Mario Romero-Cristóbal, Magdalena Salcedo Plaza, Rafael Bañares
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引用次数: 0
摘要
在许多不同的医疗环境中,机器学习(ML)工具的发展在很大程度上与日俱增。然而,如何在日常医疗实践中使用这些算法仍是一个尚未解决的难题。我们提出了一种在临床实践中应用计算工具的认识论方法(即基于逻辑原则)。我们将科学推论分为演绎法、归纳法和归纳法,并将 ML 工具的特点与循证医学(EBM)和经验医学的特点进行比较,后者是众所周知的知识生成方法范例。我们以肝脏移植为例说明我们的论点,但这种方法也可应用于本专业的其他方面。关于 EBM,它产生的是临床医生可以演绎应用的一般知识,但其结论的确定性却无法保证。相比之下,自动算法主要依靠归纳推理。它们的设计能够整合庞大的数据集,并减少人类归纳中固有的情感偏差。然而,其归纳推理能力(人类临床经验中固有的一种逻辑机制)较差,这限制了其在具有不确定性的临床环境中的表现,因为在这些环境中,数据是异构的,结果受背景影响很大,或者预后因素会迅速变化。
Why your doctor is not an algorithm: Exploring logical principles of different clinical inference methods using liver transplantation as a model.
The development of machine learning (ML) tools in many different medical settings is largely increasing. However, the use of the resulting algorithms in daily medical practice is still an unsolved challenge. We propose an epistemological approach (i.e., based on logical principles) to the application of computational tools in clinical practice. We rely on the classification of scientific inference into deductive, inductive, and abductive comparing the characteristics of ML tools with those derived from evidence-based medicine [EBM] and experience-based medicine, as paradigms of well-known methods for generation of knowledge. While we illustrate our arguments using liver transplantation as an example, this approach can be applied to other aspects of the specialty. Regarding EBM, it generates general knowledge that clinicians apply deductively, but the certainty of its conclusions is not guaranteed. In contrast, automatic algorithms primarily rely on inductive reasoning. Their design enables the integration of vast datasets and mitigates the emotional biases inherent in human induction. However, its poor capacity for abductive inference (a logical mechanism inherent to human clinical experience) constrains its performance in clinical settings characterized by uncertainty, where data are heterogeneous, results are highly influenced by context, or where prognostic factors can change rapidly.
期刊介绍:
Gastroenterology and Hepatology is the first journal to cover the latest advances in pathology of the gastrointestinal tract, liver, pancreas, and bile ducts, making it an indispensable tool for gastroenterologists, hepatologists, internists and general practitioners.