Difference between revisions of "The logic of medical language - es"

==Ambiguity and Vagueness==

As said, beyond the language used, the meaning of a medical term also depends on the contexts from which it originates, and this can generate ‘ambiguity’ or ‘polysemy’ of the terms. A term is called ambiguous or polysemic if it has more than one meaning. Ambiguity and vagueness have been the subject of considerable attention in linguistics and philosophy<ref>{{cita libro  

  }}</ref>; but despite the significant detrimental effect of ambiguity and vagueness on adherence to and implementation of the Clinical Pratice Guideline (CPG)<ref>{{cita libro  

  }}</ref>, these concepts have not been explored and differentiated yet in a medical context.

Doctors' interpretation of vague terms varies greatly<ref>{{cita libro  

  }}</ref>, leading to a reduced grip and q greater practice variation from CPGs. Ambiguity is classified into syntactic, semantic and pragmatic types<ref>{{cita libro  

As previously described, the meaning of a simple linguistic expression referred to by Mary Poppins has at least three different meanings in three different contexts. The ambiguity and vagueness in the linguistic expression behind the term ‘orofacial pain’, which at the same time could be a source of diagnostic errors, mainly concerns the inefficiency of the medical language logic in decrypting the machine message that the System sends in real time to the exterior.

Let's spend a minute trying to describe this interesting topic of '''encrypted machine language''' from which the following chapters will be articulated.

Orofacial pain does not have a meaning in its most genuine lexical form, but rather in what it means in the context in which it exists: a whole series of domains referred to and generated by it such as clinical signs, related symptoms and interactions with other neuromotor, trigeminal, dental districts, etc. ''This machine language does not correspond to verbal language, but to an encrypted language built on its own alphabet'', that generates the message to be converted into verbal (natural) language. Now the problem shifts to the ''language logic used to decrypt the code''. In order to describe this concept in an understandable way, let’s contemplate a series of examples.

We are supposing that the unfortunate Mary Poppins is suffering from ‘orofacial pain’, and she is representing the following to the healthcare professionals to whom she relates:{{q2|<!--93-->Doc, 10 years ago I started with a widespread discomfort in the jaw, including episodes of bruxism; these worsened so much that I was accusing ‘diffuse facial pain’, in particular in the area of the right ‘TMJ’ with noises in the movements mandibular.<br><!--94-->During this period, ‘vesicular lesions’ formed on my skin, which were more evident in the right half of my face.<br>In this period, however, the pain became more intense and intermittent|}}

The healthcare worker, who may be a dermatologist, a dentist or a neurologist, picks up some verbal messages in Mary Poppins’ dialogue, such as ‘diffuse facial pain’ or ‘TMJ’ or ‘vescicular lesion’, and establishes a series of hypothetical diagnostic conclusions that have nothing to do with the encrypted language.

Here, however, we should abandon a little the acquired patterns and opinions to better follow the concept of ‘encrypted language’. Let's suppose, therefore, that the System is generating and sending the following encrypted message, for instance: '''Ephaptic'''.

Now, what has ‘Ephaptic’ to do with _nOP or TMDs?

Nothing and everything, as we will better verify at the end of the chapters about the logic of medical language; but by now we will dedicate some time to the concepts of ''encryption'' and ''decryption''. We have perhaps heard about them in spy movies or in information security, but they are important in medicine too, you'll see.

==Encryption==

Let us continue with our example:

Let us take a common encryption and decryption platform. In the following example we will report the results of an Italian platform but we can choose any platform because the results conceptually do not change:

You type your message in plain text, the machine converts it into something unreadable, but anyone knowing the "code" will be able to understand it.  

Let us suppose, then, that the same happens when the brain sends a message in its own machine language, made up of wave trains, packets of ionic fields and so on; and that carries a message with it to decrypt the ‘Ephaptic’ code.

This message from the Central Nervous System must first be transduced into verbal language, to allow the patient to give meaning to the linguistic expression and the doctor to interpret the verbal message. In this way, however, the machine message is polluted by the linguistic expression: both by the patient, who is unable to convert the encrypted message with the exact meaning (epistemic vagueness), and by the doctor, because he/she is conditioned by the specific context of his/her specialization.

The patient, actually, by reporting a symptomatology of orofacial pain in the region of the temporoandibular joint, virtually combines the set of ''extension'' and ''intention'' into a diagnostic concept that allows the dentist to formulate the diagnosis of orofacial pain from temporomandibular disorders. (TMDs).

Very often the message remains encrypted at least until the system is damaged to such an extent that clinical signs and symptoms emerge so striking that, obviously, they facilitate the diagnosis.

Understanding how the encryption works is quite simple (go to decryption platform chooses and to try it out):

#choose an encryption key among those selected;

#type a word;

#get a code corresponding to the chosen key and the typed word.

For example, if we insert the word ‘Ephaptic’ in the platform encryption system, we will have an encrypted code in the three different contexts (patient, dentist and neurologist) which correspond to the three different algorithmic keys indicated by the  program, for instance: the A key corresponds to the patient's algorithm, the B key to the dental context and the C key to the neurological context.

In the case of the patient, for example, writing <code>Ephaptic</code> and using the A key, the "machine" will give us back a code like

The key can be defined as "Real context".   

