Mierau Medical Diagnostic and Coding Method
The Eighteen Foundational Postulates
Postulate 1 Initial Event
Statement
Every medical diagnostic process begins with an Initial Event.
Definition
The Initial Event is the event or circumstance that initiates the need for medical investigation or assessment.
The Initial Event is the zero-dimensional starting point of the diagnostic process.
At this point, no medical specialty, diagnostic hypothesis, diagnosis, therapeutic measure, or classification is assigned.
Principle
The Initial Event SHALL be recorded as the starting point of the diagnostic process without prematurely assigning medical meaning to it.
The subsequent diagnostic process SHALL determine the medical significance, relevance, and possible cause of the Initial Event.
Rationale
A medical diagnostic process can begin from fundamentally different situations.
For example:
Patient: "I have back pain."
or:
Bystander: "There is someone unconscious here."
or:
Preventive occasion: "The patient has reached an age at which preventive assessment is indicated."
These situations are fundamentally different, yet they have one thing in common:
They initiate a need for medical knowledge.
If the Initial Event is immediately assigned to a medical specialty or diagnosis, the subsequent search may be restricted before relevant information has even been obtained.
The Initial Event therefore has to remain directionless.
Practical Example
A patient states:
"I have been experiencing pain in the right lateral thigh for more than 20 years."
At the Initial Event, the system records only:
The patient reports persistent pain in the right lateral thigh.
It does not record:
lumbar disease
neurological disorder
orthopedic disorder
somatization
or any other diagnosis.
These may become hypotheses later — but they are not properties of the Initial Event.
Database Requirements
A medical database SHALL be able to store the Initial Event separately from all subsequent medical interpretations.
At minimum, the database should distinguish:
- Initial Event
- source of the Initial Event
- date/time
- verbatim or faithful description
- subsequent observations
- subsequent investigations
- diagnostic hypotheses
Implications
The Initial Event
- SHALL NOT itself constitute a diagnosis.
- SHALL NOT determine a medical specialty.
- SHALL NOT determine a diagnostic hypothesis.
- SHALL NOT be converted directly into a classification or code.
- SHALL remain distinguishable from later interpretations.
This establishes a fundamental separation between
What initiated the diagnostic process
and
What the diagnostic process subsequently discovered.
Related Postulates
P2 — Wide Band Scan Principle
determines how the diagnostic search space is initially opened without prematurely narrowing it.
P3 — Progressive Diagnostic Rendering
describes how relevant information can subsequently be acquired with increasing resolution.
P4 — Primacy of Medical Reality
ensures that subsequent medical reality takes precedence over its representation or classification.
P5 — Separation of Diagnosis and Classification
maintains the distinction between diagnostic knowledge and its later classification.
Key Message
Start with the event — not with the diagnosis.
Mierau Medical Diagnostic and Coding Method
The Eighteen Foundational Postulates
Postulate 1 Initial Event
Statement
Every medical diagnostic process begins with an Initial Event.
Definition
The Initial Event is the event or circumstance that initiates the need for medical investigation or assessment.
The Initial Event is the zero-dimensional starting point of the diagnostic process.
At this point, no medical specialty, diagnostic hypothesis, diagnosis, therapeutic measure, or classification is assigned.
Principle
The Initial Event SHALL be recorded as the starting point of the diagnostic process without prematurely assigning medical meaning to it.
The subsequent diagnostic process SHALL determine the medical significance, relevance, and possible cause of the Initial Event.
Rationale
A medical diagnostic process can begin from fundamentally different situations.
For example:
Patient: "I have back pain."
or:
Bystander: "There is someone unconscious here."
or:
Preventive occasion: "The patient has reached an age at which preventive assessment is indicated."
These situations are fundamentally different, yet they have one thing in common:
They initiate a need for medical knowledge.
If the Initial Event is immediately assigned to a medical specialty or diagnosis, the subsequent search may be restricted before relevant information has even been obtained.
The Initial Event therefore has to remain directionless.
Practical Example
A patient states:
"I have been experiencing pain in the right lateral thigh for more than 20 years."
At the Initial Event, the system records only:
The patient reports persistent pain in the right lateral thigh.
