Clinical thinking is one of the cognitive functions performed by a doctor in order to achieve a certain result. This result can be a correct diagnosis, a competent choice of the necessary treatment.

The necessary components of clinical thinking are analysis and synthesis of incoming information, and not a simple comparison of data. A physician with the ability to think clinically is always a competent, qualified specialist. But, unfortunately, not always a doctor with extensive experience can boast of the ability to think like that. Clinical thinking allows you to assess the patient's condition as a whole organism, taking into account all its characteristics; considers the disease as a process, clarifying the factors leading to its development, its further evolution with associated complications and concomitant diseases. Taking into account the principles of dialectics, clarifying the cause-and-effect relationships between the processes occurring in the body, using the principles of logic in solving problems allow thinking to reach a qualitatively new level of development.

Induction is a method of information processing, when they pass from the general to the particular. This means that the doctor, examining the patient, reveals some symptoms. Some of them are common to a large group of diseases, others are more specific. Based on the last group of symptoms, a presumptive diagnosis is made. Knowing the classic picture of the disease, the doctor supposes, to confirm his hypothesis, to find other symptoms of this disease in the patient, thereby confirming his hypothesis and making a final diagnosis. This method has a big drawback: such a rough approach to diagnosis does not allow a complete assessment of the patient's condition.

Deduction is a logical method that allows you to move from the particular, revealed details to the general, to draw the main conclusion. To do this, the doctor, having performed a complete clinical and instrumental study, evaluates the results and, based on an assessment of all (even minor symptoms), makes a presumptive diagnosis. The assumption that arises in the process of diagnosis is called a hypothesis. Putting forward a certain hypothesis, the doctor seeks confirmation for it, and if they are not enough to turn the hypothesis into a statement, then this hypothesis is rejected. After that, a new hypothesis is put forward, and the search is carried out anew. It must be remembered that a hypothesis, although based on objective evidence obtained from clinical research, is still an assumption and should not be given the same weight as proven facts. Setting technique differential diagnosis includes five phases.

The first phase is the search for the syndrome in relation to which the range of diseases for differentiation is determined. If the examination revealed several syndromes, one of them is distinguished from the cat. most informative.

Second phase. For comparison, a detailed description of the leading syndrome is determined; in addition, it is necessary to create a complete picture of the disease, that is, to note all the symptoms identified during the examination.

The third phase is differentiation itself. The disease included in the presumptive diagnosis is consistently compared with all diseases from the proposed list. First, they compare the nature of the manifestation of the main syndrome in the patient and in the classical picture of the alleged disease. Then it is determined whether there are or are not present in the patient's clinical picture of other symptoms characteristic of the differentiated disease, and how they are manifested. In the process, the main signs of similarities and differences between diseases are determined.

The fourth phase is the most creative diagnostic phase. At this stage, the main points of the analysis and synthesis of information take place.

Fifth phase. On the basis of logical conclusions and the data obtained, all the least probable diseases are excluded, and the final diagnosis is made Analysis - the mental dismemberment of the studied subject into its component parts or the selection of some signs for their study separately as parts of a whole.

The analytical method of thinking plays a huge role, which cannot be overestimated. After all, the perception of an object as a whole gives a very bright and rich, but almost always superficial impression. Analysis is absolutely essential in diagnosis. Human diseases present a complex picture in the form of a variegated mosaic. In addition to this, there are paraclinical data, so sometimes the indicators to be assessed are in the tens. By means of analysis, various representations are brought under the corresponding concepts. Because of this, analysis is absolutely necessary to isolate the most significant symptoms. Analysis is followed by synthesis. Synthesis is the mental reunification of parts of a whole. This is the joining of various ideas and concepts to each other and the understanding of their diversity in a single act of cognition. Thinking without synthesis is also impossible to imagine as a brick falling upwards. Among all the perceptions that are provided to our mind by the senses, connection is the only one that is not given by the object. We cannot imagine anything connected in the object of knowledge before we connect our sensations in consciousness and thinking. This connection is carried out only by the subject, that is, by the doctor, the cat. comprehends the object - the patient with his suffering.

Synthesis allows you to form concepts of a higher order and link them into judgments. But diagnostic thinking would be incomplete and imperfect if we did not conduct a semiotic analysis of at least the most essential symptoms. Therefore, the primary synthesis is followed by a pathogenetic assessment of symptoms, which can be considered as an analysis for more high level... Analysis is easier than synthesis, lends itself to dismemberment and detailing. It begins with a listing of all the information, the cat. collected by the doctor about the patient. Here, the sequence and methodology of the interview and examination is very important (as the propaedeutic teaches), so that then it is easier to carry out the next stage - the grouping of symptoms according to their degree of importance, significance. This grouping at the same time means the separation of signs according to their diagnostic significance. Therefore, analysis includes elements of synthesis from the very beginning. In everyday practice, doctors unconsciously apply logical laws and build a variety of inferences (syllogisms). The use of logic in the process of diagnostic and therapeutic activities is actually called clinical, medical thinking. Even such a form as epicrisis is an entimeme (abbreviated syllogism). All epicrises are written according to the scheme below.

