Counterfactual Diagnosis: Bridging Disease and Illness Through Two-Level Reasoning

Area of Science:

• Philosophy of Medicine
• Clinical Diagnosis
• Patient Experience

Background:

• Current diagnostic models often struggle to integrate objective biological findings with subjective patient experiences.
• Philosophical frameworks like Boorse's theory of disease and phenomenology offer insights into understanding illness.
• Counterfactual reasoning, or "what-if" thinking, is a cognitive tool used in various domains.

Purpose of the Study:

• To propose a novel two-level diagnostic model that connects biological explanations of illness with patient experience.
• To demonstrate how counterfactual reasoning can serve as a shared logical structure between clinical evidence and patient narratives.
• To enhance diagnostic approaches by incorporating both objective causes and subjective life changes associated with illness.

Main Methods:

• Developing a two-level diagnostic model based on counterfactual reasoning.
• Analyzing the application of counterfactuals at the objective (clinician) and subjective (patient) levels of diagnosis.
• Integrating Boorse's theory of disease and phenomenological perspectives.

Main Results:

• Clinicians utilize counterfactuals to investigate the causes of illness at an objective level.
• Patients employ counterfactuals to articulate their illness experience by imagining life without sickness at a subjective level.
• The model reveals a common underlying logical structure in how both clinicians and patients engage in "what-if" thinking.

Conclusions:

• The proposed model offers a shared logical framework for understanding clinical evidence and patient experience.
• This approach supports evidence-based diagnosis while prioritizing the patient's narrative and lived reality.
• It promotes a more thoughtful, patient-centered diagnostic process that addresses both biological and life-altering aspects of illness.