Clinical Diagnosis

 A friend of mine was diagnosed with a form of dementia. I remember him telling me that some days he thought, “This is just a clinical diagnosis. There is no blood test or MRI. I think they got it wrong.” This led me to think about the diagnosis of abuse. It too is a clinical diagnosis. Because of this, counselors and advisors need to be careful in making the diagnosis. We must be disciplined to avoid asserting the consequent or falling into various cognitive biases.

With this in mind I did a google search for “clinical diagnosis and asserting the consequent.” AI produced the following summary of information available. I found it extremely helpful. Those who are helping victims identify abuse must be cautious. Cognitive biases can prevent identifying abuse or can cause a wrongful accusation to be attached to an innocent individual. Below is the information produced by AI.

When making a clinical diagnosis, "asserting the consequent" is a logical fallacy where a clinician incorrectly assumes that because a certain symptom or sign is present, a specific disease must be the cause. This flawed reasoning can lead to misdiagnosis because many different conditions can cause the same symptom.  

Understanding asserting the consequent

This fallacy, also known as "affirming the consequent," takes the following logical form:  

• Premise 1: If a patient has disease A, then they will show symptom B.
• Premise 2: The patient has symptom B.
• Flawed Conclusion: Therefore, the patient has disease A.  

This reasoning is invalid because symptom B is a consequence that can have other possible causes. The truth of the consequent (symptom B) does not guarantee the truth of the antecedent (disease A).  

A medical example

• Premise 1: If a patient has the flu (A), they will have a fever (B).
• Premise 2: The patient has a fever (B).
• Flawed Conclusion: Therefore, the patient has the flu (A).  

This is a fallacy because other illnesses, such as bronchitis, or even a drug reaction, can also cause a fever.  

How asserting the consequent leads to diagnostic error

In clinical practice, the diagnostic process involves complex reasoning under conditions of uncertainty. Asserting the consequent is one of several cognitive biases that can interfere with this process.  

It can manifest in the following ways:

• Confirmation bias: This is a closely related cognitive error where a clinician forms an initial hypothesis and then unconsciously seeks out or overemphasizes evidence that confirms it, while ignoring or downplaying contradictory information. A clinician might anchor on an early finding, such as a patient's self-report of a symptom, and then use the fallacy of affirming the consequent to justify their initial, and potentially incorrect, diagnosis.
• Availability bias: A recent or dramatic case can increase the mental "availability" of a certain diagnosis. A clinician might overemphasize the possibility of a particular condition simply because they recently saw a similar case, even if the symptoms could have multiple causes.
• Premature closure: This error occurs when a clinician seizes on a potential diagnosis and stops considering other possibilities. For example, if a patient with a known history of migraines reports a severe headache, a physician might prematurely conclude it is another migraine attack, even though the symptoms could signal a more serious condition like a subarachnoid hemorrhage.  

How to overcome this fallacy in clinical diagnosis

Several strategies can help clinicians avoid asserting the consequent and other cognitive biases:  

• Differential diagnosis: Explicitly generate a list of alternative diagnoses that could explain the patient's symptoms. This forces a consideration of other possibilities and discourages premature closure.
• Metacognition and reflection: Intentionally slow down the reasoning process, especially in complex or uncertain cases. Reflective reasoning involves taking time to analyze and question initial assumptions, rather than relying solely on automatic, intuitive thinking.
• Consider disconfirming evidence: Actively look for evidence that might disprove the initial hypothesis. Instead of seeking only confirmatory data, a clinician can ask themselves, "What would make me change my mind about this diagnosis?".
• Seek peer consultation: Discussing challenging cases with colleagues or seeking a second opinion can provide an alternative perspective and reduce the influence of individual biases.
• Use structured tools: For high-stakes decisions, checklists and evidence-based clinical decision tools can help ensure a systematic approach and reduce the chance of cognitive error. 

 

https://www.ama-assn.org/about/ethics/4-widespread-cognitive-biases-and-how-doctors-can-overcome-them#:~:text=Four%20to%20look%20out%20for,Related%20Coverage

 

https://codex.ucsf.edu/primer-3-role-clinical-reasoning-diagnostic-excellence#:~:text=Notable%20biases%20include:%20availability%20bias,work%2Dup%20is%20not%20pursued

 

https://www.aafp.org/pubs/afp/issues/2011/1101/p1042.html

 

https://www.fhea.com/resource-center/anchoring-cognitive-bias-confirmation-bias-fhea/#:~:text=With%20anchoring%20bias%2C%20the%20clinician,diagnosis%20of%20migraine%20over%20stroke

WHY?