Medical thinking is one of the most difficult types of intellectual activity. the most important qualities of the doctor's thinking ”contradictions inherent in the doctor's thinking.

The first contradiction is the contradiction between the centuries-old experience of using traditional clinical methods for examining patients and the achievements of modern medicine, accompanied by a significant increase in the volume of laboratory and instrumental research. The personality of the doctor, his personal medical thinking, individual understanding of the patient - recede into the background, and at the same time the interests of the patient also recede into the background, being replaced by the stereotyped, routine use of techniques, which are often seen as the beginning and end of all medical wisdom. " The increase in the volume of information is increasingly in conflict with the need for a doctor in an almost constant lack of time to allocate really valuable, the most essential information.

The second contradiction in the physician's thinking is the contradiction between the integrity of the object (a sick person) and the growing differentiation of medical science. The narrow specialization of doctors in nosological forms, research methods, organs and systems, combined with the tendency to organize large multidisciplinary hospitals, leads to the fact that the patient is examined and treated by a team of doctors. the contradiction between a deep penetration into the essence of the processes occurring in the organs and systems of the human body, and the need for a synthetic approach to the patient, the relationship of both types of thinking, their unity and difference could contribute to the creation of a single picture of it in medicine, clarification of the characteristics of both of its forms.

Clinical thinking is a kind of doctor's activity, involving special forms of analysis and synthesis associated with the need to correlate the overall picture of the disease with the identified symptom complex of the disease, as well as quick and timely decision-making about the nature of the disease based on the unity of conscious and unconscious, logical and intuitive components of experience. (BME. T. 16).

The concept of "clinical thinking" is often used in medical practice, as a rule, to denote the specific professional thinking of a practitioner aimed at diagnosing and treating a patient. At the same time, it should be noted that the understanding of the essence of clinical thinking largely depends on the initial data of worldview and epistemological positions.

Clinical thinking is a complex, contradictory process, mastering which is one of the most difficult and important tasks of medical education. It is the degree of mastery of clinical thinking that first of all determines the qualifications of a doctor.

In general, the doctor's thinking is subject to the general laws of thinking. However, the mental activity of a physician, as well as of a teacher, psychologist and lawyer, differs from the mental processes of other specialists due to their special work - working with people. The diagnosis, as well as the perceptual side of the activities of the teacher, psychologist and lawyer, is fundamentally different from scientific and theoretical knowledge.

In contrast to scientific and theoretical knowledge, diagnostics, as a rule, does not reveal new laws, new ways of explaining phenomena, but recognizes already established diseases known to science in a particular patient.

The correctness of the diagnosis, as a rule, is influenced by the psychological characteristics of the patient's personality, the level of his intellectual development.

That is why a careful study of the patient's conscious activity, the psychological side of his personality is very important in both diagnostic and therapeutic processes. The patient's thinking, today, is increasingly used in psychological counseling, psychotherapy, hypnosis, auto-training, where with the help of the word the activity of certain organs and the whole organism is influenced.

A feature of the doctor's activity, which leaves an imprint on the nature and content of clinical thinking, is an individual approach to the patient, taking into account his personal, constitutional, genetic, age, professional and other characteristics, which often determine not only clinical features the patient, but also the essence of the disease. It should also be noted that the quality of clinical thinking of each particular doctor depends on his consistent development of diagnostic and therapeutic skills and techniques, on the nature of logical techniques, intuition. The ethical side of medical work, his personality and general culture are of great importance for characterizing the clinical thinking of a doctor.

The level of modern medicine, different technical means patient examinations (computed tomography, electroencephalography, electrocardiography and many other paraclinical methods) make it possible to establish an accurate diagnosis almost without error, but no computer can replace an individual approach to a patient, taking into account his psychological and constitutional characteristics, and most importantly, replace the clinical thinking of a doctor ...

Here is just one example of the possibility of clinical thinking in professional activity doctor. With the help of paraclinical examination methods, the patient was diagnosed with a brain tumor.