{{q4|<!--117-->Why do you say that the patient's "key" is defined as the REAL one?|<!--118-->difficult answer, but please observe the Gate Control phenomenon and you will understand}}

First of all: Only the patient is unconsciously aware of the disease that afflicts his own system, but he does not have the ability to transduce the signal from the machine language to the verbal language. The same procedure occurs in 'Systems Control Theory', in which a dynamic control procedure called ‘State Observer’ is designed to estimate the state of the system from output measurements. Matter of fact, in the control theory, observability is a measure of how much the internal state of a system can be deduced from the knowledge of its external outputs<ref>[[wikipedia:Observability|Osservability]] </ref>. While in the case of a biological system a ‘Stochastic Observability’ of linear dynamic systemsis preferred<ref>{{cita libro  

  }}</ref>, the Gramian matrices are used for the stochastic observability of nonlinear systems<ref>[[wikipedia:Controllability_Gramian|Controllability Gramian]]</ref><ref>{{cita libro  

This would already be enough to bring now our attention on an extraordinarily explanatory phenomenon called ''Gate Control''. If a child gets hit in the leg while playing soccer, in addition to crying, the first thing he does is to rub extensively the painful area so that the pain decreases. The child does not know the ‘Gate Control’, but unconsciously activates an action that, by stimulating the tactile receptors, closes the gate at the entrance of the nociceptive input of the C fibres, consequently decreasing the pain; the phenomenon was discovered only in 1965 by Ronald Melzack and Patrick Wall<ref>{{cita libro  

As much as in computers, encryption-decryption also takes place in biology. In fact, in a recent research the authors examined the influence of molecular mechanisms of the ‘long-term potentiation’ (LTP) phenomenon in the hippocampus on the functional importance of synaptic plasticity for storage of information and the development of neuronal connectivity. It is not yet clear if the activity modifies the strength of the single synapses in a digital ('''01''', all or nothing) or analog (graduated) way. In the study it emerges that individual synapses appear to have an 'all or nothing' enhancement, indicative of highly cooperative processes, but different thresholds for undergoing enhancement. These findings raise the possibility that some forms of synaptic memory may be digitally stored in the brain<ref>{{cite book  

==Decryption==

Now, assuming that the machine language and the assembler code are well structured, we insert the encrypted message from the Mary Poppins System in the 'Mouth of Truth‘<ref>[[:wikipedia:Bocca_della_Verità|<!--132-->Mouth of truth in Wikipedia]]</ref>:

Let's pretend that we are Martians in possession of the right key (algorithm or context) the A key that corresponds to the 'Real Context'. We would be able to perfectly decrypt the message, as you can verify by entering the code in the appropriate window:  

{{q2|Ephaptic|}}

But, luckily or not, we are not Martians, so we will use, contextually to the information acquired from the social and scientific context, the dental key that correspond to B key, with the consequent decryption of the message into:{{q2|5GoI49E5!|}}

Using the C key that corresponds to the neurological context, the decryption of the message would be:{{q2|26k81n_g+|}}

These are extraordinarily interesting elements of language logic, and please note that the encrypted message of the real context ‘meaning’ of the ‘disease’, the A key, is totally different from the one encrypted through the B keys and the C key: they are constructed in conventionally different contexts, while there is only one reality and this indicates a hypothetical '''diagnostic error'''.

This means that medical language logics mainly built on an extension of verbal language, are not very efficient in being quick and detailed in diagnostics, especially the differential one. This is because the distortion due to the ambiguity and semantic vagueness of the linguistic expression, called ‘vagueness epistemic’ or ‘epistemic uncertainty’, or better ‘uncertain knowledge’, forcibly directs the diagnosis towards the '''specialist reference context''' and not on the exact and real one.{{q4|<!--138-->Why, then, are we relatively successful in diagnostics? |<!--139-->An entire separate encyclopedia would be needed to answer to this question, but without going too far, let's try to discuss the reasons.}}

Basic diagnostic intuition is a quick, non-analytical and unconscious way of reasoning. A small body of evidence indicates the ubiquity of intuition and its usefulness in generating diagnostic hypotheses and ascertaining the severity of the disease. Little is known about how experienced doctors understand this phenomenon, and about how they work with it in clinical practice. Most reports of the physician’s diagnostic intuition have linked this phenomenon to non-analytical reasoning and have emphasized the importance of experience in developing a reliable sense of intuition that can be used to effectively engage analytical reasoning in order to evaluate the clinical evidence. In a recent study, the authors conclude that clinicians perceive clinical intuition as useful for correcting and advancing diagnoses of both common and rare conditions<ref>{{cite book  

  }}</ref>It should also be noted that the Biological System sends a uniquely integrated encrypted message to the outside, in the sense that each piece of code will have a precise meaning when individually taken, while if combined with all the others it will generate the complete code corresponding to the real message, that is to "Ephaptic”.

In short, an instrumental report (or a series of instrumental reports) is not enough to decrypt the machine message in an exact way corresponding to reality. If we expect the message to be decrypted from 2/3 of the code, which perhaps corresponds to a series of laboratory investigations, we would get the following decryption result:{{q2|Ef+£2|}}

This outcome comes from the deletion of the last two elements of the originating code: <math>13375545765503</math> resulting from <math>133755457655037A</math>. So, part of the code is decrypted ('''Ef''') while the rest remains encrypted and the conclusion speaks for itself: it is not enough to identify a series of specific tests, yet it is necessary to know how to tie them together in a specific way in order to complete the real concept and build the diagnosis.

Therefore, there is a need for:{{q4|<!--145-->A System Logic that integrates the sequence of the machine language code|<!--146-->true! we'll get there with a little patience}}