|
|
| Line 1: |
Line 1: |
| <div class="homepage-container">
| | |
| {{main menu it | | {{main menu it |
| |link to German= Hauptseite | | |link to German= Hauptseite |
| Line 8: |
Line 8: |
|
| |
|
|
| |
|
| | [[File:Atm1 sclerodermia.jpg|left|300px]] Il linguaggio medico è un'estensione del linguaggio naturale. Tuttavia, questo linguaggio può causare malintesi ed errori a causa della sua semantica sottosviluppata e della mancanza di coerenza con le idee scientifiche standard. Questo passaggio descrive le caratteristiche essenziali della logica del linguaggio che mostrano perché un termine come "Dolore Orofacciale" può assumere significati diversi secondo la logica classica o quella formale. |
|
| |
|
| [[File:Atm1 sclerodermia.jpg|left|300px]]
| | Il linguaggio medico, nonostante i progressi tecnologici, necessita ancora di miglioramenti. Si distinguono i linguaggi naturali dai linguaggi formali, come la matematica. I linguaggi formali hanno regole sintattiche e semantiche precise, mentre i linguaggi naturali hanno una sintassi più vaga e mancano di semantica esplicita. |
| 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:
| |
| | |
| «5GoI49E5!»
| |
| Using the C key that corresponds to the neurological context, the decryption of the message would be:
| |
| | |
| «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.
| |
| | |
|
| |
| Question 2.jpg «Why, then, are we relatively successful in diagnostics?»
| |
| (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[28]
| |
| | |
| 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 "Efapsi".
| |
| | |
| 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:
| |
| | |
| «Ef+£2»
| |
| This outcome comes from the deletion of the last two elements of the originating code: {\displaystyle 13375545765503} resulting from {\displaystyle 133755457655037A}. 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:
| |
| | |
|
| |
| Question 2.jpg «A System Logic that integrates the sequence of the machine language code»
| |
| (true! we'll get there with a little patience)
| |
| | |
| Final Considerations
| |
| The logic of language is by no means a topic for philosophers and pedagogues; but it substantially concerns a fundamental aspect of medicine that is Diagnosis. Note that the International Classification of Diseases, 9th Revision (ICD-9), has 6,969 disease codes, while there are 12,420 in ICD-10 (OMS 2013)[29]. Based on the results of large series of autopsies, Leape, Berwick and Bates (2002a) estimated that diagnostic errors caused 40,000 to 80,000 deaths annually[30]. Additionally, in a recent survey of over 6,000 doctors, 96% believed that diagnostic errors were preventable[31].
| |
| | |
| Charles Sanders Peirce (1839–1914) was a logician and practicing scientist[32]; he gradually developed a triadic account of the logic of inquiry. He also distinguishes between three forms of argumentation, types of inference and research methods that are involved in scientific inquiry, namely:
| |
| | |
| Abduction or the generation of hypotheses
| |
| Deduction or drawing of consequences from hypotheses; and
| |
| Induction or hypothesis testing.
| |
| In the final part of the study conducted by Donald E Stanley and Daniel G Campos, the Peircean logic is considered as an aid to guaranteeing the effectiveness of the diagnostic passage from populations to individuals. A diagnosis focuses on the individual signs and symptoms of a disease. This manifestation cannot be extrapolated from the general population, except for a very broad experiential sense, and it is this sense of experience that provides clinical insight, strengthens the instinct to interpret perceptions, and grounds the competence that allows us to act. We acquire basic knowledge and validate experience in order to transfer our observations into the diagnosis.
| |
| | |
| In another recent study, author Pat Croskerry proposes the so-called "Adaptive Expertise in Medical Decision Making", in which a more effective clinical decision could be achieved through adaptive reasoning, leading to advanced levels of competence and mastery[33].
| |
| | |
| Adaptive competencies can be obtained by emphasizing the additional features of the reasoning process:
| |
| | |
| Be aware of the inhibitors and facilitators of rationality (Specialists are unwittingly projected towards their own scientific and clinical context).
| |
| Pursue the standards of critical thinking. (In the specialist, self-referentiality is supported and criticisms from other scientific disciplines or from other medical specialists are hardly accepted).
| |
| Develop a global awareness of cognitive and affective biases and learn how to mitigate them. Use argument that reinforces point 1.
| |
| Develop a similar depth and understanding of logic and its errors by involving metacognitive processes such as reflection and awareness. Topic is already mentioned in the first chapter ‘Introduction’.
| |
| In this context, extraordinarily interesting factors emerge that lead us to a synthesis of all what has been presented in this chapter. It is true that the arguments of abduction, deduction and induction streamline the diagnostic process but we still speak of arguments based on a clinical semeiotics, that is on the symptom and/or clinical sign[29]. Even the adaptive experience mentioned by Pat Croskerry is refined and implemented on the diagnosis and on the errors generated by a clinical semeiotics[33].
| |
| | |
| Therefore, it is necessary to specify that semeiotics and/or the specific value of clinical analysis are not being criticized because these procedures have been extraordinarily innovative in the diagnostics of all time. In the age in which we live, however, it will be due to the change in human life expectancy or the social acceleration that we are experiencing, ‘time’ has become a conditioning factor, not intended as the passing of minutes but essentially as bearer of information.
