Human Values in Computer Diagnosis

I would like to begin with two examples of how human values might be added into the calculus of computer diagnosis and clinical management. The first issue concerns the implications for outcome when a particular diagnosis is made. Not all diagnoses are made in the same way. Some have significantly adverse implications if they are present and others do not. Take, for example, a case of a middle-aged man with an episode of hematuria following mild abdominal trauma. There are a number of possible diagnoses, each with an associated outcome. The first option is a condition with no adverse outcome for the patient, for example, the presence of a solitary renal cyst. The primary reason for making such a diagnosis is that the cause of bleeding is identified and other conditions do not have to be considered. The patient is not directly benefited but is protected from future concern and the cost and risk of further examination. A second possibility is a condition with a bad or even fatal outcome for which nothing can be done, for example, an advanced pancreatic carcinoma which has now invaded the kidney. A third intermediate possibility is that a condition is found that is serious and treatable, or even curable. An example of this would be an early resectable renal cell carcinoma. From the viewpoint of the patient, diagnosis number three is the most important one to make since it provides an opportunity to save the individual from a potentially fatal disease and restore health.