 

How easy it is to lose the will to live

The good that is done is ignored…or

Worse yet attributed to an effort to hide sinful intentions.

The wrongs, grievous failures, even when well intentioned, are emphasized and never forgotten.  

Bad opinions are formed and never adjusted despite deep personal transformation—

“once a drunk always a drunk.”

 

Injustice surrounds us.

Men with a large smile and little ability

Rise above the strongly committed men of integrity.

Rightly did Asaph, and Habakkuk whine, that the wicked prosper while the righteous suffer.  

The injustice erodes the very core of my desire to believe in the success of righteousness.

Why?

Repentance

   Recently, I was asked how I gauge if an abuser is repentant. I explained that I have used 2 Corinthians 7:10-11 as a template for years. As I wrote out the exposition of the passage as it relates to abusers, I realized that the principles apply to every sin. By comparing the actions of others--and more importantly to ourselves--we can see the reality of our repentance.

2 Corinthians 7:10-11

10 For the sorrow that is according to the will of God produces a repentance without regret, leading to salvation, but the sorrow of the world produces death. 11 For behold what earnestness this very thing, this godly sorrow, has produced in you: what vindication of yourselves, what indignation, what fear, what longing, what zeal, what avenging of wrong! In everything you demonstrated yourselves to be innocent in the matter.

 

For the sorrow that is according to the will of God produces a repentance…

·         "without regret, leading to salvation,"

·      Does the abuser regret losing control

·      Does the abuser regret the consequences he faces for his sin

·      Does the abuser regret the loss of prestige, respect, influence, etc.

·         "For behold what earnestness this very thing,"

·      Is the abuser working diligently to see a change?

·      Does he faithfully complete all homework?

·      Is his attitude serious toward changing his life?

·         "this godly sorrow,"

·      Does he consistently express sadness for the harm he has done to others?

·      When reminded of his sin, does the abuser apologize or complain about his sin being “brought up” again?

·      Is his sorrow focused on the harm his actions did to others or on the hardship they brought to him.

·         "what vindication of yourselves,"

·      This one is tricky at first glance.

·      Does the abuser so repent as to promote restitution for his actions?

·      Does the abuser now oppose control within himself and others with zeal and passion?

·      Are the actions of the abuser establishing a new life pattern in which an accusation of abuse would seem impossible? (For restoration of a minister, BCO 34-8 requires that it only be done when the sentiment of the church “demands it.” This is what I look for in a penitent abuser.)

·         "what indignation,"

·      Does the abuser hate what they have done.

·      Is the abuser “beating himself up” for the sins he committed.

·      This indignation will fuel the earnest repentance.

·         "what fear,"

·      Is the abuser terrified that they will abuse again.

·      An alcoholic once told me, “I know that I have another drunk in me. I am terrified that I might not have another sober. This “fear” kept him sober.

·      "what longing,"

·      Does the abuser look to the future with hope?

·      Does the abuser imagine what it will be like to be trustworthy and safe?

·         "what zeal,"

·      Is repentance the driving factor in the abuser’s life.

·      Is the abuser ever aware of his propensity to control and is he committed to “take every thought captive to the obedience of Christ.”

·         "what avenging of wrong!"

·      Is the abuser willing to make up for his wrongs to the very people he hurt?

·      Does the abuser recognize why his victims do not want to be around him?

·      Does he willingly honor this desire?

 

    This is what I teach survivors of abuse to use when trying to see if the abuser is safe. These principles can guide us as we examine ourselves in turning from whatever sin we have adopted. 

 

What is Personal Worship

 

WHAT IS PERSONAL WORSHIP?

Augustine expressed the feeling of every Christian heart when he began his classic work Confessions by writing “You move us to delight in praising You; for You have formed us for Yourself, and our hearts are restless till they find rest in You.  Lord, teach me to know and understand which of these should be first, to call on You, or to praise You; and likewise to know You, or to call upon You.”  The Christian finds deep satisfaction when she calls on, praises, and comes to know her Lord. Since the fall this longing is only met through personal discipline to resist the forces of the world, the flesh, and the devil which each conspires to place obstacles between the Christian and her experience of her Savior.

Paul tells us how to overcome the ever-present obstacles to personal worship in Romans 12:1. “Therefore I urge you, brethren, by the mercies of God, to present your bodies a living and holy sacrifice, acceptable to God, which is your spiritual service of worship.” The word translated “urge” is the Greek word “parakaleo.” Parakaleo literally means to call alongside. It is often translated as “comfort” or “comforter.” The image that best helps me understand Paul’s meaning occurred after I was examined to become an elder. Another elder came beside me and placed his arm around my shoulder. He explained to me a weakness found during my examination. He applied gentle pressure that reassured me. Through that pressure he began to guide me to move to the front of the sanctuary for the beginning of the worship service. Joel Smith’s strong, gentle, and directive arm comforted me in the face of my weakness while also showing what I needed to do next…which was enter the worship of our God. Paul is coming beside you saying, “Let’s worship Jesus.” He shows us that our deepest longing is satisfied in a “spiritual service of worship.” Let’s consider this verse as a guide to developing our personal worship.

