding proteins.

Predictive values of thyroxine, thyrotropin, and triiodothyronine concentrations in serum.

Thyroid disorders: automatic diagnosis in CONSULT I.

Interpretive reporting by computer.

A suggestion for an effective use of a computer-aided diagnosis system in screening for hyperthyroidism. -

A suggestion for an effective use of a computer-aided diagnosis system in screening for hyperthyroidism.

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A suggestion for an effective use of a computer-aided diagnosis system in screening for hyperthyroidism.