| |
|
| |
|
| In this sense, the type of medical language described above, based on the symptom and on the clinical sign, is unable to anticipate the disease, not because there is no know-how, technology, innovation, etc., but because the right value is not given to the information carried over time
| | Un caso clinico illustra le sfide del linguaggio medico: il paziente Mary Poppins ha ricevuto diagnosi diverse da diversi specialisti a causa delle limitazioni del linguaggio medico. Il linguaggio medico, sviluppato a partire dal linguaggio naturale, manca di una semantica specifica. Ad esempio, il termine "malattia" è vago e non ha una definizione precisa. |
| This is not the responsibility of the health worker, nor of the Health Service and nor of the political-industrial class because each of these actors does what it can do with the resources and preparation of the socio-epochal context in which it lives.
| |
|
| |
|
| The problem, on the other hand, lies in the mindset of mankind that prefers a deterministic reality to a stochastic one. We will discuss these topics in detail.
| | L'ambiguità e la vaghezza dei termini medici possono portare a errori diagnostici. Il significato di un termine dipende dal contesto in cui viene usato. L'intuizione diagnostica e l'esperienza del medico sono importanti per formulare ipotesi diagnostiche. |
|
| |
|
| In the following chapters, all dealing with logic, we will try to shift the attention from the symptom and clinical sign to the encrypted machine language: for the latter, the arguments of the Donald E Stanley-Daniel G Campos duo and Pat Croskerry are welcome, but are to be translated into topic ‘time’ (anticipation of the symptom) and into the message (assembler and non-verbal machine language). Obviously, this does not preclude the validity of the clinical history (semeiotics), essentially built on a verbal language rooted in medical reality.
| | La logica di Peirce è utile per garantire l'efficacia del processo diagnostico. La diagnosi si concentra sui segni e sintomi individuali della malattia. La competenza medica si basa sull'esperienza e sulla conoscenza acquisita. |
|
| |
|
| We are aware that our Linux Sapiens is perplexed and wondering:
| | In futuro, il linguaggio medico deve integrare il linguaggio del Sistema Organico per anticipare i sintomi e migliorare la diagnosi. |
|
| |
|
| {{ArtBy| | | {{ArtBy| |
| Line 91: |
Line 40: |
| *[[Logica di sistema|Logica di Sistema]] | | *[[Logica di sistema|Logica di Sistema]] |
|
| |
|
| ===Caso clinico e logica del linguaggio medico=== | | === Caso clinico e logica del linguaggio medico=== |
| La paziente Mary Poppins (ovviamente un nome fittizio) è stata seguita e curata per oltre 10 anni da più colleghi, tra cui dentisti, medici di famiglia, neurologi e dermatologi. La sua breve storia è la seguente: | | La paziente Mary Poppins (ovviamente un nome fittizio) è stata seguita e curata per oltre 10 anni da più colleghi, tra cui dentisti, medici di famiglia, neurologi e dermatologi. La sua breve storia è la seguente: |
| *la donna ha notato per la prima volta piccole macchie di pigmentazione anormale sul lato destro del viso all'età di 40 anni (ora ne aveva 50). Al suo ricovero in reparto dermatologico è stata eseguita una biopsia cutanea, coerente con la diagnosi di sclerodermia localizzata del viso (''morfea''); sono stati prescritti corticosteroidi. | | * la donna ha notato per la prima volta piccole macchie di pigmentazione anormale sul lato destro del viso all'età di 40 anni (ora ne aveva 50). Al suo ricovero in reparto dermatologico è stata eseguita una biopsia cutanea, coerente con la diagnosi di sclerodermia localizzata del viso (''morfea''); sono stati prescritti corticosteroidi. |
| *All'età di 44 anni iniziò ad avere contrazioni involontarie del massetere destro e dei muscoli temporali; le contrazioni sono aumentate di durata e frequenza nel corso degli anni. Le contrazioni spasmodiche sono state indicate dal paziente sia come blocco diurno che notturno. Alla sua prima valutazione neurologica, la discromia era meno evidente. Tuttavia, il suo viso era asimmetrico a causa di una leggera rientranza della guancia destra e di una marcata ipertrofia del massetere e dei muscoli temporali destro. Le diagnosi erano varie, a causa della limitazione del linguaggio medico come vedremo di seguito. | | *All'età di 44 anni iniziò ad avere contrazioni involontarie del massetere destro e dei muscoli temporali; le contrazioni sono aumentate di durata e frequenza nel corso degli anni. Le contrazioni spasmodiche sono state indicate dal paziente sia come blocco diurno che notturno. Alla sua prima valutazione neurologica, la discromia era meno evidente. Tuttavia, il suo viso era asimmetrico a causa di una leggera rientranza della guancia destra e di una marcata ipertrofia del massetere e dei muscoli temporali destro. Le diagnosi erano varie, a causa della limitazione del linguaggio medico come vedremo di seguito. |
|
| |
|