We find difficulties when defining disease in relation to a set of sufficient and necessary characters that we
can see repeated uniformly in every instance of this term or under the principle in which all its members
have identical properties as they have a common nature. In studying the term disease, we have to explore
other principles which could help us categorize it.
In this work, we analyze other alternatives. Following the epistemologist Cesar Lorenzano, we claim that
each disease is a clinical theory, and each patient is an example of that theory. How we learn is through
exemplary demonstrations that teachers practically show. It is what we call paradigmatic exemplars
necessary for doctors to incorporate the theoretical structure of each disease, which, together with the
clinical case models, instructs how the patient can present himself to the consultation.
How do the doctors select from all the diseases the one that best fits as a hypothesis for their patient? How
does the doctor elaborate and epistemically justify his diagnosis?
We can explain this subject through Pierce's abductive reasoning, with the elements of structuralist
metatheory and the use of paradigmatic exemplars.
Terministic Screens Chapter Three Terministi.docxtodd191
Terministic Screens
Chapter Three
Terministic Screens
1
Directing the Attention
We might begin by stressing the distinction between a "scientistic" and a
"dramatistic" approach to the nature of language. A "scientistic" approach
begins with questions of naming, or definition. Or the power of language to
define and describe may be viewed as derivative; and its essential function
may be treated as attitudinal or hortatory: attitudinal as with expressions of
complaint, fear, gratitude, and such; hortatory as with commands or
requests, or, in general, an instrument developed through its use in the social
processes of cooperation and competition. I say "developed"; I do not say
"originating." The ultimate origins of language seem to me as mysterious as
the origins of the universe itself. One must view it, I feel, simply as the
"given." But once an animal comes into being that does happen to have this
particular aptitude, the various tribal idioms are unquestionably developed
by their use as instruments in the tribe's way of living (the practical role of
symbolism in what the anthropologist, Malinowski, has called "context of
situation"). Such considerations are involved in what 1 mean by the
"dramatistic," stressing language as an aspect of "action," that is, as
"symbolic action."
The two approaches, the "scientistic" and the "dramatistic" (language
as definition, and language as act) are by no means mutually exclusive.
Since both approaches have their proper uses, the distinction is not being
introduced invidiously. Definition itself is a symbolic act, just as my
proposing of this very distinction is a symbolic act. But though at this
moment of beginning, the overlap is considerable, later the two roads
diverge considerably, and direct our attention to quite different kinds of
observation. The quickest way to indicate the differences of direction might
be by this formula: The "scientistic" approach builds the edifice of language
with primary stress upon a proposition such as "It is, or it is not." The
"dramatistic" approach puts the primary stress upon such hortatory
expressions as "thou shalt, or thou shalt not." And at the other extreme the
distinction be-
45
comes quite obvious, since the scientistic approach culminates in the kinds
of speculation we associate with symbolic logic,
while the dramatisdc culminates in the kinds of speculation that
find their handiest material in stories, plays, poems, the rhetoric of oratory
and advertising, mythologies, theologies, and philosophies
after the classic model.
The dramatistic view of language, in terms of
"symbolic action," is exercised about the necessarily suasive
nature of even the most unemotional scientific nomenclatures. And we shall
proceed along those lines; thus:
Even if any given terminology is a reflection of reality, by its very
nature as a terminology it must be a selection of reality; and to th.
Dialectical Change
Examples Of Dialectical Journal
Explanation Of Dialectical Therapy
The Great Gatsby Dialectical Journal Essay
What Is Dialectical Theory On Practice
Dialectical Behavior Therapy (DBT) Essay
The Great Gatsby Dialectical Journal
Dialectical Behavior Therapy ( Dbt ) Essay
Dialectical Journal Analysis
The Great Gatsby Dialectical Journal Essay
Dialectical Tensions: A Case Study
Dialectical Journal Essay
Great Gatsby Dialectical Journal
Dialectical Tension Examples
9/11 Dialectical Journal
Example Of The Hegelian Dialectic
Dialectical Behavior Study
Example Of A Dialectical Journal
Dialectical Journal Sample
The document describes a trip to the airport, noting the hot and sweaty conditions upon disembarking the plane and the stiff legs from cramped seating. It contrasts the unglamorous experience of the average traveler with imagined impressions of dignitaries arriving fresh and composed. The traveler is relieved to finally feel crisp air again upon entering one of the fanciest airports seen.
1 Assessment 4 Context Five Qualitative Methodologies .docxoswald1horne84988
1
Assessment 4 Context
Five Qualitative Methodologies
Ethnography
Ethnography is a descriptive research approach designed for in-depth investigation and
description of cultures, cultural groups, large organizations and groupings, and their features.
Ethnographers immerse themselves in the culture or organization they are studying, becoming a
part of the culture in order to learn about it from the inside out. Consequently, this approach
often requires longer timeframes for data collection, and ethnographers frequently return a
number of times to the sites of their investigations to obtain more data. As a result, many
doctoral learners avoid ethnographic studies because of the typically long time commitments.
However, ethnography can be a fruitful approach, even in shorter periods, for understanding the
customs, culture, belief systems, and implicit “rules” of organizations and large groups.
Ethnography is based on the anthropological tradition of research. Keep in mind that the culture
being studied could be a corporate culture, such as that of Microsoft or a small start-up
company; or the culture of a particular group of people operating in a specific social
environment, such as that of a third-grade classroom among the students, teachers, teacher’s
aides, and so on. An important aspect of this research approach is that the participants (culture)
are studied in their natural habitat and social contexts. Individuals are not the unit of analysis for
ethnography, although they may be sources of valuable data. Thus, qualitative research
questions in social psychology and group psychology often are well-answered by ethnographic
research.
Case Study
A case study is the in-depth study—using multiple methods and data sources—of a single case.
Sometimes a number of cases are studied and reported together. The “case” in a case study is
the object of study. A case study is an exploration of a “bounded system” over time. The phrase
“bounded system” means that the target to be studied is easily distinguished for other instances
of the same phenomenon; it has a clear boundary differentiating it from all others. Think of a
case of measles (that is, one patient who has the measles), or a case of homicide (a single
incident of murder, including the victim, the murderer, the police, the attorneys—anyone and
anything relevant to the particular murder event). In those cases, the boundary is clear and it
encircles all the information about the patient and his or her disease or the victim and the
circumstances of the murder.
One could study a single case (in which a single instance is investigated in depth) or multiple
cases (in which a number of instances of the target are studied and then compared with one
another). For example, a single case study might investigate a single treatment program (the
bounded system being that program and no other) or a new way of teaching reading in a school
system (the bounded system being.
Epidemiological Research Terms and Concepts Book By O.S MiettinenMuh Saleh
Istilah dan Konsep Penelitian Epidemiologi.
epidemiologi dapat diartikan sebagai ilmu yang mempelajari kejadian atau kasus yang terjadi pada penduduk.
Epidemiologi juga meliputi pemberian ciri pada distribusi status kesehatan, penyakit, atau masalah kesehatan masyarakat lainnya berdasarkan usia, jenis kelamin, ras, geografi, agama, pendidikan, pekerjaan, perilaku, dan sebagainya
This document discusses two sections (18 and 153) from Hahnemann's Organon regarding symptom selection for homeopathic treatment. It argues that section 18 indicates symptoms alone should guide treatment selection, not abstract notions of disease. Section 153 stresses attending to peculiar, extraordinary symptoms rather than common symptoms. The document asserts these sections mean the physician should focus on symptoms unique to each individual case, not just general symptoms shared across cases of a disease. Adjuvant treatments and prescribing multiple remedies are deemed unnecessary and non-homeopathic according to these principles of finding each case's single most similar remedy.