It does not record:
lumbar disease
neurological disorder
orthopedic disorder
somatization
or any other diagnosis.
These may become hypotheses later — but they are not properties of the Initial Event.
Database Requirements
A medical database SHALL be able to store the Initial Event separately from all subsequent medical interpretations.
At minimum, the database should distinguish:
- Initial Event
- source of the Initial Event
- date/time
- verbatim or faithful description
- subsequent observations
- subsequent investigations
- diagnostic hypotheses
Implications
The Initial Event
- SHALL NOT itself constitute a diagnosis.
- SHALL NOT determine a medical specialty.
- SHALL NOT determine a diagnostic hypothesis.
- SHALL NOT be converted directly into a classification or code.
- SHALL remain distinguishable from later interpretations.
This establishes a fundamental separation between
What initiated the diagnostic process
and
What the diagnostic process subsequently discovered.
Related Postulates
P2 — Wide Band Scan Principle
determines how the diagnostic search space is initially opened without prematurely narrowing it.
P3 — Progressive Diagnostic Rendering
describes how relevant information can subsequently be acquired with increasing resolution.
P4 — Primacy of Medical Reality
ensures that subsequent medical reality takes precedence over its representation or classification.
P5 — Separation of Diagnosis and Classification
maintains the distinction between diagnostic knowledge and its later classification.
Key Message
Start with the event — not with the diagnosis.
Mierau Medical Diagnostic and Coding Method
The Eighteen Foundational Postulates
Postulate 1 Initial Event
Statement
Every medical diagnostic process begins with an Initial Event.
Definition
The Initial Event is the event or circumstance that initiates the need for medical investigation or assessment.
The Initial Event is the zero-dimensional starting point of the diagnostic process.
At this point, no medical specialty, diagnostic hypothesis, diagnosis, therapeutic measure, or classification is assigned.
Principle
The Initial Event SHALL be recorded as the starting point of the diagnostic process without prematurely assigning medical meaning to it.
The subsequent diagnostic process SHALL determine the medical significance, relevance, and possible cause of the Initial Event.
Rationale
A medical diagnostic process can begin from fundamentally different situations.
For example:
Patient: "I have back pain."
or:
Bystander: "There is someone unconscious here."
or:
Preventive occasion: "The patient has reached an age at which preventive assessment is indicated."
These situations are fundamentally different, yet they have one thing in common:
They initiate a need for medical knowledge.
If the Initial Event is immediately assigned to a medical specialty or diagnosis, the subsequent search may be restricted before relevant information has even been obtained.
The Initial Event therefore has to remain directionless.
Practical Example
A patient states:
"I have been experiencing pain in the right lateral thigh for more than 20 years."
At the Initial Event, the system records only:
The patient reports persistent pain in the right lateral thigh.
It does not record:
lumbar disease
neurological disorder
orthopedic disorder
somatization
or any other diagnosis.
These may become hypotheses later — but they are not properties of the Initial Event.
Database Requirements
A medical database SHALL be able to store the Initial Event separately from all subsequent medical interpretations.
At minimum, the database should distinguish:
- Initial Event
- source of the Initial Event
- date/time
- verbatim or faithful description
- subsequent observations
- subsequent investigations
- diagnostic hypotheses
Implications
The Initial Event
- SHALL NOT itself constitute a diagnosis.
- SHALL NOT determine a medical specialty.
- SHALL NOT determine a diagnostic hypothesis.
- SHALL NOT be converted directly into a classification or code.
- SHALL remain distinguishable from later interpretations.
This establishes a fundamental separation between
What initiated the diagnostic process
and
What the diagnostic process subsequently discovered.
Related Postulates
P2 — Wide Band Scan Principle
determines how the diagnostic search space is initially opened without prematurely narrowing it.
P3 — Progressive Diagnostic Rendering
describes how relevant information can subsequently be acquired with increasing resolution.
P4 — Primacy of Medical Reality
ensures that subsequent medical reality takes precedence over its representation or classification.
P5 — Separation of Diagnosis and Classification
maintains the distinction between diagnostic knowledge and its later classification.
Key Message
Start with the event — not with the diagnosis.
