Medical thought and the scientific method
When a person studies a university degree, whether they like it or not, their way of thinking is affected, molded to a certain way of thinking based on the area in which they have become professional.
It happens to me with some frequency that when I meet a person, and they don't know that I'm a doctor, which is wonderful because once they know everything changes, they will even limit themselves to talking about some specific topics because they could feeling a bit self-conscious. But when I meet them, that I see some special coloration in their skin, or in their eyes, or some particular movement of the hand, or some limitation in mobility, a tic, something that the person has already got used to living with, I usually start thinking about possible diagnoses, it's inevitable.
At that precise moment, just like when I am in a consultation with a patient, hundreds of thoughts go through my mind, and I know that the same thing happens in any person who exercises a certain profession. And I would like in this publication to talk a little about the scientific method commented on a way of thinking, that which is not seen but happens.
This post arose as a result of some reflections he had from reading the posts of the user @lemouth, where obviously thought is a great tool.
Academic training always fills you with a lot of information, in the case of the doctor I can tell you that the training is given in the first stage by the following:
- Histology: study of all the cells of the organism, in addition to the tissues that compose us.
- Anatomy: Study of the organs of each organic system (respiratory, cardiovascular, muscular, etc).
- Biochemistry: (one of my favorites) the interaction of each of the molecules in our body, function of enzymes, how energy is produced and how it is used, among many other things.
- Physiology: how our body works from the molecular to the systemic, here you learn everything normal about the functioning of the body.
Then comes everything abnormal, that is:
Physiopathology, then pathology, study of specific diseases in detail by clinic (pediatrics, internal medicine, obstetrics, surgery), semiology (study of signs and symptoms).
Much more, such as pharmacology, epidemiology, statistics, in short, a lot of knowledge that is acquired over the course of 6 years of study, plus the practical part, obviously. With all this knowledge in mind, the thought is molded to start looking for what is failing and how to solve it.
To give an example of what happens in the mind of a doctor when he is with a patient, I will give an example, a clinical case, in which I will be able to string together everything that is discarded:
A patient arrives for consultation, passes and goes to the chair.
- At that moment the doctor's mind is already activated, he is analyzing the way of walking, if there is any ailment when walking, if there is tremor, if it goes to one side or the other, he begins to look for some signs before let him say it
The patient sits down, and the next question could be What has brought you here? or How can I help you?. And in this way he begins to state what he feels, the consultation will pass with some specific questions based on what he tells me, but they are always questions that are the product of a quick analysis of what the patient is saying, which is like a kind of discovery which is happening little by little.
But, to be specific about how a doctor's thinking is structured after having precise information about the patient, suppose that she has told us:
"Doctor, for several days I have been experiencing pain in my lower back and the pain radiates to my left leg, to the point that it makes it difficult for me to walk."
Lower back pain can be due to several causes, given that in that area we have muscles, also kidneys, and a number of nerves, I must start by ruling out the most superficial to the deepest.
So I will ask the patient to sit in a way that allows me to see her lower back to analyze whether there are changes in color or not, to touch the area and see if there are changes in temperature, or if there is muscle tension of some kind. explain what you feel.
Once this is ruled out, it is necessary to move on to another stage, and that is to focus on ruling out if there is any kidney problem (calculi, infection, inflammation) so all the laboratory tests that need to be done will go through your mind, and even image.
It will also be necessary to assess nerve function to rule out nerve compression in the lumbar spine. You have to make sure that you have not lifted a lot of weight, or have not fallen, things that could cause these symptoms.
In this way, differential diagnosis is made, in which both physical examination and laboratory and imaging studies are used; obviously, it can be both an injury to the lumbar spine and kidney stones, one thing does not exempt the other.
I do not want to make this explanation much longer, but I hope that the people who read this post will have a much clearer understanding of all the systematization that exists in the thinking of a health professional when he assumes caring for a patient. And these diagnostic processes can be delayed depending on the time it takes to carry out the tests.
It is a fairly complex process in which many factors interact to be able to determine something, to have a result, and obviously, then comes the process of selecting an appropriate treatment, which must be personalized many times considering whether or not the person is allergic to the first line of treatment, or if you have any other medical condition that limits the use of a particular drug.
As you can see from this writing, the scientific method is always present, because it is a rational process, in which, starting from a basic knowledge, it is intended to reach a result (diagnosis).
I say goodbye, giving thanks in advance for the support.
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To be a successful doctor, you need to have an academic background and training as well but it will be good if one can pursue a master's course in the field of medicine.
Oh yes, the study in this medical career never ends, and each time, as time goes by, it is about specializing more and more, going deeper and deeper into knowledge. Certainly.
What is also amazing is that there is a true economic impact to academic training. It is however super hard to quantitatively assess (I imagined some economists may have tried, but I don't have the info).
Thanks for this post!
Cheers!
Yes, there certainly is such an economic impact. Economics or a vision of it is implicit in almost everything in the world.
Thank you very much for commenting and your support.