Chapter 12the weak and the orphaned are deprived of justic.docxcravennichole326
Chapter 12
the weak and the orphaned are deprived of justice all the foundations of the earth are shaken. Ps. 82.3–5 Leininger (1988) maintains that caring is the essence of humanity and is essential for human growth and survival. She contends that care is one of the most powerful and elusive aspects of our health and identity and must be the central focus of nursing and the helping and healing professions. Similarly, Roach (1987) claims that care is the basic constitutive phenomenon of human existence and thus ontological in that it constitutes man as man. She points out that all existentials used to describe Dasein’s self have their central locus in care. Roach states, “When we do not care, we lose our being and care is the way back to being. Care is primordial, the source of action and is not reducible to specific actions” (1987, p. 15). Although Roach (1984) claims that caring is the human mode of being, she wonders how convincing the view is that caring is the natural expression of what is authentically human when there is so much evidence of lack of caring, both within our personal experiences as well as in the society around us. Roach points out that we live in an age where violence is commonplace and where atrocities are committed against individuals and communities everywhere. To compound the effect of such violence on the broader social body, many incidents enter our living rooms through the press, radio, and television often as quickly as they occur. As a result, modes of being with another in our world involve both caring and uncaring dimensions. What, then, are the basic modes of being with another? By analyzing two of my own studies on clients’ (patients’ and students’) perceptions of caring and uncaring encounters (Halldorsdottir, 1989, 1990), as well as related literature, I have determined that there are five basic modes of being with another as follows: life-giving (biogenic), life-sustaining (bioactive), life-neutral (biopassive), life-restraining (biostatic), and life-destroying (biocidic) (see Figure 12.1 and Table 12.1). In this chapter, I describe the five basic modes of being with another through examples of caring and uncaring encounters in hospitals as experienced by former patients, my co-researchers in the former study (Halldorsdottir, 1989). The phenomenological perspective of qualitative research theory guided the methodological approach to the studies analyzed, involving the use of theoretical sampling, intensive unstructured interviews, and constant comparative analysis. TABLE 12.1 Five Basic Modes of Being With Another Life-destroying (biocidic) mode of being with another is a mode where one depersonalizes the other, destroys the joy of life, and increases the other’s vulnerability. It causes distress and despair and hurts and deforms the other. It is transference of negative energy or darkness. Life-restraining (biostatic) mode of being with another is a mode where one is insensitive or indifferent to the ...
Terministic Screens Chapter Three Terministi.docxtodd191
Terministic Screens
Chapter Three
Terministic Screens
1
Directing the Attention
We might begin by stressing the distinction between a "scientistic" and a
"dramatistic" approach to the nature of language. A "scientistic" approach
begins with questions of naming, or definition. Or the power of language to
define and describe may be viewed as derivative; and its essential function
may be treated as attitudinal or hortatory: attitudinal as with expressions of
complaint, fear, gratitude, and such; hortatory as with commands or
requests, or, in general, an instrument developed through its use in the social
processes of cooperation and competition. I say "developed"; I do not say
"originating." The ultimate origins of language seem to me as mysterious as
the origins of the universe itself. One must view it, I feel, simply as the
"given." But once an animal comes into being that does happen to have this
particular aptitude, the various tribal idioms are unquestionably developed
by their use as instruments in the tribe's way of living (the practical role of
symbolism in what the anthropologist, Malinowski, has called "context of
situation"). Such considerations are involved in what 1 mean by the
"dramatistic," stressing language as an aspect of "action," that is, as
"symbolic action."
The two approaches, the "scientistic" and the "dramatistic" (language
as definition, and language as act) are by no means mutually exclusive.
Since both approaches have their proper uses, the distinction is not being
introduced invidiously. Definition itself is a symbolic act, just as my
proposing of this very distinction is a symbolic act. But though at this
moment of beginning, the overlap is considerable, later the two roads
diverge considerably, and direct our attention to quite different kinds of
observation. The quickest way to indicate the differences of direction might
be by this formula: The "scientistic" approach builds the edifice of language
with primary stress upon a proposition such as "It is, or it is not." The
"dramatistic" approach puts the primary stress upon such hortatory
expressions as "thou shalt, or thou shalt not." And at the other extreme the
distinction be-
45
comes quite obvious, since the scientistic approach culminates in the kinds
of speculation we associate with symbolic logic,
while the dramatisdc culminates in the kinds of speculation that
find their handiest material in stories, plays, poems, the rhetoric of oratory
and advertising, mythologies, theologies, and philosophies
after the classic model.
The dramatistic view of language, in terms of
"symbolic action," is exercised about the necessarily suasive
nature of even the most unemotional scientific nomenclatures. And we shall
proceed along those lines; thus:
Even if any given terminology is a reflection of reality, by its very
nature as a terminology it must be a selection of reality; and to th.
Dialectical Change
Examples Of Dialectical Journal
Explanation Of Dialectical Therapy
The Great Gatsby Dialectical Journal Essay
What Is Dialectical Theory On Practice
Dialectical Behavior Therapy (DBT) Essay
The Great Gatsby Dialectical Journal
Dialectical Behavior Therapy ( Dbt ) Essay
Dialectical Journal Analysis
The Great Gatsby Dialectical Journal Essay
Dialectical Tensions: A Case Study
Dialectical Journal Essay
Great Gatsby Dialectical Journal
Dialectical Tension Examples
9/11 Dialectical Journal
Example Of The Hegelian Dialectic
Dialectical Behavior Study
Example Of A Dialectical Journal
Dialectical Journal Sample
The document describes a trip to the airport, noting the hot and sweaty conditions upon disembarking the plane and the stiff legs from cramped seating. It contrasts the unglamorous experience of the average traveler with imagined impressions of dignitaries arriving fresh and composed. The traveler is relieved to finally feel crisp air again upon entering one of the fanciest airports seen.
1 Assessment 4 Context Five Qualitative Methodologies .docxoswald1horne84988
1
Assessment 4 Context
Five Qualitative Methodologies
Ethnography
Ethnography is a descriptive research approach designed for in-depth investigation and
description of cultures, cultural groups, large organizations and groupings, and their features.
Ethnographers immerse themselves in the culture or organization they are studying, becoming a
part of the culture in order to learn about it from the inside out. Consequently, this approach
often requires longer timeframes for data collection, and ethnographers frequently return a
number of times to the sites of their investigations to obtain more data. As a result, many
doctoral learners avoid ethnographic studies because of the typically long time commitments.
However, ethnography can be a fruitful approach, even in shorter periods, for understanding the
customs, culture, belief systems, and implicit “rules” of organizations and large groups.
Ethnography is based on the anthropological tradition of research. Keep in mind that the culture
being studied could be a corporate culture, such as that of Microsoft or a small start-up
company; or the culture of a particular group of people operating in a specific social
environment, such as that of a third-grade classroom among the students, teachers, teacher’s
aides, and so on. An important aspect of this research approach is that the participants (culture)
are studied in their natural habitat and social contexts. Individuals are not the unit of analysis for
ethnography, although they may be sources of valuable data. Thus, qualitative research
questions in social psychology and group psychology often are well-answered by ethnographic
research.
Case Study
A case study is the in-depth study—using multiple methods and data sources—of a single case.
