How it began

The first medical-philosophical issues that attracted my interest in the philosophy of medicine already in my early student days in the early 1960s, were the question of whether human beings have free will, the mind-body problem, and the concept of disease. A few years later, I learned problems of clinical decision-making as additional ones when I started my clinical training in 1968. Living in West Berlin then, i.e., the free sector of then divided Berlin, Germany, I regularly witnessed at clinical rounds the debates between our chief and senior officers about their conflicting bedside diagnoses and treatment recommendations. It was surprising and even disturbing to me as a young physician to encounter such differences among their clinical judgments. This observation made me aware of an issue for the first time that our teachers had not taught us during our medical education, i.e., methods of clinical reasoning. Clinical reasoning, also called clinical decision-making, diagnostic-therapeutic decision-making, and clinical judgment, lies at the heart of clinical practice and thus medicine. Although as students of medicine we had learned large parts of natural sciences such as chemistry, physics, and biology; of biomedical sciences auch as anatomy, physiology, biochemistry, pathology, pathophysiology; and many clinical disciplines, diseases, therapies, and methods of diagnosing and treating individual, specific diseases such as gastritis, leukemia, schizophrenia, etc., we had learned nothing about how to search for a diagnosis and treatment in general, i.e., how to arrive at a clinical judgment. I asked myself whether there was a scientific methodology of clinical judgment that our teachers had withheld from us, and if so, what did it look like? My extensive search was disappointing. It revealed that there was no such methodology. I have been concerned with this topic ever since, and have found that a variety of highly intriguing linguistic, methodological, logical, epistemological, moral, and metaphysical issues and problems are involved. So, I have been devoting myself since 1970 to research in the following areas: the language of medicine, medical praxiology, medical epistemology, medical deontics, medical logic, medical artificial intelligence, and medical metaphysics. Some results of this long-standing inquiry have been presented in The Handbook introduced below.