 

PRESENT YOUR BODY

Worship is something that occurs in our bodies. Paul does not allow for a distinction between the physical and the spiritual. He sees us as a unified whole. Worship involves the spiritual component of our being but it is expressed through our physical bodies. Our eyes close; our voice rises to heaven; our ears are attentive to the truth found in the music, the Scripture, and the prayers we offer; our heads bow while our hands are lifted. Worship involves our bodies being offered to God. Be aware of your body as you enter worship.

Our bodies become the living sacrifice we offer to God. A sacrifice does not have the right of self-determination. As we offer our bodies we remember 1 Corinthians 6:20. “For you have been bought with a price: therefore glorify God in your body.” If I can begin worship with a moment of silence in which I actively relinquish my body to God—not protecting my dignity (2 Samuel 6:14-22)—I thereby align myself with the purpose of worship. In that moment—which can become normative in my life—I am free from my plans; my strategies; and the pressures of meeting the expectations of those around me. In that moment Jesus is Lord and I am given over to Him. This is the beginning or your “spiritual service of worship.”

In the chapters that follow we will expand this idea of worship. As you learn more about prayer, scripture reading, meditation, and even silence, begin each discipline by presenting your body as a living sacrifice. Give yourself without any reservations to Jesus.

 

FURTHER CONSIDERATIONS

1)      Re-read Romans 12:1 and write out your observations about the image of worship it presents.

 

 

2)      How can you specifically follow the instructions in this verse?

 

 

3)      What obstacles do you personally face in presenting your body as a living sacrifice?

 

 

4)      Read 2 Samuel 6:14-22. What needs to occur in your life to allow you to live consistent with David’s word in v. 22?

 

 

5)      What do you want to see change in your life during the next thirteen weeks?

 

Covid Vaccines: by Dr. Wiley Smith

 

Discussions are underway in Christian circles on whether one should take a COVID-19 vaccine. The concern centers on association of the vaccines with tissue from aborted babies. Here is my opinion as a pro-life medical professional. I am a family physician and member of Grace Presbyterian Church PCA in Dalton, Georgia. My prior experience includes 24 years of active duty in the U.S. Army, 9 years of missionary work in Belize with Mission to the World, and my present role as a traveling medical missionary with Mission to the World. In past days, I was the board chairman for Crisis Pregnancy Center in Augusta, Georgia. Presently I am the medical supervisor for our local pro-life center, Women's Enrichment Center. Concerning vaccines and the immune system, I spent a year at Walter Reed Army Institute of Research studying experimental design and immunology.

Before describing the COVID-19 vaccines that are coming out, allow me to give a bit of biology lesson. Each of the billions of cells in our bodies contain genetic instructions in the form of DNA. The cells also contain a protein construction factory. The instructions for the protein construction factory on how to build proteins and other components are translated from DNA into another form called messenger RNA. Viruses such as COVID-19 hijack the protein construction factory by inserting their own, foreign RNA. The cells then busy themselves building new viruses, which break out of the cells and infect other cells. Viruses cannot reproduce themselves without invading normal cells.

The Lord has built into our bodies defenses against the viruses. Viruses have an outer coating of proteins. Our immune system can recognize these proteins as being foreign, and produce antibodies which coat and inactivate the virus. In the case of COVID-19, there is a protein called the spike protein that the virus uses to attach to our cells. We develop immunity to COVID-19 by developing antibodies to the spike protein. COVID-19, being very infectious and able to replicate quickly, is able to overcome our immune system before it has a chance to make effective antibodies, if we have never before been exposed to the virus.

There are three vaccines that have reached a stage to be widely distributed in the near future. These three vaccines all take a similar approach to teaching our immune systems how to make antibodies against the spike protein. The vaccines contain a short segment of messenger RNA which is specific for building only spike protein and nothing else associated with the COVID-19 virus. Entering some cells, the messenger RNA induces the cells to make copies of the spike protein. That protein is recognized by the body as being foreign, inducing the production of antibodies and giving us immunity. The messenger RNA does not make any alterations to cellular DNA. Neither does the messenger RNA remain active for very long.