Sometimes a number of cases are studied and reported together. The “case” in a case study is
the object of study. A case study is an exploration of a “bounded system” over time. The phrase
“bounded system” means that the target to be studied is easily distinguished for other instances
of the same phenomenon; it has a clear boundary differentiating it from all others. Think of a
case of measles (that is, one patient who has the measles), or a case of homicide (a single
incident of murder, including the victim, the murderer, the police, the attorneys—anyone and
anything relevant to the particular murder event). In those cases, the boundary is clear and it
encircles all the information about the patient and his or her disease or the victim and the
circumstances of the murder.
One could study a single case (in which a single instance is investigated in depth) or multiple
cases (in which a number of instances of the target are studied and then compared with one
another). For example, a single case study might investigate a single treatment program (the
bounded system being that program and no other) or a new way of teaching reading in a school
system (the bounded system being.
Epidemiological Research Terms and Concepts Book By O.S MiettinenMuh Saleh
Istilah dan Konsep Penelitian Epidemiologi.
epidemiologi dapat diartikan sebagai ilmu yang mempelajari kejadian atau kasus yang terjadi pada penduduk.
Epidemiologi juga meliputi pemberian ciri pada distribusi status kesehatan, penyakit, atau masalah kesehatan masyarakat lainnya berdasarkan usia, jenis kelamin, ras, geografi, agama, pendidikan, pekerjaan, perilaku, dan sebagainya
This document discusses two sections (18 and 153) from Hahnemann's Organon regarding symptom selection for homeopathic treatment. It argues that section 18 indicates symptoms alone should guide treatment selection, not abstract notions of disease. Section 153 stresses attending to peculiar, extraordinary symptoms rather than common symptoms. The document asserts these sections mean the physician should focus on symptoms unique to each individual case, not just general symptoms shared across cases of a disease. Adjuvant treatments and prescribing multiple remedies are deemed unnecessary and non-homeopathic according to these principles of finding each case's single most similar remedy.
Chapter 12the weak and the orphaned are deprived of justic.docxcravennichole326
Chapter 12
the weak and the orphaned are deprived of justice all the foundations of the earth are shaken. Ps. 82.3–5 Leininger (1988) maintains that caring is the essence of humanity and is essential for human growth and survival. She contends that care is one of the most powerful and elusive aspects of our health and identity and must be the central focus of nursing and the helping and healing professions. Similarly, Roach (1987) claims that care is the basic constitutive phenomenon of human existence and thus ontological in that it constitutes man as man. She points out that all existentials used to describe Dasein’s self have their central locus in care. Roach states, “When we do not care, we lose our being and care is the way back to being. Care is primordial, the source of action and is not reducible to specific actions” (1987, p. 15). Although Roach (1984) claims that caring is the human mode of being, she wonders how convincing the view is that caring is the natural expression of what is authentically human when there is so much evidence of lack of caring, both within our personal experiences as well as in the society around us. Roach points out that we live in an age where violence is commonplace and where atrocities are committed against individuals and communities everywhere. To compound the effect of such violence on the broader social body, many incidents enter our living rooms through the press, radio, and television often as quickly as they occur. As a result, modes of being with another in our world involve both caring and uncaring dimensions. What, then, are the basic modes of being with another? By analyzing two of my own studies on clients’ (patients’ and students’) perceptions of caring and uncaring encounters (Halldorsdottir, 1989, 1990), as well as related literature, I have determined that there are five basic modes of being with another as follows: life-giving (biogenic), life-sustaining (bioactive), life-neutral (biopassive), life-restraining (biostatic), and life-destroying (biocidic) (see Figure 12.1 and Table 12.1). In this chapter, I describe the five basic modes of being with another through examples of caring and uncaring encounters in hospitals as experienced by former patients, my co-researchers in the former study (Halldorsdottir, 1989). The phenomenological perspective of qualitative research theory guided the methodological approach to the studies analyzed, involving the use of theoretical sampling, intensive unstructured interviews, and constant comparative analysis. TABLE 12.1 Five Basic Modes of Being With Another Life-destroying (biocidic) mode of being with another is a mode where one depersonalizes the other, destroys the joy of life, and increases the other’s vulnerability. It causes distress and despair and hurts and deforms the other. It is transference of negative energy or darkness. Life-restraining (biostatic) mode of being with another is a mode where one is insensitive or indifferent to the ...
This document discusses how semiotics, the study of signs and their meanings, can expand views of clinical medicine. It contrasts the work of Ferdinand de Saussure and Charles Sanders Peirce on semiotic theory. Saussure viewed a sign as consisting of a signifier and signified, while Peirce defined signs in triadic relations of sign-object-interpretant. The document uses a case study of a man experiencing chest pain to illustrate how semiotics can aid medical interpretation of symptoms.
This document provides an overview of the course POLS 270: Political Theory at Hong Kong Baptist University. It introduces the instructor, Dr. Giuseppe Mario Saccone, and covers topics that will be discussed over the course, including political ideology, language, concepts, political science vs. political theory vs. political philosophy, and ideology. The summary highlights that the course will examine how language and concepts are used and contested in politics, explore the relationships and differences between political science, theory and philosophy, and discuss major political values and ideologies.
The document summarizes ten research perspectives: postpositivism, pragmatism, constructivism, critical theory, interpretivism, race/gender/ethnicity theories, queer theory, critical race theory, and art-based research. These perspectives differ in their views of truth, from postpositivism's view that absolute truths cannot be known, to pragmatism focusing on practical consequences, to constructivism believing truth is subjective. Critical theory and interpretivism both emphasize power relations and critique of ideologies. Race/gender/ethnicity, queer theory and critical race theory acknowledge marginalization but differ in their specific focuses. Art-based research uses art to communicate research findings.
Artandcreativityingestalttherapy-Amendt-LyonAngie Miller
This document discusses the use of art and creativity in Gestalt therapy. It describes how the founders of Gestalt therapy, including Fritz Perls and Laura Perls, incorporated artistic expression and creativity into the theoretical foundations and practice of Gestalt therapy. Some key points discussed include how Gestalt therapy views the creative process as analogous to psychotherapy, how artistic expression can help clients work through issues, and how the founders emphasized using a variety of artistic media and drawing from their humanistic backgrounds to enhance therapeutic understanding and communication.
Symbolic Interactionism Theory - PHDessay.com. (PDF) Symbolic Interactionism. Symbolic Interactionism In Sociology Pdf - slide share. Symbolic Interactionism | PDF | Sociology | Gender. Compare and contrast two of the following: functionalism, conflict .... Symbolic Interactionism as a Tool for Conveying Ideas: Dissecting the .... 10 Symbolic Interactionism Examples (And Easy Definition).
The document discusses the challenges of writing a cause and effect essay. It notes that researching and identifying causal relationships between events requires exploring various sources. Crafting a coherent essay structure with a logical flow between introduction, body paragraphs, and conclusion is also difficult. Additionally, using analytical skills to interpret causal connections and express complex relationships with clarity requires finesse. Meeting all these challenges results in a rewarding exploration of the intricate web of relationships in the world. Resources like HelpWriting.net can provide expertise to guide writers through the process.
A Slight Hysterical Tendency Performing Diagnosis In Charlotte Perkins Gilm...Rick Vogel
This chapter analyzes Charlotte Perkins Gilman's short story "The Yellow Wallpaper" and how it depicts the process of diagnosis. The story was written semi-autobiographically after Gilman herself was diagnosed with "hysteria" and prescribed the "rest cure" by her doctor Silas Weir Mitchell. The chapter argues that the story presents a contradictory view of diagnosis, simultaneously expressing the narrator's desire for diagnosis but also her rejection of the imposed diagnosis of just a "slight hysterical tendency." Through its depiction of the narrator's deteriorating mental state, the story challenges the medical ideology of cure and questions whether accurate diagnosis is even possible.
