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Arch Hellen Med, 17(3), May-June 2000, 300-325


The science of kliniki diagnostiki: Concerning method

Konstantopouleio General Hospital, “Agia Olga”, N. Ionia, Athens, Greece

In this paper it is argued that kliniki diagnostiki (as it is proposed to call the scientific process by which clinical diagnosis is made) is an empirical science with logos (logos=reason, thinking by syllogism), and with its own method (which differentiates it from other applied sciences and from art), which is applied to a specific individual each time under conditions of uncertainty. Firstly, an angument is made against the view that clinical medicine is not a science. Next, the "state of the art" of science as it emerges from contemporary epistemology is described briefly. The point stressed is that science is not absolute, as the reality that it examines is not certain. Furthermore, the human senses, through which empirical knowledge is perceived, frequently err. Although science is not immune from error, there is a method to detect it and the detection of error is one of the main targets of science. Thirdly, a differentiation is made between science and art, defining science, according to Aristotle, as the knowledge of the general, in which "what" is happening and "why" is happening, is known. Kliniki diagnostiki, although it deals with the individual human-case, is a science according to the above definition, because (a) it possesses general knowledge of the disease, (b) the clinician-scientists know the "what" and "why" of things, and (c) then is able to teach what they know. In the remainder of the paper it is argued, and the thesis justified that kliniki diagnostiki is an empirical science with reason, based on perceptual observation and on the logical apparatus of the hypotheticodeductive reasoning. The hypothetical nature of the syllogism calls for testing of the hypothesis, which is accepted as true only when correspondence with reality, as it is perceived, is proved. Clinical semiotics is the basis of the clinical diagnosis as science. The diagnostician reads symptoms and signs the patient sends, and translate them into the formal language of medicine. Kliniki diagnostiki is applied research where the experimental material is the individual patient and the research apparatus is the clinician-diagnostician. By its nature, diagnosis is a "poetic" (ποιείν, poein=to create) science in the meaning that we make (create) it. There is no such entity as diagnosis out there, in the real world. The diagnostician invents, creates diagnosis by collecting, evaluating and testing empirical data (i.e. the patient), by the power of reason and by the same power, the created diagnosis, is justified.

Key words: Applied research, Clinical diagnosis, Clinical problem, Clinical research, Clinical sign, Diagnosis, Empirical science, Science and art, Science of individual (case based).

© 2000, Archives of Hellenic Medicine