'Logic of medical language'
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[[|Italian]]'Logic of medical language'
Medical language is an extended natural language
Language plays a crucial role in medicine but often leads to errors and misunderstandings due to its inherently ambiguous and context-dependent nature. The term "orofacial pain," for instance, can vary in meaning based on whether it is interpreted using classical or formal logic.
Advancements in medical and dental technologies such as electromyographs, CBCT, and digital oral scanners underscore the need for more precise medical language.
Medical discourse occurs in natural languages like English or Italian and formal languages such as mathematics. Natural languages develop organically and are full of semantic ambiguities, unlike formal languages which are constructed with strict syntactic and semantic rules.
To prevent the discussion from becoming overly theoretical, an illustrative clinical case will be examined using different logical frameworks.
Clinical case and logic of medical language
The patient, Mary Poppins (a pseudonym), has been under multidisciplinary medical care for over a decade, treated by dentists, general practitioners, neurologists, and dermatologists. Her medical journey is detailed as follows:
At 40, Mrs. Poppins first observed abnormal pigmentation spots on her right cheek. A decade later, during dermatology hospitalization, a biopsy diagnosed her with localized facial scleroderma, or morphea, for which she was prescribed corticosteroids. At 44, she started experiencing involuntary contractions in her right masseter and temporal muscles, increasing over time. Initially less noticeable, her facial asymmetry became pronounced, characterized by right cheek retraction and masseter hypertrophy. This complex presentation led to diverse diagnoses, showcasing the challenges of medical language in capturing her condition comprehensively.
The clinical narrative simplifies to: Mrs. Poppins communicates her long-standing psychophysical discomfort using natural language, which led to extensive testing including anamnesis, stratigraphy, and CT scans of the temporomandibular joint (Figures 1, 2, and 3). These investigations culminated in a diagnosis of "Temporomandibular Disorders" (TMD).[1][2][3]. Conversely, the neurologist identified a neuromotor organic pathology, termed "Neuropathic Orofacial Pain" (nOP), and downplayed the TMD aspects. To remain neutral, we consider her condition as a dual diagnosis of "TMDs/nOP".................
This case underscores the pivotal role of medical language and its potential pitfalls in clinical diagnostics.
Unlike formal languages such as those used in mathematics and computer programming, which are governed by strict rules of syntax and semantics, medical language is an evolved extension of natural language, enriched with specialized terminology. Terms like "neuropathic pain," "Temporomandibular Disorders," and "allodynia" illustrate this blend, where everyday language meets technical specificity without a unique syntactic or semantic framework. Consider the term "disease," central to medical practice yet vaguely defined, illustrating the inherent ambiguity and the essential need for context in medical communications.
The question arises whether the term "disease" should refer to individual symptoms experienced by the patient or to a systemic condition affecting the organism as a whole. This ambiguity invites a broader interpretation of health and disease as dynamic states, influenced by an array of biological and pathological interactions within the body over time.................
"The notion of a 'language without semantics' highlights a critical oversight in medical terminology, where words are used without a universally agreed-upon meaning, potentially leading to miscommunication and diagnostic errors."[4]
In essence, the challenge lies in distinguishing between an individual's symptoms and a holistic view of the disease affecting the entire system, requiring a nuanced approach that integrates various anatomical and functional aspects for a comprehensive assessment.
Final Considerations
The logic of language is not exclusively of interest to philosophers and educators; it plays a crucial role in medicine, particularly in diagnostics. Notably, the International Classification of Diseases has expanded significantly, from 6,969 disease codes in its ninth revision (ICD-9) to 12,420 in the tenth revision (ICD-10), reflecting its complexity and the evolving understanding of health and disease.[5] Diagnostic errors are a significant issue, estimated to cause between 40,000 and 80,000 deaths annually in the US alone.[6]
Charles Sanders Peirce's triadic logic—comprising abduction, deduction, and induction—is fundamental for effective diagnostic processes. It aids in moving from general observations to specific, actionable medical conclusions.[7]
Pat Croskerry's concept of "adaptive expertise" is pivotal for advancing medical decision-making, emphasizing the importance of cognitive flexibility and critical thinking in clinical settings.[8] This involves understanding and mitigating potential cognitive biases to enhance diagnostic accuracy.
Overall, the integration of advanced logical frameworks and a better understanding of cognitive processes can significantly improve the accuracy and effectiveness of medical diagnostics.....................................
- ↑ Tanaka E, Detamore MS, Mercuri LG, «Degenerative disorders of the temporomandibular joint: etiology, diagnosis, and treatment», in J Dent Res, 2008».
PMID:18362309
DOI:10.1177/154405910808700406 - ↑ Roberts WE, Stocum DL, «Part II: Temporomandibular Joint (TMJ)-Regeneration, Degeneration, and Adaptation», in Curr Osteoporos Rep, 2018».
PMID:29943316
DOI:10.1007/s11914-018-0462-8 - ↑ Lingzhi L, Huimin S, Han X, Lizhen W, «MRI assessment and histopathologic evaluation of subchondral bone remodeling in temporomandibular joint osteoarthritis: a retrospective study», in Oral Surg Oral Med Oral Pathol Oral Radiol, 2018».
PMID:30122441
DOI:10.1016/j.oooo.2018.05.047 - ↑ Sadegh-Zadeh Kazem, «Handbook of Analytic Philosophy of Medicine», Springer, 2012, Dordrecht».
ISBN: 978-94-007-2259-0
DOI:10.1007/978-94-007-2260-6 - ↑ Stanley DE, Campos DG, «The Logic of Medical Diagnosis», in Perspect Biol Med, Johns Hopkins University Press, 2013».
ISSN: 1529-8795
PMID:23974509
DOI:10.1353/pbm.2013.0019 - ↑ Leape LL, Berwick DM, Bates DW, «What Practices Will Most Improve Safety? Evidence-based Medicine Meets Patient Safety», in JAMA, 2002».
PMID:12132984
DOI:10.1001/jama.288.4.501 - ↑ Charles Sanders Peirce
- ↑ Croskerry P, «Adaptive Expertise in Medical Decision Making», in Med Teach, 2018».
PMID:30033794
DOI:10.1080/0142159X.2018.1484898
particularly focusing on the field of the neurophysiology of the masticatory system