The document provides an analysis of the film "Iceman Reborn" which reveals the relevance of the concept of holism to the story of Otzi. Holism means that parts of a whole are interconnected and cannot be fully understood separately. The story of Otzi includes research from various sources like scientists, radiologists, and archaeologists. Without the collaboration of these sources, their research would not be as advanced.
Best Essay About Experience In Life ~ Thatsnotus. Example Of Essay About Life Experience. life experience essay example. My life experience essay - Expert Custom Essay Writing Service You Can .... an experience that changed my life essay. Write An Essay About Your Life Experience | Best Writing Company. Breathtaking Life Changing Experience Essay ~ Thatsnotus. My Life Experience Essay – Telegraph. Life Experience Essay. Life Experience Essay Example - Narrative essay on life experiences jesus. An experience that changed my life essay.
Applebaum: Themes in phenomenological psychological researchMarc Applebaum, PhD
Description of Event (150 words maximum): Descriptive phenomenology is a well-established approach to qualitative research in which the researcher develops the ability to carefully analyze participants’ descriptions of their experiences. Researchers learn to attend carefully to interview data, setting aside their preconceptions about participants’ experiences, and deepening their own ability to empathically listen and discover essential psychological meanings. This presentation accompanied a 2-day overview of the method and discussion of its applications. Students were introduced to the descriptive phenomenological method, which Giorgi, Wertz, Halling, and Englander have applied to a range of important psychological themes.
This document discusses the emerging field of narrative medicine. It begins by introducing narrative medicine as clinical practice informed by narrative competence, or the ability to understand and apply stories of illness. It then summarizes the key concepts and developments in narrative medicine, including:
- Training programs in narrative skills for healthcare professionals that focus on close reading, reflective writing, and bearing witness.
- Research showing such training can strengthen relationships with patients and perspective-taking abilities.
- The growing number of narrative medicine programs worldwide.
The document then outlines three core components of narrative medicine: attention, representation, and affiliation, citing relevant theories and evidence for each. It emphasizes how narrative skills can enhance clinical practice and the patient-provider
This document provides an overview of conceptions of truth and evidence throughout the history of philosophy. It discusses ideas from ancient Greek philosophers like Plato and Aristotle, Roman thinkers like Cicero, medieval scholars, early modern philosophers like Descartes, and 20th century thinkers like Russell and Husserl. Key points discussed include ancient notions of evidence, medieval conceptions like intentiones, Descartes' view of clear and distinct perceptions, Brentano's intentionalism, Russell's view of evidence and axioms, and Husserl's phenomenology. The document examines different theories of truth and how notions of evidence, facts, correspondence, and uncoveredness relate to truth.
.There are different paths to reality, they are determined by the knower, being instrumental methodological study object, epistemological axis, among others. Reality presents several faces, what is observable and what is perceived sensory empirical data obtained correspond to the visible, the main thing is to discover the hidden side, which is behind the perceptible or data. Epistemology is the whole process of obtaining scientific knowledge, ranging from the pre knowledge to get to know the hidden side, one thing is what is seen and what is not, and one that is not seen, is really it is.
Violence Essay | Essay on Violence for Students and Children in English .... Domestic Violence Essay | Essay on Domestic Violence for Students and .... Reasons Of Violence In Schools - Free Essay Example | PapersOwl.com. Gun Violence Essay - Marc Kirchner ENG 201 18 February 2018 What are We .... Domestic violence essay. Essay on violence in schools - Get Help From Custom College Essay .... Domestic Violence Essay - Explain the 10 common myths about IPV 1 .... Domestic Violence Essay ~ Addictionary. Studio Mouvance - Domestic violence essay outline. 011 Essay Example Schooledviolence On Crime And ~ Thatsnotus. Domestic violence essay | Year 11 HSC - Legal Studies | Thinkswap. Domestic Violence Essay | Legal Studies - Year 12 HSC | Thinkswap. 004 Essay Example On Crime And Violence ~ Thatsnotus.
The document discusses the history and philosophy of integrated management approaches for illness, including Integrated Management of Childhood Illness (IMCI) and proposes a new generalized approach called Integrated Management of Human Illness (IMHI). IMHI aims to provide comprehensive, integrated care for patients by considering biological, clinical, behavioral, environmental, and socioeconomic factors. The key aspects of IMHI discussed are its holistic nature, emphasis on prevention and assessment of subclinical issues, and approach through syndromic classification and management of illness.
Here are the key points regarding gender differences in educational attainment:
- Historically, from the 1960s through the mid-1980s, boys generally outperformed girls in educational achievement across all levels, with the exception of performance at age 11.
- This was often cited as evidence that girls were less intelligent than boys. However, this view has been challenged.
- Since the mid-1980s, girls have begun to outperform boys at most levels of education. Girls now leave school with better exam results than boys and are more likely to go to university.
- Girls get higher grades than boys at GCSE, A-level, and degree level. They also have higher rates of staying in full-time
The document discusses homeostasis, which is the process by which the human body regulates its internal environment and maintains a stable, constant condition. It explains that homeostasis involves negative feedback loops that work to return the body's internal conditions to normal levels if they fluctuate outside of the typical range. Examples of homeostatic mechanisms that regulate internal conditions like temperature and blood pressure are provided.
Approaching Worldviews In Multicultural Counselling The Possible Worldview O...Becky Gilbert
The document discusses approaches to multicultural counseling and worldviews. It explores the worldviews of Charles Sanders Peirce and Gregory Bateson, focusing on Peirce's concept of infinite semiosis and Bateson's ecology of mind. It argues that their theories can strengthen the conceptual model of approaching client worldviews in counseling proposed by Parkkinen and Puukari. Specifically, it notes that client worldviews are dynamically constructed through counselor-client interactions and influenced by social and technological changes.
Poetry explication essay - Orozco 1 Poetry Explication Essay Edgar .... Here is an example of an explication. Example Of Explication - Printable Templates Free.
UNLOCKING HEALTHCARE 4.0: NAVIGATING CRITICAL SUCCESS FACTORS FOR EFFECTIVE I...amsjournal
The Fourth Industrial Revolution is transforming industries, including healthcare, by integrating digital,
physical, and biological technologies. This study examines the integration of 4.0 technologies into
healthcare, identifying success factors and challenges through interviews with 70 stakeholders from 33
countries. Healthcare is evolving significantly, with varied objectives across nations aiming to improve
population health. The study explores stakeholders' perceptions on critical success factors, identifying
challenges such as insufficiently trained personnel, organizational silos, and structural barriers to data
exchange. Facilitators for integration include cost reduction initiatives and interoperability policies.
Technologies like IoT, Big Data, AI, Machine Learning, and robotics enhance diagnostics, treatment
precision, and real-time monitoring, reducing errors and optimizing resource utilization. Automation
improves employee satisfaction and patient care, while Blockchain and telemedicine drive cost reductions.
Successful integration requires skilled professionals and supportive policies, promising efficient resource
use, lower error rates, and accelerated processes, leading to optimized global healthcare outcomes.
