Computer simulation of medical reasoning in the assessment of kidney disease.

A system for the simulation of clinical reasoning was applied to the evaluation of patient data in nephrological diseases. The system allows the physician to computerise the medical logic in his area of specialisation, to prepare suitable protocols for recording clinical observations, to analyse the patient data for assessing his present clinical status and to plan appropriate diagnostic and therapeutic interventions. The medical logic is expressed in modular form as a series of inferences to be confirmed or rejected on the basis of Boolean combinations of clinical findings and previous inferences. The acceptable Boolean combinations are formulated in terms of threshold logic. The computer programs produce alphabetical lists of the clinical findings appearing in the medical logic, which are organised by the physician into data acquisition protocols appropriate to each phase of clinical activity. The system was run on a series of 22 patients hospitalised in the Department of Nephrology. The patient status reports produced by the computer were in substantial agreement with the assessment of a senior nephrologist. The protocols assured a more complete and accurate recording of patient data than that appearing in the routine patient chart. The program was of value in standardising patient examinations and in the training of new medical staff.