This essay presents a theoretical construct upon which to base a working — “pragmatic” — definition of the History of Present Illness (HPI). The major thesis of this essay is that analysis of both the logic of hypothesis formation and literary narrative — especially detective stories — facilitates understanding of the diagnostic process. The essay examines three elements necessary to a successful development of a patient's HPI: the logic of hypothesis formation, based upon the work of the philosopher-logician Charles Sanders Peirce; the organization of knowledge in relation to structures of narrative; and the feedback necessary to the successful physician-interviewer. It concludes with a systematic description of the design of hypothesis formation within diagnoses.

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