INTERNET OF THINGS BASED MODEL FOR IDENTIFYING PEDIATRIC EMERGENCY CASESamsjournal
Pediatric emergency cases need rapid systems that measure vital body parameters data, analyze and
categorize emergency cases for precise action. Current systems use manual examination resulting in
delayed medication, death, or other severe medical conditions.In this paper, we propose a Internet of
Things (IoT) based model, created using Balena fin with Raspberry pi compute module. It is used for
determining emergency cases, in pediatric section, specifically the triage section. It is later tested using
hospital data that represents the vital parameters in pediatric. Our approach entails designing and setting
up the hardware and software infrastructure, to accommodate data via Bluetooth protocol, and transmit it
to the cloud server database via Message Queuing Telemetry Transport (MQTT). Later, we perform
machine learning on the data by training a model and finally develop a Plotly Dash analytical application
integrating the model for visualization near real-time.Findings show that emergency cases are detected
using vital body parameters which include the body temperature, oxygen levels, heart rate and the age. The
model indicates a 97% accuracy.In conclusion, children’s emergency cases are detected in time using IoT
gadgets and machine learning classification.
THE APPLICATION OF MATHEMATICAL MODELS IN MANAGEMENT OF AQUIFERamsjournal
Before feeling water -shortage crisis human has understood the importance of water From the
religious texts. Considering recent conditions of the world the water will replace most recent
boundaries, at future. Imamzadeh Jaafar plain is located 5 kilometers northeast of Gachsaran, south
of Kohgilooye and Boerahmad province. The plain has 61km 2 area extents and contains two,
alluvial and carbonate aquifers. These aquifers supply the water needs, agricultural, industrial and
domestic. Highly exploitation and transportation of groundwater resources, especially by National Oil
Company, caused highly drawdown in alluvial aquifer, 1.85m in a 5 years period from 1361 to
1365 as reported by Mahab Ghods Consulting Engineers. There are two artificial recharge
projects, 1 flood spreading system and 1 recharge ponds system, in the plain. To present the future
water resources management program the hydrogeological behaviors of the alluvial aquifer and the
effects of artificial recharge must be evaluated. edrock, hydrodynamic coefficients, topography, water
resources and were collected, field surveys were performed and required maps were prepared. Using
conceptual model and MODFLOW PMWIN code the mathematical model of the plain was
calibrated against water year 1380 -81 and then verified against water year 1384 - 85. The verified
model was used to predict future conditions of aquifer. The results implied the rapid response of
aquifer to precipitation due to high aquifer ransmissivity, positive water budget at year 1385
comparing year 65, change of direction of groundwater flow from plain outlet to the center of
plain in response to highly exploitation at the center of plain, water level in the wells located
downward the flood spreading system will raise as 1 to 6m and water level in t he wells located
downward the recharge pond system will lower as 1 to 4m.
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THE EPISTEMOLOGICAL BASES THAT SUPPORT REASONING OF CLINICAL DIAGNOSIS
1. Advanced Medical Sciences: An International Journal (AMS) Vol 10, No.1/2/3, August 2023
DOI: 10.5121/ams.2023.10301 1
THE EPISTEMOLOGICAL BASES THAT SUPPORT
REASONING OF CLINICAL DIAGNOSIS
Raul I Chullmir
Department of Postgraduate Education. Philosophy of Science. Universidad Nacional de
Tres de Febrero (UNTREF), Buenos Aires Argentina
ABSTRACT
We find difficulties when defining disease in relation to a set of sufficient and necessary characters that we
can see repeated uniformly in every instance of this term or under the principle in which all its members
have identical properties as they have a common nature. In studying the term disease, we have to explore
other principles which could help us categorize it.
In this work, we analyze other alternatives. Following the epistemologist Cesar Lorenzano, we claim that
each disease is a clinical theory, and each patient is an example of that theory. How we learn is through
exemplary demonstrations that teachers practically show. It is what we call paradigmatic exemplars
necessary for doctors to incorporate the theoretical structure of each disease, which, together with the
clinical case models, instructs how the patient can present himself to the consultation.
How do the doctors select from all the diseases the one that best fits as a hypothesis for their patient? How
does the doctor elaborate and epistemically justify his diagnosis?
We can explain this subject through Pierce's abductive reasoning, with the elements of structuralist
metatheory and the use of paradigmatic exemplars.
KEYWORDS
Medical epistemology, Diagnosis, Health & Disease, Theory of Disease, Medicine by Exemplars.
1. INTRODUCTION
From a naturalistic perspective, "health" is a state of normality that leaves disease as something
abnormal. It is a deviation from what is considered "natural" in the species, from what is publicly
acceptable, considering disease as something objective, devoid of values, a phenomenon that
exists in the real world. For the naturalistic view, "health" is to be within a range of statistical
values of what occurs most frequently. From this vision, "health" would be the absence of
disease, which can be clinically proven.
A contrary vision is a normative perspective, which says that the criterion of "abnormality" does
not constitute a sufficient condition to define the disease, given that the criterion itself contains a
value judgment. In this case, objectivity passes through the concept of damage. For normativism,
the state of health of a person is a positive concept; it is determined not only with quantitative or
statistical data; it requires a holistic diagnosis and an evaluation of the person's general state to
himself, others, and society. There needs to be more than simply describing the disease using
empirical data because such descriptions always contain subjective, cultural, or ethical
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assessments. Rather than the absence of disease, the idea of "health" refers to the human being's
ability to achieve vital goals [1].
For WHO1
, "health" is a state of complete physical, mental, and social well-being and not merely
the absence of infirmity or disease. The problem with such broad definitions is that if medicine is
concerned with maintaining health, it should avoid suffering, but not all suffering is an object of
medicine. Although necessary, poverty, loneliness, political, economic, or social exclusion
cannot be part of medical knowledge.
When discussing disease, the term does not include a set of necessary and sufficient characters
that we see repeated in each of its instances uniformly. Myocardial infarction, hearing loss,
alopecia, cancer, and gambling addiction are all diseases. However, what do they have in
common? Regarding the Austrian philosopher Ludwig Wittgenstein's "games," what do all
games, all chairs, or "all" diseases have in common?
In The Tractatus[2], Wittgenstein refers to the multiple and diverse discursive possibilities that
language offers us. It moves away from the scientific and rationalist claim to represent or
objectify the world. It delimits what can be said in a usual way (referential function of language)
but analyzes other alternatives in communication, such as the exercise of "showing." More than
with a definition, what Wittgenstein seeks is to enter the pragmatic sphere of the action of
communicating through the use we make of words. Thus, the meaning of an expression no longer
resides in its capacity to represent something of reality but instead in questions derived from the
use of words within a context or way of life. And what he says is that the use of a term is learned
by pointing to the specific object in which it is applied [3].
There is a yearning to find something familiar in all the entities we usually subsume under a
general term. We believe there must be something in common in all games, chairs, or diseases.
The idea of a general concept that is a property of all its particular instances connects with other
simple and primitive ideas that structure language. It is comparable to the idea that properties are
ingredients of things with those properties. For example, that beauty is the property of all
beautiful things, as alcohol is the property of beer and wine so that we can get the pure,
unadulterated beauty of something that is beautiful.
It is similar to the idea of treating words as if they were proper names and then confusing the
name bearer with the meaning of the name. Wittgenstein exposes it as how plants are
taxonomically classified. We can classify a series of objects by their reference to the presence or
absence of characteristics that make them familiar. In all cases, we have the idea that there is a
common element or ingredient, and Wittgenstein tells us there is no such element or element,
only specimens that form a family. It is impossible to define each term without defining each
term of the definition itself, and so on to infinity.