Two of the vaccines, which are the ones that are on track for approval in the U.S., are almost identical in how they are manufactured and work. The Pfiser and Moderna vaccines are made with synthetically manufactured messenger RNA. This RNA is then coated with a capsule of lipids (fat) that allows the messenger RNA to enter cells. This is all done by synthetic machinery. There is nothing in the manufacturing process that involves tissues of aborted fetuses.

The third vaccine under consideration is the Oxford / AstraZeneca vaccine. This vaccine uses a different approach. Messenger RNA is inserted into the shell of a virus that causes colds in monkeys, but does not make us sick. The virus shell then allows the messenger RNA to enter our cells. Recall that viruses require the mechanisms of a living cell to reproduce. To reproduce the monkey cold virus, a human cell line called HEK 293 is used. These cells originated from the kidney of a fetus aborted in the 1970's. These cells have been modified so that they can reproduce themselves indefinitely, so that the cells used today are many generations away from the aborted fetus. No cells from recently aborted fetuses are involved. Fetus-derived cells are filtered out of the vaccine, so that no such cells enter us when administered.

So, those who do not wish to have anything to do with cells derived from aborted fetuses may wish to avoid the Oxford / AstraZeneca vaccine, but can take the Pfiser or Moderna vaccines with no such concern. It appears that the Pfiser and Moderna vaccines will be released first in the U.S.

There are other reasons we as Christians should seek out vaccination for COVID-19. I have heard a prediction that 450,000 Americans may die of COVID-19 by the end of February 2021. That is more Americans who died in the four years of World War II. The only way we can finally overcome COVID-19 is for enough of us to become immune so as to break the chain of transmission of the virus. If we wait until the virus infects the majority of us, millions would die. To be immunized and to develop immunity means that we care not only for ourselves, but for all others who bear the image of God.

Pregnant women who are infected by COVID-19 are at increased risk of severe complications and death, as are their unborn babies. If we care for them, we also have reason to be immunized.

 

A Man Born Blind

Do you remember the story in John about the man born blind in John 9? The story begins this way: “As He passed by, He saw a man blind from birth. And His disciples asked Him, "Rabbi, who sinned, this man or his parents, that he would be born blind?" Jesus answered, "It was neither that this man sinned, nor his parents; but it was so that the works of God might be displayed in him.” Jesus proceeds to heal this man. Recently I thought about Jesus’ statement and my personal judgements. I have always assumed that the way this man would display “the works of God” was in being healed. He was a canvas that God would paint with a great miracle. What if Jesus meant something far more profound?

                Psalm 139:14 declare that “I am fearfully and wonderfully made.” Was the blind man? Did God form his inward parts? Did God weave him together in his mother’s womb? We quickly respond, “Well, or course.” Really? Even in his blindness? What if Jesus’ statement about the blind man displaying the works of God were true even without the healing. What if he was born blind to display God’s works, even in his blindness?

                I have always assumed that all physical disabilities are a result of the fall. Without sin, they would never exist. This is inferred from Jesus statement that he came so that the blind would see and the lame would walk. And yet, I wonder. When Adam and Eve fell God promised broken relationships, pain in childbirth, futility in work and death. He did not say, your sons and daughters will now be blind, deaf, lame, or short. Is it possible that Jesus’ words regarding the blind man spoke of his magnificent value as an image-bearer of God even in his blindness? Is it possible that Jesus was reminding us that disabilities do not diminish our value at all? Could His words provide us with a model for how we see those who are not like us, or who are not like the “norm?” Before the fall, could a boy have fallen from a rock and broken his leg severely enough to walk with a limp? Could an accidental back swing of a hammer have taken out the eye of a man’s wife? (Remember, errors and accidents are not necessarily sinful).

                I am not yet convinced of my musing but I am intrigued. Regardless of where I ultimately land on this idea, I now see far greater value in those with disabilities than I did two weeks ago. I also see that God will display His works uniquely in each person’s life. Therefore, He will guide and direct our steps throughout “the days that were ordained for me.” (Psalm 139:16)

Governance

How would you govern a nation made up of people with different perspectives of what success looks like, different values, and different philosophical foundations?

·   Should those in power dictate what the rest of the nation must think?

·   Should the different groups denigrate one another with insults and insinuations of nefarious objectives?

·   Should those in the minority band together as an oppressed people?

·   Could such a nation find leaders capable of finding common ground who will give away some of the power of their group to serve those outside of power, promote goodwill among the differing groups and build a more peaceful nation?

 Having read the biographies of Washington, Adams, Hamilton, Burr, Jay, Monroe, and John Quincy Adams, I am convinced that the founder of the United States envisioned a nation whose leaders would work together instead of against one another. They were imperfect in their application of this principle, but it guided their service to our nation and laid a foundation that can sustain us today.