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11 A Model of Inexact Reasoning in Medicine

Inexact reasoning is common i the sciences. It is characterized by such phrases as "the art of good guessing," the "softer aspects of physics" (or chemistry, or any other science), and "good scientific judgment." By definition, inexact reasoning defies analysis as applications of sets of inference rules that are expressed in the predicate logic. Yet it need not defy all analysis. In this chapter we examine a model of inexact reasoning applied to a subdomain of" medicine. Helmer and Rescher (1960) assert that the traditional concept of "exact" versus "inexact" science, with the social sciences accounting for the second class, has relied on a false distinction usually reflecting the presence or absence of mathematical notation. They point out that only a small portion of natural science can be termed exact-areas such as pure mathematics and subfields of physics in which some of the exactness "has even been put to the ultimate test of formal axiomatization." In several areas of applied natural science, on the other hand, decisions, predictions, and explanations are made only after exact procedures are mingled with unformalized expertise. The general awareness regarding these observations is reflected in the common references to the "artistic" components in the "science of medicine." During the years since computers were first introduced into the medical arena, researchers have sought to develop techniques for modeling clinical decision making. Such efforts have had a dual motivation. Not only has their potential clinical significance been apparent, but the design of such programs has required an analytical approach to medical reasoning, which has in turn led to distillation of decision criteria that in some cases