Bambrough [4] [5]acknowledges the importance of Wittgenstein's proof that at least some
general terms can be justifiably applied by his exemplars, even though those exemplars have
nothing in common. For nominalists, what all games have in common is that they have nothing in
common except that they are "called" games. For realists, games would have something in
common apart from being called games, which is that they "are" games. The problem is that due
to the form of the question "What do three chairs or three books have in common," the answer
1
https://www.who.int/about/governance/constitution
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should be that they have something in common. However, if we talk about what "all" books or
"all" chairs have in common, that is a philosophical question we should be able to answer, but we
cannot find an all-encompassing answer. The simple answer is that what all games have in
common is that they are all games, and we call them games. There is nothing immanent,
transcendent, or subsistent.
There is no objective justification for the realist or nominalist position for applying a general
term, be it games, chairs, or books, but rather that they are exemplars of the term. The specimens
have something in common that they are specimens of something. For Wittgenstein, neither the
nominalists are right in justifying naming the general term nor are the realists right in thinking
that the term has some elements in common.
When defining, we use language to represent the real world, and although language allows us to
represent the objects of reality, they do not "are” realities. The world is populated by individual
objects that we group under the same term called "universal." "Bird" is one universal, "fruit" is
another, and "disease" is another universal. We talk about birds, fruits, or diseases, but the
universal is not identical to any particular species. In the world of birds, there is the sparrow, the
raven, or the ostrich. The word "bird" includes all its members but is not any of them2
. Also, the
term sparrow becomes universal because it represents all the sparrows we can know, but it is not
any in particular unless we point to a bird and say, "I mean that sparrow in particular."
We need examples to be shown to learn about a disease. They are the paradigmatic examples,
models that belong to the practical knowledge that doctors will use from the first contact with a
patient, which will help him to postulate, in the face of a set of determined signs and symptoms
(semiology) that said the combination could be explained as caused by disease X, as you have
learned during the training.
For Wittgenstein, knowledge is not learning by memorization; knowledge can be acquired in the
closed space of a classroom; it is achieved through experience and observing examples.
Wittgenstein and Kuhn [6] refer to the importance of learning through exemplars. They were
talking about a seeing-like experience that captures in a glance a totality that goes beyond mere
perception, organizes the way of thinking, and helps understand and see relationships. This
appreciation is interpreted and organized when a complex unified perceptual structure (Gestalten)
is projected onto it, which interrelates the parts in an organized whole [7][8].
Learning to see is learning to interpret. Wittgenstein related this integral way of perceiving with
the musical ear, which allows the expert to quickly recognize a melody [9] or the ability to
observe that a detective has when discovering an enigma [10], Cesar Lorenzano relates it to the
talent of an art expert when he recognizes different styles in a painting with a glance, and
interprets that experience with medical knowledge [11], an art that, in the manner of
Wittgenstein, needs teachers, who warn us what happens with the patient: "look how his voice
trembles," "look at the color of his skin," "see the dryness of his eyes." it has to have a good eye
to be a doctor; however, different from music, it is not necessary to be born with that gift; it can
be learned through multiple experiences through practice and learning. That is formed during
professional training from the recognition and internalization of similar structures, thanks to the
training that the doctor acquires during his training in the hospital environment when clinical
cases are discussed in the room. In this intersubjective exercise, the Gestalten acquire its
constituent elements, allowing it to be related to a first paradigmatic example, which is
consolidated and perfected thanks to the analysis of new examples that, by differing from the
2
K. Sadegh-Zadeh, “Handbook of analytic philosophy of medicine,” 2012.:171
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original, show the range of variability that each case of the same illness can acquire in an endless
process of acquiring perceptive experience.
In Wittgensteinian manner, what diseases have in common is that they have nothing in common
except that we call them all diseases. What they have are similarities and relationships that
intersect. There is nothing immanent, transcendent, or subsistent.
While the student is learning the theoretical structure of each disease, his teachers help him to
unite that conceptual information with the perceptual recognition of each patient. The text
defines, and the expert shows. During his training, the doctor sees more than 60,000 patients; this
sum of experiences and rigorous theoretical training ensures the quality of medical learning.
We should avoid assuming that diseases do not have determining characteristics. Pulmonary
tuberculosis is a well-defined disease characterized by the existence of pulmonary lesions caused
by a specific germ, Koch's bacillus. The finding of pulmonary lesions and Koch's bacillus is a
sufficient and necessary condition for its diagnosis. Nevertheless, we must not confuse the
disease's mental representation with a particular individual's complaint. Diabetes is not "seen";
what is seen is a patient, "Pedro," who is an example of an empirical application of a clinical
theory called diabetes. The doctor's job is to "translate" what the individual refers to and turn his
story into diabetes[12].
A frequent mistake is to need clarification on both levels. When one says, "Pedro has diabetes,"
diabetes is considered a category in itself, a universal that brings together all patients whose
disease state is classified by the same nosological predicate. Diabetes represents a condition, and
if we use the term "diabetes," it is because we understand that what happens to Pedro corresponds
to the case and justifies using the term.
The disease is the set of all patients who share the same condition, which we label with the same
name, for example, diabetes, as an economical way of referring to the case. In it, semiological
phenomena are united, which are those that are perceived, together with anatomo-
physiopathological alterations that are in the depth of the organism and that the doctor must
interpret. We follow Lorenzano [13] when he says that each disease is a clinical theory and each
patient is an example of that theory. Without the specimen and actual patient, the disease would
be no more than an abstract entity. Although theoretical constructs serve to represent the world,
they are not part of the world except in words. If we accept that disease is an immutable,
transcendent, or abstract "something," we could never have full knowledge of it, and that is
contrary to science.
2. LEARN BY EXEMPLARS
Diabetes, like any other disease, is learned through ostensible demonstrations that teachers teach
in practice. They are the paradigmatic examples, those that are described in textbooks canonized
by the medical community, which is the epistemic subject that orders the current paradigm and
groups the sign-symptoms (semiological disease) under the same term, disease, in which it
synthesizes its structural peculiarities. They are also the first patients with whom the doctor
learned, allowing him to distinguish one disease from another since they resemble the one he
learned about. Medical knowledge is the use of these paradigmatic exemplars plus the application
of the structures of clinical theory.
In classical textbooks, it is common to be taught a disease deductively so that symptoms and
signs can be inferred from underlying pathophysiology. For example, in the text, pneumonia
begins by describing various possible etiologies; viral, bacterial, fungal, parasitic, chemical,
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etcetera; we then go on to the chain of events that causally explain the clinical symptoms. The
biomedical data help shape the empirical evidence confirming the deduction so that the student
can feel able to explain precisely and safely what elements led the patient to suffer that disease
step by step.
The evaluation methods of this type of classical teaching correspond to the former theoretical
portion. In a classic anatomy exam, the student faces an anatomical slide and a question text of
the style: "Mark and list in the anatomical slide the ligaments and structures that make up the
knee."
The preparation is the paradigmatic example corresponding to the theoretical structure of any
knee disease, but how is each malady recognized clinically? How is the sign-symptomatological
example that is going to correspond to the real patient that the doctor is going to receive in the
hospital or his office instilled in the mind of the novice doctor?