Mierau Medical Diagnostic and Coding Method
The Eighteen Foundational Postulates
Postulate 1 Initial Event
Statement
Every medical diagnostic process begins with an Initial Event.
Definition
The Initial Event is the event or circumstance that initiates the need for medical investigation or assessment.
The Initial Event is the zero-dimensional starting point of the diagnostic process.
At this point, no medical specialty, diagnostic hypothesis, diagnosis, therapeutic measure, or classification is assigned.
Principle
The Initial Event SHALL be recorded as the starting point of the diagnostic process without prematurely assigning medical meaning to it.
The subsequent diagnostic process SHALL determine the medical significance, relevance, and possible cause of the Initial Event.
Rationale
A medical diagnostic process can begin from fundamentally different situations.
For example:
Patient: "I have back pain."
or:
Bystander: "There is someone unconscious here."
or:
Preventive occasion: "The patient has reached an age at which preventive assessment is indicated."
These situations are fundamentally different, yet they have one thing in common:
They initiate a need for medical knowledge.
If the Initial Event is immediately assigned to a medical specialty or diagnosis, the subsequent search may be restricted before relevant information has even been obtained.
The Initial Event therefore has to remain directionless.
Practical Example
A patient states:
"I have been experiencing pain in the right lateral thigh for more than 20 years."
At the Initial Event, the system records only:
The patient reports persistent pain in the right lateral thigh.
It does not record:
lumbar disease
neurological disorder
orthopedic disorder
somatization
or any other diagnosis.
These may become hypotheses later — but they are not properties of the Initial Event.
Database Requirements
A medical database SHALL be able to store the Initial Event separately from all subsequent medical interpretations.
At minimum, the database should distinguish:
- Initial Event
- source of the Initial Event
- date/time
- verbatim or faithful description
- subsequent observations
- subsequent investigations
- diagnostic hypotheses
Implications
The Initial Event
- SHALL NOT itself constitute a diagnosis.
- SHALL NOT determine a medical specialty.
- SHALL NOT determine a diagnostic hypothesis.
- SHALL NOT be converted directly into a classification or code.
- SHALL remain distinguishable from later interpretations.
This establishes a fundamental separation between
What initiated the diagnostic process
and
What the diagnostic process subsequently discovered.
Related Postulates
P2 — Wide Band Scan Principle
determines how the diagnostic search space is initially opened without prematurely narrowing it.
P3 — Progressive Diagnostic Rendering
describes how relevant information can subsequently be acquired with increasing resolution.
P4 — Primacy of Medical Reality
ensures that subsequent medical reality takes precedence over its representation or classification.
P5 — Separation of Diagnosis and Classification
maintains the distinction between diagnostic knowledge and its later classification.
Key Message
Start with the event — not with the diagnosis.
Mierau Medical Diagnostic and Coding Method
The Eighteen Foundational Postulates
Postulate 1 Initial Event
Statement
Every medical diagnostic process begins with an Initial Event.
Definition
The Initial Event is the event or circumstance that initiates the need for medical investigation or assessment.
The Initial Event is the zero-dimensional starting point of the diagnostic process.
At this point, no medical specialty, diagnostic hypothesis, diagnosis, therapeutic measure, or classification is assigned.
Principle
The Initial Event SHALL be recorded as the starting point of the diagnostic process without prematurely assigning medical meaning to it.
The subsequent diagnostic process SHALL determine the medical significance, relevance, and possible cause of the Initial Event.
Rationale
A medical diagnostic process can begin from fundamentally different situations.
For example:
Patient: "I have back pain."
or:
Bystander: "There is someone unconscious here."
or:
Preventive occasion: "The patient has reached an age at which preventive assessment is indicated."
These situations are fundamentally different, yet they have one thing in common:
They initiate a need for medical knowledge.
If the Initial Event is immediately assigned to a medical specialty or diagnosis, the subsequent search may be restricted before relevant information has even been obtained.
The Initial Event therefore has to remain directionless.
Practical Example
A patient states:
"I have been experiencing pain in the right lateral thigh for more than 20 years."
At the Initial Event, the system records only:
The patient reports persistent pain in the right lateral thigh.
