Abstract
BackgroundIn medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients; sometimes even before they report their symptoms. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life.Methodology and Principal FindingsTo test this proposal we developed an experimental paradigm with functional magnetic resonance imaging (fMRI) using radiological diagnosis as a model. Twenty-five radiologists diagnosed lesions in chest X-ray images and named non-medical targets (animals) embedded in chest X-ray images while being scanned in a fMRI session. Images were presented for 1.5 seconds; response times (RTs) and the ensuing cortical activations were assessed. The mean response time for diagnosing lesions was 1.33 (SD ±0.14) seconds and 1.23 (SD ±0.13) seconds for naming animals. 72% of the radiologists reported cogitating differential diagnoses during trials (3.5 seconds). The overall pattern of cortical activations was remarkably similar for both types of targets. However, within the neural systems shared by both stimuli, activation was significantly greater in left inferior frontal sulcus and posterior cingulate cortex for lesions relative to animals.ConclusionsGeneration of diagnostic hypotheses and differential diagnoses made through the immediate visual recognition of clinical signs can be a fast and automatic process. The co-localization of significant brain activation for lesions and animals suggests that generating diagnostic hypotheses for lesions and naming animals are served by the same neuronal systems. Nevertheless, diagnosing lesions was cognitively more demanding and associated with more activation in higher order cortical areas. These results support the hypothesis that medical diagnoses based on prompt visual recognition of clinical signs and naming in everyday life are supported by similar brain systems.
Highlights
There is substantial and converging evidence that a significant part of the understanding of the environment that we have in our everyday lives is carried out by brain mechanisms that are fast, automatic, and effortless [1,2,3]
Generation of diagnostic hypotheses and differential diagnoses made through the immediate visual recognition of clinical signs can be a fast and automatic process
Diagnosing lesions was cognitively more demanding and associated with more activation in higher order cortical areas. These results support the hypothesis that medical diagnoses based on prompt visual recognition of clinical signs and naming in everyday life are supported by similar brain systems
Summary
There is substantial and converging evidence that a significant part of the understanding of the environment that we have in our everyday lives is carried out by brain mechanisms that are fast, automatic, and effortless [1,2,3]. To exemplify, when a doctor encounters a patient with pronounced jaundice diagnostic hypotheses related to liver diseases immediately and automatically come to her/his awareness This type of diagnosis has been ascribed to pattern recognition or nonanalytical reasoning [9,10]. We propose that the generation of diagnostic hypotheses in such circumstances is the result of neurocognitive processes that are similar to those involved in naming objects or concepts in everyday life. A critical test of this proposal would be to compare the brain systems involved in diagnosing lesions with those involved in naming. We propose that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life
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