For some decades, and since the beginning of the career, it has been sought that the student is
prepared to solve clinical situations that imply previous anatomical knowledge, presenting the
case as a paradigmatic example of a specific disease. For example: "During a soccer game, a
player receives a blow to the side of the leg that is supporting his weight. At that time, he
experiences severe pain in his knee that prevents him from walking again. What are the structures
most likely to have been injured?3
"
An example from biochemistry points to something similar. Once the student learned the
metabolism and the consequences of the nutritional deficit of the different types of vitamins, the
following clinical case is presented:"A 40-year-old woman who had suffered from obesity went
to the doctor, proud of having lost 35 kilograms in the last two years, but now she notices that her
hair is falling out. On interrogation, she tells her doctor that she has followed a strict fat-free diet.
Her alopecia is probably related to a deficiency of which of the following vitamins?4
"
Classical teaching with examples, which correspond to the pathophysiological basis of the
theoretical structure of the disease, is combined with examples of "real" patients that include the
practical sign-symptoms of the event that triggers the causal chain that the student has learned
during the basic cycle when studying biomedical sciences (anatomy, physics, chemistry,
physiology, pathology, and etcetera).
This kind of teaching is not intended to relegate to a world other than the universe of science.
What is sought is that the doctor is trained, in addition to theoretical elaborations, with clinical
cases from the "real" world. He cognitively elaborates on different types of ailments with models
that will help him relate the case with other "similar" ones that will appear in the future.
The novice doctor, due to lack of experience, tends to use the deductive model as he has learned
it in books when beginning his task. However, it is recognized that this teaching model has been a
source of error or delays in diagnosis [14]. With the addition of "real" paradigmatic specimens, it
is sought that the doctor can automatically access practical information already stored in his
memory so that he can quickly recognize the case as if he were an expert.
3
USMLE Step 1. Qbook. Kapplan Medical. 2002
4
Ibidem
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We have all heard stories of using expert intuition, the chess master who passes in front of a line
of players and announces without stopping: "White checkmates in three moves," or the doctor
who makes a complex diagnosis after looking at a patient. Expert intuition seems magical, but it
is not. The expert has stored in his memory information obtained thanks to previous interaction
with many specimens, and in a familiar situation, that information is triggered, and what is called
intuition is neither more nor less than the recognition of those observations.
Nobel laureate Daniel Kahneman [15] sets an example for someone who has just learned to play
chess. In the beginning, each move is like a letter. The novice player learns simple plays, such as
syllables, that he must join to form words. On the other hand, the expert immediately perceives
entire saved sentences as paradigmatic exemplars of certain moves. He interprets the case and
relates it familiarly with others already seen; in this way, he solves complex situations that he has
never experienced more easily and quickly.
Mario Bunge [16] warns that at least two conditions must exist to justify expert intuition: a) a
sufficiently stable environment that gives predictability to the problem, and b) having had the
opportunity of a prolonged practice that allows recognizing that these regularities really exist.
Furthermore, even if that prediction is correct, the derived conclusions are subject to errors that
should not be minimized.
The most significant source of confusion comes from wanting to over-generalize these
applications. Extensive practice is needed, and even then, the expert model is still subject to
failure due to perceptual bias, often caused by incorrect expectations, lack of experience, or lack
of cognitive skills of the user, also, for breach of trust that results in the abandonment of data, that
should have been considered[17].
Without ceasing to repair what Bunge warns us, what teaching through practical examples seeks
is that at the moment of diagnosing, the student perceives that what has been learned deductively
and practical knowledge are used for different things. After acquiring the information
corresponding to the biomedical sciences, that knowledge remains encapsulated, and the doctor
unpacks it when he needs it. He uses the deduction for complex cases or when he needs to
increase the explanatory component of the problem.The hypothetico-deductive model is "weak"
in solving problems, but it is the one that manages to tie up loose ends necessary to put together a
causal explanation.
Doctor learns each disease through an ideal model, a "perfect" prototype with complete sign
symptoms and a coherent pathophysiological deduction. However, just as in mathematical
formulas, that ideal model does not exist in the real world. The patient is a concrete clinical case
presented to the consultation with a specific problem; the teachers' task is to "show" what these
specimens appear. The combination of both educational procedures gives a more exact way of
selecting and testing clinical hypotheses during diagnosis.
3. THE PROCESS OF DIAGNOSTIC REASONING
During the diagnostic stage, doctors must separate, from all the diseases they have learned, which
may correspond to what happens in his patient. That action triggers interesting questions; How
does the doctor select from all the diseases the one that best fits as a hypothesis for his patient? In
other words, how does the doctor elaborate and epistemically justify his diagnosis?
At first, it was considered that diagnostic reasoning was similar to that used by a scientist to
justify a discovery, a deductive succession of facts causally linked that explain the chosen
disease. However, that is different from what usually happens.
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Considering the patient as a possible exemplar, the doctor looks for facts that serve as evidence.
When considered heuristically, evidence is a statement that expresses a fact that occurs in the
world, which, when faced with a hypothesis, can confirm or refute it. The evidence gives the
event a justification that allows us to believe something, either because it exists as positive
evidence or because it does not appear, then will be as negative evidence. These pieces of
evidence as a collection of facts must be considered pragmatically concerning a hypothesis and a
temporal-spatial context. In the process, different possibilities are played. According to the
context, the evidence can play against, in favor of the hypothesis, or be neutral.
What at first is evidence may not be evidence later, or others may appear to refute it. What is
evident to us may not be to another. The term has no semantic content; its true value depends on
the circumstances that surround each experience. The fall of a hammer is confirmatory evidence
of the law of gravity; it will fall if we do the test in the garden of a house, but if we place it in a
capsule revolving around the earth, it will not happen. The evidence can only be clear if we
attend to the context.
Considering the signs and symptoms as evidence of a fact that appears surprisingly in a patient,
the doctor begins to draw up hypotheses; it is here where abductive reasoning can help us
understand the selection process.
Studied by Charles Sanders Peirce (1839-1914), the abduction starts from a surprising fact. It is a
novelty or anomaly that is considered a "problem."
In what follows, we take Pierce's original syllogistic reasoning [18][19] and add a medical
example. In brackets are our comments:
1-The surprising fact "C" is observed.
("C" here is evidence, it is a sign-symptoms taken as evidence that a disease could exist. The
patient has a cough and may be sick with bronchitis)
2-But if "A" were true, "C" would be a regular thing.
("A" would be the hypothesis of a disease (bronchitis) that we have intuitively selected. It is a
conditional hypothesis, a belief. We have doubts, and we want to approach it slowly. We
temporarily accept that disease "A" could be the reason for which "C" has appeared).
3-Therefore, there is a reason to suspect that "A" is true.
(Considered "C" as clinical evidence of "A," its presence would validate the use of "A" as a
hypothesis. Therefore, there is reason to suspect that the cough is caused by bronchitis).
Evidence C potentially makes our patient a possible exemplar and makes us suspect that
hypothesis "A" might be the case. However, "suspect" is not "believe." This hypothesis can only
be established as a suggestion and must be accepted interrogatively.
If fact "C" is tentatively taken as evidence of having been caused by hypothesis "A," it means that
we have left aside other diseases that account for the same evidence.
There are several ways to deal with this problem to select a hypothesis in relation to evidence. It
is trivial to assume that the choice will be based on the most straightforward, most plausible,
most explanatory, and least ad-hoc hypothesis. However, the primary argument is that the
evidence must not merely implicate the hypothesis but also explain the rest of the observed data.
One of the various possible hypotheses or diseases is chosen because we assume it will provide a
better explanation according to all the available evidence. The term "best," used in relation to one
over any other, is problematic, and it can never be concluded that the chosen hypothesis will be
correct.
