What is the correct method of diagnosis

Adrián Israel Martínez Franco adrianfile at GMAIL.COM
Wed Nov 1 13:41:45 UTC 2017

Hello Jain:
I found interesting your opinion and agree that clinicians barely not use
the Bayesian methodology in clinical practice, but you can apply the
Bayesian Method differently.
The previous likelihood it is not always the prevalence, you can change the
previous likelihood based on the clinical findings of a particular patient,
although you can still argue that this previous value you assign to a
single patient it is based on your own subjectivity and prior experiences.
You do not have absolutes in Bayesian Method.
Bayesian methods give the opportunity to clinicians to think on a scale of
grays instead of thinking about a disease as something white or black.
(This is the interesting part of clinical decision making, we need to make
a white or black decision for patients with incomplete information).
Like in the second case you exposed about the Myocardial Infarction there
is still 20% of probability that your patient does not have the
Myocardial Infarction, and as the clinical data suggest with no specific
t-wave, it is almost sure that your patience is in that 20% group and not
need to be diagnosed as MI.

On Wed, Nov 1, 2017 at 6:46 AM, Jain, Bimal P.,M.D. <BJAIN at partners.org>

> As the prescribed Bayesian method does not appear to be employed for
> diagnosis in practice in CPCs and clinical problem solving exercises, it is
> not clear what the correct method of diagnosis is. I investigate this issue
> in my attached paper and conclude that the probability based Bayesian
> method is not correct as a probability fails to represent evidence for a
> disease in a given, individual patient in whom diagnosis is being performed.
> The correct method is the one which is employed in CPCs and clinical
> problem solving exercises. It consists of formulating a suspected disease
> as a diagnostic hypothesis and confirming ( or disproving ) it by evidence
> in the form of a likelihood ratio.
> Please review and comment on this paper.
> Thanks.
> Bimal
> Bimal P Jain MD
> Northshore Medical Center
> Lynn MA 01904
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Dr. Adrián Israel Martínez Franco

Fulbright Scholar in Residence, Health Science ABAC.

Profesor del Departamento de Informática Biomédica UNAM

adrianfile at gmail.com

amartinezfranco at abac.edu <amartinezfrancl at abac.edu>

Cel.: +521 554 057 1239

Offcie: +1 229 391 5248

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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