A Complex Model of Clinical Narrative Information for the Diagnostic Act

BackgroundThe act of diagnosis is one which precipitates semiotic closure, the complex integration of signs and symptoms through cognitive perspectives to ultimately activate causal reasoning and calibrate the assignment of a disease entity to the patient. In writing about this act, physicians encode both structured and unstructured information into the medical record. Unstructured information contains a latent structure which entwines both the cognitive components of the diagnostic act and the linguistic patterns associated with clinical documentation. Existing models of clinical language primarily use a physical or dialogic model of information as their basis, and do not adequately account for the complexity inherent in the diagnostic act. MethodsFraming the diagnostic information collected in clinical care as a narrative, we developed a model representative of said information, accounting for its content and structure, as well as the inherent complexity therein. Using an exemplar text, we present the use of known predication and semantic relations from ontological (the Unified Medical Language System) and linguistic theory (Rhetorical Structure Theory) to facilitate the operationalization of the model, and analyze the result. ResultsThe resulting model is demonstrated to be complex, representative of the clinical narrative text, and is fundamentally aligned with the clinical acts of both documentation and diagnosis. We find the models representation of the cognitive aspects of narrative consistent with models of reading, as well as an adequate model of information as presented by clinical medicine and the clinical sub-language. ConclusionsWe present a model to represent diagnostic information in the physicians note which accounts for the clinical and textual narrative precipitated by the cognition involved in encoding said information into the unstructured medical record. This model prepends the development of (computational) linguistic models of the clinical sublanguage within the physicians note as it relates to diagnosis, beyond the information level of the lexical unit. Such analysis would facilitate better reflection on the structure and meaning of the clinical note, offering improvements to medical education and care.