I guess a doctor needs to be always updated right? But that is important for most of the professional careers available
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Updating is essential. Even in basic things like what cardiopulmonary resuscitation respects, every two years you have to take acting courses because there is always some change. In addition to new medicines, discoveries in diseases, in short, many things But you are right, the same thing happens in all professions
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Ud. escribe como un Psiquiatra. ¿Será que es esa su especialidad?
Todas esas materias que menciona en su artículo, yo también las curse en la universidad, adermás de otras que me permiten cuidar a un paciente hasta que él pueda encontrar su salud biopsicosocial. Entre tantas cosas que me pasan por la cabeza, yo no entiendo cómo mi título es "Licenciada", sí estuve en salones escuchando clases con los futuros médicos, bioanalistas, entre otras carreras afines...
Al igual que un médico, nosotras las enfermeras, usamos la observación al paciente para "saber" su pronóstico, su estado y luego ofrecer un diagnóstico oportuno para nustro informe. Ambas profesiones mantienen similitudes y procesos delicados, en donde no puede haber fallas porque sino sería fatal para el paciente. Por ello, el trabajo debe hacerse con amor a la profesión y apego a las normas de seguridad, para el paciente y para nosotros también.
Saludos Dr. @apineda
You write like a psychiatrist, is that your specialty?
All those subjects you mention in your article, I also took them in college, plus others that allow me to take care of a patient until he can find his biopsychosocial health. Among so many things that go through my head, I do not understand how my title is "Licenciada", I was in classrooms listening to classes with future doctors, bioanalysts, among other related careers....
Just like a doctor, we nurses use patient observation to "know" their prognosis, their condition and then offer a timely diagnosis for our report. Both professions maintain similarities and delicate processes, where there cannot be failures because otherwise it would be fatal for the patient. Therefore, the work must be done with love for the profession and adherence to safety standards, for the patient and for us as well.
Greetings Dr. @apineda
Soy médico general, pero la psiquiatría siempre ha sido un área que me ha gustado, por lo que la manera en la que pensamos siempre para mi ha sido motivo de curiosidad.
Mi respetada licenciada, la verdad es que son áreas muy afines tanto las enfermería como la medicina, se complementan, y ambas son necesarias.
Sin embargo, si hay una visión distinta, según entiendo, incluso desde su propio origen mismo.
La enfermería surgió con Florencia Nightingale, con la finalidad de ella poder ayudar a los heridos de la guerra a estar mejor, a liviar su dolor, a tenderlo, pero más desde lo humano. Y en la actualidad todo esto pero con basamento científico.
En el caso de la medicina desde su surgimiento ha centrado sus esfuerzos en la enfermedad, en como curarla.
Creo que en eso es que hay una diferencia sustancial, pero la formación en cuanto a anatomía, fisiología, etc, es bastante similar. Pero el enfoque al cuidar al paciente si es diferente.
Claro, es una percepción personal, gracias @wayuu-reg
I am a general practitioner, but psychiatry has always been an area that I have liked, so the way we think has always been a matter of curiosity for me.
My respected graduate, the truth is that nursing and medicine are very similar areas, they complement each other, and both are necessary.
However, if there is a different vision, as I understand, even from its very origin.
Nursing emerged with Florencia Nightingale, with the aim of her being able to help the wounded from the war to be better, to relieve their pain, to tend it, but more from the human point of view. And today all this but with scientific basis.
In the case of medicine, since its inception, it has focused its efforts on illness, on how to cure it.
I think that is where there is a substantial difference, but the training in terms of anatomy, physiology, etc., is quite similar. But the approach to caring for the patient is different.
Sure, it's a personal perception.
Sí doctor, entiendo perfectamente y se de esa história de la Nightingale. En cuanto a lo que habla de similitud en las materias a cursas, prácticamente son las mismas, sin cambio alguno. Y para muestra, le he dicho que curse esas mismas materias con otras personas que optaban por otras carreras, como la mmedicina. Pero he trabajado poco la enfermería como tal, más que todo mi especialidad está dada por la experiencia en laboratorios de bioquímica y hemoterapia. Si he atendido pacientes en el área de Prenatal, Obstetricia y Ginecología cuando acuden a la sala de partos. Estoy por jubilarme pero el patrono no lo quiere... Saludos!
Hola, me gustó tu post y me hizo rememorar algunas cosas: tu segundo párrafo me hizo pensar en Sherlock Holmes y cómo su observación es para él algo natural por la fuerza del hábito. Tal vez te guste leer esta nota introductoria del doctor que enseñó a Conan Doyle, el dr. Bell:
https://puertasdeficcion.blogspot.com/2022/02/el-senor-sherlock-holmes-por-el-doctor.html
Y luego el differential diagnosis me hizo pensar en dr. House, médico cuya creación está inspirada en Holmes.
Una pregunta: en las materias que señalaste no vi epistemología. ¿No tienen esa materia en ningún momento de la carrera, siendo que son los resultados en conocimientos de la epistemología la raíz de todas las ciencias (incluso de las que sean más empíricas con poca carga teorética, pues estas tienen una epistemología base por difolt)?