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Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?

Medical approach to patients is a fundamental step to get the correct diagnosis. The aim of this paper is to analyze some aspects of the reasoning process inherent in medical diagnosis in our era. Pathologic signs (anamnestic data, symptoms, semiotics, laboratory and strumental findings) represent i...

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Autores principales: Soldati, Gino, Smargiassi, Andrea, Mariani, Alberto A., Inchingolo, Riccardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485552/
https://www.ncbi.nlm.nih.gov/pubmed/28670453
http://dx.doi.org/10.1186/s40248-017-0098-z
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author Soldati, Gino
Smargiassi, Andrea
Mariani, Alberto A.
Inchingolo, Riccardo
author_facet Soldati, Gino
Smargiassi, Andrea
Mariani, Alberto A.
Inchingolo, Riccardo
author_sort Soldati, Gino
collection PubMed
description Medical approach to patients is a fundamental step to get the correct diagnosis. The aim of this paper is to analyze some aspects of the reasoning process inherent in medical diagnosis in our era. Pathologic signs (anamnestic data, symptoms, semiotics, laboratory and strumental findings) represent informative phenomena to be integrated for inferring a diagnosis. Thus, diagnosis begins with “signs” and finishes in a probability of disease. The abductive reasoning process is the generation of a hypothesis to explain one or more observations (signs) in order to decide between alternative explanations searching the best one. This process is iterative during the diagnostic activity while collecting further observations and it could be creative generating new knowledge about what has not been experienced before. In the clinical setting the abductive process is not only theoretical, conversely the physical exploitation of the patient (palpation, percussion, auscultation) is always crucial. Through this manipulative abduction, new and still unexpressed information is discovered and evaluated and physicians are able “to think through doing” to get the correct diagnosis. Abductive inferential path originates with an emotional reaction (discovery of the signs), step by step explanations are formed and it ends with another emotional reaction (diagnosis). Few bedside instruments are allowed to physicians to amplify their ability to search for signs. Stethoscope is an example. Similarities between ultrasound exploration and percussion can be found. Bedside ultrasonography can be considered an external amplifier of signs, a particular kind of percussion and represents a valid example of abductive manipulation. In this searching for signs doctors act like detectives and sometimes the discovering of a strategic, unsuspected sign during abductive manipulation could represent the key point for the correct diagnosis. This condition is called serendipity. Ultrasound is a powerful tool for detecting soft, hidden, unexpected and strategic signs.
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spelling pubmed-54855522017-06-30 Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics? Soldati, Gino Smargiassi, Andrea Mariani, Alberto A. Inchingolo, Riccardo Multidiscip Respir Med State of the Art Medical approach to patients is a fundamental step to get the correct diagnosis. The aim of this paper is to analyze some aspects of the reasoning process inherent in medical diagnosis in our era. Pathologic signs (anamnestic data, symptoms, semiotics, laboratory and strumental findings) represent informative phenomena to be integrated for inferring a diagnosis. Thus, diagnosis begins with “signs” and finishes in a probability of disease. The abductive reasoning process is the generation of a hypothesis to explain one or more observations (signs) in order to decide between alternative explanations searching the best one. This process is iterative during the diagnostic activity while collecting further observations and it could be creative generating new knowledge about what has not been experienced before. In the clinical setting the abductive process is not only theoretical, conversely the physical exploitation of the patient (palpation, percussion, auscultation) is always crucial. Through this manipulative abduction, new and still unexpressed information is discovered and evaluated and physicians are able “to think through doing” to get the correct diagnosis. Abductive inferential path originates with an emotional reaction (discovery of the signs), step by step explanations are formed and it ends with another emotional reaction (diagnosis). Few bedside instruments are allowed to physicians to amplify their ability to search for signs. Stethoscope is an example. Similarities between ultrasound exploration and percussion can be found. Bedside ultrasonography can be considered an external amplifier of signs, a particular kind of percussion and represents a valid example of abductive manipulation. In this searching for signs doctors act like detectives and sometimes the discovering of a strategic, unsuspected sign during abductive manipulation could represent the key point for the correct diagnosis. This condition is called serendipity. Ultrasound is a powerful tool for detecting soft, hidden, unexpected and strategic signs. BioMed Central 2017-06-27 /pmc/articles/PMC5485552/ /pubmed/28670453 http://dx.doi.org/10.1186/s40248-017-0098-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle State of the Art
Soldati, Gino
Smargiassi, Andrea
Mariani, Alberto A.
Inchingolo, Riccardo
Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?
title Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?
title_full Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?
title_fullStr Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?
title_full_unstemmed Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?
title_short Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?
title_sort novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?
topic State of the Art
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485552/
https://www.ncbi.nlm.nih.gov/pubmed/28670453
http://dx.doi.org/10.1186/s40248-017-0098-z
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