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Let us put a case. It begins with a fact taken as evidence for a tentative hypothesis. For example:
a) that bird is white, b) all swans are white, c), it is possible that this bird is a swan.
The method is based on a fact that is converted into evidence and tries to get a hypothesis right.
There is a fact -a white bird- and an inductively accepted rule or hypothesis -all swans are white-.
Our task is to ask ourselves if the case belongs to said rule.
Abductive reasoning starts from a weak argument -the judgment is nothing more than a complex
version of the fallacy of affirmation of the consequent- but it is strengthened as a heuristic tool
from a cyclical selection and testing process. If it is a swan, it is white. If it also has the rest of the
properties that can be deduced from being a swan, that is, beak, neck, weight, size, and shape; all
these singulars reinforce that the hypothesis of being a swan is the most accurate. Our data
becomes evidence. Being white is a sample, which, together with the rest of the data, reinforces
the appropriateness of the hypothesis. If it fits, it is approved; if not, it is rejected, and a new start
is made.
If the data is refuted, it will be based on our chosen hypothesis. However, the fact will still exist
(we saw a white bird that is not a swan). That information should be reinterpreted and used for an
alternative hypothesis. The examples that we have previously learned help us on the track to draw
up new hypotheses. That bird is white and has a flattened beak; all ducks have flattened beaks,
and this bird may be a duck.
Although abductive reasoning is a good process for selecting clinical hypotheses [16] [17], more
is needed to explain complex reasoning during diagnosis. However, if we add the explanation
that Cesar Lorenzano gives when he proposes the medical diagnosis using the tools of
structuralist metatheory [18], the description becomes more exhaustive.
Through structuralist metatheory, medical epistemology seeks to understand the nature of
medical knowledge with questions such as: What is medical knowledge, and how can it be
justified? How does theoretical knowledge differ from the practice of medicine?
According to the structuralist conception, a theory is a conceptual structure used to produce
knowledge. The theory claims to represent a "piece of reality," so its statements say that in this
system happens "what the theory claims." It postulates that diseases are theoretical entities
representing what happens to patients when they get sick.
To reconstruct a theory, doctors begin by considering the non-theoretical data (Mpp or Partial
Potential Models), which means the signs and symptoms the patient brings that allow him to be
framed in a "semiological disease." He takes these non-theoretical data, appeals to his previous
experience of having made contact with other patients that he has seen and who have suffered
from a similar condition, paradigmatic exemplars, that perceptual experience that he has
developed under intersubjective control with other colleagues. Then the doctor adds his
theoretical knowledge, that is, the pathophysiological interpretation of those symptoms (Mp or
potential model). With this, he begins the process of selecting hypotheses, which are the different
diseases or clinical theories that compete for a place in his mind, sensing that this patient could be
an empirical application, an example of one of those possible hypotheses. He then issues a
diagnosis, which will always be tentative, hypothetical, and subject to corroboration.
In this graph, we have analyzed the process of selection and testing of clinical hypotheses as part
of an abductive process. We add the analysis made by the structuralist metatheory, and we add
the use of exemplars, combining and completing both reasoning, which gives a more exact way
of selecting and testing clinical hypotheses for medical diagnosis.
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We start from the first premise, which contains the non-theoretical description, that is, the
problem that the patient brings to the consultation, the semiological data, and the signs and
symptoms that the patient refers to.The second premise contains the practical knowledge, the
medical experience obtained with paradigmatic examples that the doctor has managed to obtain
during his previous training, to which is added the theoretical interpretation, which explains the
symptoms and signs that the patient brings to the consultation. With these two premises, a first
clinical hypothesis is extracted. That is a disease in which these data, when used as evidence,
could justify its selection before proceeding to the testing process.
If the data, according to their relevance, fit within the proposed disease, identifying the initial
conditions continue, that is the rest of the elements that characterize it. The previous is the testing
phase. If approved, it will be possible to trace a deductive retrograde flow of how the events
occurred for the disease to develop.
The complete model, that is, the corroboration of the diagnosis, will be completed if the disease
evolves as predicted by its evolutionary law or axiom if the patient responds to treatment; if the
etiological agent that triggered the sequence is found, then the diagnosis will have been correct.
This scheme is apt to describe the structure of all medical diagnoses and, therefore, all exemplary
medical clinic cases. According to Lorenzano [20], "In this conception, a theory consists only of
structurally characterized exemplars, and the general word that encompasses them -disease- does
not have more content than that of these exemplars, and refers exclusively to them, not to a
supposed abstract entity called "disease."
4. REVIEW OF LITERATURE
In different articles about the philosophy of medicine, medical diagnosis has been considered in
dissimilar ways. According to the metatheoretical studies reviewed in the field of general
epistemology, especially in the domain of medical epistemology, we see that disease is
considered as a conceptual structure [21]–[23], which combines a theory with an actual patient;
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we added the idea of paradigmatic exemplars (as proposed by Cesar Lorenzano)[24], along with
studies on abductive reasoning [14], in order to explain the clinical process of medical diagnosis.
5. METHODOLOGY
The clinical process of diagnosing is a complex reasoning procedure that includes not only the
knowledge of the disease and its pathophysiological deduction, as has been learned in textbooks
[25], but also metaphysical, epistemological issues, normative, and logical aspects that permeate
this process. We can add the complexity of the "nature of disease" as a controversial issue. The
question of whether it is a value-laden concept remains open. We wish to add the importance of
ostensible demonstration of the patients, actual or fictitious, in-hospital medical education
(medical epistemology). The objective is to show that although deduction is essential in the
diagnostic process, abductive reasoning and the proper use of some scientific metatheories
contribute to making this process more effective and better understood by the treating physician.
6. RESULTS AND DISCUSSION
The clinical process of diagnosing is highly influenced by how it is learned. Not just by reading
medical textbooks but by how academic tests are presented to the medical student. Hospital
clinical practice is equally important during the training period when the future doctor contacts
his first patient next to the patient's bed. They will be empirical representations (paradigm
exemplars) of the theory previously learned in medical textbooks.
7. CONCLUSION
Having described what we understand by paradigmatic examples, we made an analysis of the
concept of disease, and we examined Wittgenstein's solution when defining the terms by their
use, which, together with the need to show examples through experienced teachers, is how that
the doctor manages to incorporate these specimens during his training, Finally we saw the
importance of their use for medical diagnosis.
REFERENCES
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Hist. Ideas, vol. 59, pp. 1–28, 1922.
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[5] C. Lorenzano, “WITTGENSTEIN YLOSPARADIGMASDEKUHN,” EPISTEME, no. 11, pp. 57–69,
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[6] T. S. Kuhn, “La estructura de las revoluciones científicas (incluye la posdata de 1969),” México
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[8] C. J. Lorenzano, “La Construccion de una Teoria y su Esquema Racional,” Vol. Colect. del Inst.
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[9] S. Janick, Allan; Toulmin, LA VIENA DE WITTGENSTEIN. Madrid: Taurus, 1974.
[10] R. Monk, Ludwig Wittgenstein : el deber de un genio, 2da. 1997. Barcelona: Anagrama, 1997.
[11] C. Lorenzano, “La estructura del conocimiento práctico,” Rev. Filos., vol. 29, no. 2, pp. 21–41, 2005.
[12] LORENZANO C., CHULLMIR R., ARTE CIENCIA Y EPISTEMOLOGIA. BUENOS AIRES, 2020.