Medicina y lógica: El proceso diagnóstico en neurología
Resumen
Medicine and logic: the diagnosis process in neurology
How do doctors think when they ought to solve the enigma: what is my patient suffering from? Such is the question behind this article. Our analysis rests on real life situations, where medical residents discuss specific cases in neurology, aiming at a joint diagnosis. Our theoretical thesis claims that the diagnostic process has a rational component that lends itself to logical reconstruction, though it still requires the personal presence of a medical doctor. By presenting a particular case in neurology we show how the cognitive process, which strive at the several diagnoses of this specialty, namely the syndromatic, topographic and etiologic, is reconstructed via abductive reasoning, in combination with deductive reasoning when discarding diagnostic hypotheses is in order. This analysis supports the idea that clinical judgment, which goes back to the XIXth century and rests upon a rational medicine based on diagnostics, is very much in use.
Key words: Medical logic, medical knowledge, diagnosis, neurology, cognitive process, abduction, deduction, induction, inference to the best explanation.
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Ackerknecht, Erwin (1982), A Short History of Medicine. Baltimore: The Johns Hopkins University Press.
Aliseda, Atocha (2006), Abductive Reasoning: Logical Investigations into Discovery and Explanation. Synthese Library, volume 330, Netherlands: Springer.
Bailar, J. C. (1985), “When research results are in conflict”, The New England Journal of Medicine 313(17): 1080-1081.
Castañeda, Gonzalo (1935), Tratado de clínica general. México: Editorial Cultura.
Cohen, Robert S. & Thomas Schnelle (1986 [1927]), “Some specific features of the medical way of thinking,” Cognition and Fact. Materials on Ludwik Fleck. Reidel Publishing Company.
Cruchet, René (1955), Les règles de la pensée en Médecine. Paris: Masson.
Eichhorst, Hermann (1905), Traité de diagnostic medical. Paris: G. Steinheil Editeur. Estañol, Bruno (1996), La invención del método anatomo-clínico. México: UNAM.
Estañol Vidal, Bruno y Cárdenas Molina, Eduardo (1996), “El razonamiento clínico y la hipótesis diagnóstica”, Anales Médicos 41(2): 78-82.
Foucault, Michael (1963), El nacimiento de la clínica. México: Siglo XXI Editores. Horton, Richard (1995), “The interpretative turn,” The Lancet 346(3):3
Galdston, Iago (1941), “Diagnosis in historical perspective,” Bulletin of the History of Medicine 9(4): 367-384.
Groves, M., Scott, I. and Alexander, H. (2002), “Assessing clinical reasoning: A method to monitor its development in a PBL curriculum,” Med. Teach. 24(5): 505-515.
Jiménez Borreguero, Juan Francisco (2008), “Medicina humanista”, consultado en http://es.geocities.com/humanismo7/medicos.htm
Laín Entralgo (1981), El diagnóstico médico. España: Salvat Editores.
Malterud, Kristi (2001), “The art of science of clinical knowledge: Evidence beyond measures and numbers,” The Lancet 358: 397-400.
Montgomery, Kathryn (2006), How Doctors Think? Oxford: Oxford University.
Nonaka, Ukujiro, Toyama, Ryoko and Konno, Noboru (2000), “SECI, Ba and leadership: A unified model of dynamic knowledge creation,” Long Range Planning 33: 5-34.
Peirce, C.S., Collected Papers of Charles Sanders Peirce. Volúmenes 1-6 editados por Hartshorne, C y Weiss, P. Cambridge: Harvard University Press, 1931-1935; Volúmenes 7-8 editados por Burks, A.W. Cambridge: Harvard University Press, 1958.
Pinel, Phillippe (1980), The Clinical Training of Doctors. An Essay of 1793. Editado, traducido y ensayo introductorio de Dora B. Weiner. Baltimore: The John Hopkins University Press.
Peng, Yung & Reggia, James A (1990), Abductive Inference Models for Diagnostic Problem-Solving. New York: Springer-Verlag.
Reess, Bob and Shuter, Paul (1996), Medicine Through Time. Oxford: Heinemann.
Rodríguez de Romo, Ana Cecilia (2003), “La enfermedad en el pensamiento de Claudio Bernard. El caso del azúcar y la grasa”, Ludus Vitalis 11(20): 166-176.
Rillo, Arturo G. (2006), “El arte de la medicina: una investigación hermeneútica”, Gaceta Médica de México 142(3): 253-260.
Thagard, Paul (1999), How Scientists Explain Disease. Princeton: Princeton University Press.
Villey, Raymond (1979), Histoire du diagnostic medical. Paris: Masson.
Weiner, Herbert (2002). The Concept of Psychosomatic Medicine. Los Angeles, UCLA: Neuropsychiatric Institute.
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