It does not record:
lumbar disease
neurological disorder
orthopedic disorder
somatization
or any other diagnosis.
These may become hypotheses later — but they are not properties of the Initial Event.
Database Requirements
A medical database SHALL be able to store the Initial Event separately from all subsequent medical interpretations.
At minimum, the database should distinguish:
- Initial Event
- source of the Initial Event
- date/time
- verbatim or faithful description
- subsequent observations
- subsequent investigations
- diagnostic hypotheses
Implications
The Initial Event
- SHALL NOT itself constitute a diagnosis.
- SHALL NOT determine a medical specialty.
- SHALL NOT determine a diagnostic hypothesis.
- SHALL NOT be converted directly into a classification or code.
- SHALL remain distinguishable from later interpretations.
This establishes a fundamental separation between
What initiated the diagnostic process
and
What the diagnostic process subsequently discovered.
Related Postulates
P2 — Wide Band Scan Principle
determines how the diagnostic search space is initially opened without prematurely narrowing it.
P3 — Progressive Diagnostic Rendering
describes how relevant information can subsequently be acquired with increasing resolution.
P4 — Primacy of Medical Reality
ensures that subsequent medical reality takes precedence over its representation or classification.
P5 — Separation of Diagnosis and Classification
maintains the distinction between diagnostic knowledge and its later classification.
Key Message
Start with the event — not with the diagnosis.
Mierau Medical Diagnostic and Coding Method
The Eighteen Foundational Postulates
Postulate 1 Initial Event
Statement
Every medical diagnostic process begins with an Initial Event.
Definition
The Initial Event is the event or circumstance that initiates the need for medical investigation or assessment.
The Initial Event is the zero-dimensional starting point of the diagnostic process.
At this point, no medical specialty, diagnostic hypothesis, diagnosis, therapeutic measure, or classification is assigned.
Principle
The Initial Event SHALL be recorded as the starting point of the diagnostic process without prematurely assigning medical meaning to it.
The subsequent diagnostic process SHALL determine the medical significance, relevance, and possible cause of the Initial Event.
Rationale
A medical diagnostic process can begin from fundamentally different situations.
For example:
Patient: "I have back pain."
or:
Bystander: "There is someone unconscious here."
or:
Preventive occasion: "The patient has reached an age at which preventive assessment is indicated."
These situations are fundamentally different, yet they have one thing in common:
They initiate a need for medical knowledge.
If the Initial Event is immediately assigned to a medical specialty or diagnosis, the subsequent search may be restricted before relevant information has even been obtained.
The Initial Event therefore has to remain directionless.
Practical Example
A patient states:
"I have been experiencing pain in the right lateral thigh for more than 20 years."
At the Initial Event, the system records only:
The patient reports persistent pain in the right lateral thigh.
It does not record:
lumbar disease
neurological disorder
orthopedic disorder
somatization
or any other diagnosis.
These may become hypotheses later — but they are not properties of the Initial Event.
Database Requirements
A medical database SHALL be able to store the Initial Event separately from all subsequent medical interpretations.
At minimum, the database should distinguish:
- Initial Event
- source of the Initial Event
- date/time
- verbatim or faithful description
- subsequent observations
- subsequent investigations
- diagnostic hypotheses
Implications
The Initial Event
- SHALL NOT itself constitute a diagnosis.
- SHALL NOT determine a medical specialty.
- SHALL NOT determine a diagnostic hypothesis.
- SHALL NOT be converted directly into a classification or code.
- SHALL remain distinguishable from later interpretations.
This establishes a fundamental separation between
What initiated the diagnostic process
and
What the diagnostic process subsequently discovered.
Related Postulates
P2 — Wide Band Scan Principle
determines how the diagnostic search space is initially opened without prematurely narrowing it.
P3 — Progressive Diagnostic Rendering
describes how relevant information can subsequently be acquired with increasing resolution.
P4 — Primacy of Medical Reality
ensures that subsequent medical reality takes precedence over its representation or classification.
P5 — Separation of Diagnosis and Classification
maintains the distinction between diagnostic knowledge and its later classification.
Key Message
Start with the event — not with the diagnosis.