Dozens of questions immediately arise before the doctor (the cause of its occurrence, the topic of its location, the structure and nature of the tumor - there are more than a hundred varieties, is the tumor primary or metastatic, which parts of the brain have been affected, what functions are impaired, is the tumor subject to surgical removal or it is necessary to carry out conservative treatment, what concomitant pathology the patient has, what method of treatment is most acceptable, what method of anesthesia, anesthesia to use during the operation, what medications the patient may be allergic to, what is the patient's psychological profile and many other questions). When solving all these issues, thousands of mental operations are performed in the cerebral cortex, and only thanks to a kind of analysis and synthesis, namely, the doctor's clinical thinking, is the only correct solution found.

Thus, the formation of clinical thinking is a long-term process of self-knowledge, self-improvement, based on the desire for professionalism, increasing the level of doctor's claims, mastering deontological and psychological approaches when communicating with a patient.

Clinical thinking is a meaningfully specified process of dialectical thinking that gives integrity and completeness to medical knowledge.

In this definition of clinical thinking, it is quite rightly assumed that it is not some special, exclusive type of human thinking, that human thinking is generally the same in any form of intellectual activity, in any profession, in any field of knowledge. At the same time, the definition also emphasizes the provision on the specifics of clinical thinking, the importance of which must be taken into account when considering the problem of its formation and development. The specificity of clinical thinking that distinguishes it from others is as follows:

1. The subject of research in medicine is extremely complex, including all types of processes from mechanical to molecular, all spheres of human life, including those that are not yet available for scientific comprehension, although obvious, for example, extrasensory perception, bioenergetics. Human individuality cannot yet find a concrete expression in a clinical diagnosis, although all clinicians and thinkers have been talking about the significance of this component of the diagnosis since time immemorial.

2. In the process of diagnostics in medicine, non-specific symptoms and syndromes are discussed. This means that in clinical medicine there are no symptoms that are indicative of only one disease. Any symptom may or may not be present in a patient with a certain disease. Ultimately, this explains why a clinical diagnosis is always more or less a hypothesis. At one time this was pointed out by S.P. Botkin. In order not to frighten the reader by the fact that all medical diagnoses are the essence of a hypothesis, let us explain. A medical diagnosis can only be accurate in relation to those criteria that are currently accepted by the scientific community.

3. In clinical practice you cannot use all research methods from their huge arsenal for various reasons. It may be allergic to diagnostic manipulations, diagnostic measures must not harm the patient. Medical institutions do not have some diagnostic methods, some diagnostic criteria are not sufficiently developed, etc.

4. Not everything in medicine lends itself to theoretical comprehension. For example, the mechanism of many symptoms remains unknown. General pathology is increasingly in a state of crisis. Any pathological conditions are associated with the damaging effect of free radicals. The mechanism, previously considered as classical compensatory, is now considered predominantly pathological. There are many examples.

5. Clinical medicine began to be called clinical from Burgav. Its defining feature is that clinical thinking is brought up in the process of communication between a student, a doctor-teacher and a patient at his bed (at the patient's bedside). This explains why any kind of distance learning medicine is unacceptable. Neither a trained artist, nor a phantom, nor business games, nor theoretical mastering of the subject can replace the patient. This position needs to be substantiated from the other side.

Despite the fact that a person's thinking is one, which has already been noted, for each person it is formed exclusively individually. Studying medicine outside of communication with the patient and with the teacher, the student, in his own way, will highlight the emphasis of importance in the subject being studied. This means that the student's thinking will not be clinical.

6. It is impossible to consider the specifics of clinical thinking in isolation from taking into account the style of clinical thinking, its development and changes in the near future. Style is a feature of the method, depending on the era. For example, in ancient medicine, the main thing in diagnostics was the determination of the prognosis. By the end of the nineteenth century, a doctor's style of work had developed, which consisted of observing patients and examining it according to the traditional scheme: first, a survey, then a physical examination, and then a paraclinical study.

Following the requirements of this style was to protect the doctor from diagnostic error, over-examination, and over-therapy. In the second half of the twentieth century, significant changes took place in clinical medicine. New research methods appeared, the diagnosis of the disease increasingly became morphological during life (biopsy, radiological, ultrasound research methods). Functional diagnostics made it possible to approach preclinical diagnostics of diseases.

Saturation with diagnostic tools, requirements for efficiency in rendering medical care demanded a correspondingly greater efficiency of clinical thinking. The style of clinical thinking consists in observing the patient, while fundamentally remains, however, the need for prompt diagnosis and therapeutic intervention dramatically complicates the work of the clinician.

7. Modern clinical medicine challenges the physician to acquire clinical experience as soon as possible, since every patient has the right to be treated by an experienced physician. The clinical experience of a doctor is still the only criterion for the development of his clinical thinking. As a rule, the experience of a doctor comes in adulthood.

The listed 7 provisions, which to some extent reveal the specifics of clinical thinking, prove the relevance of the problem of the formation and development of clinical thinking.

The mechanisms of the development of human thinking in general and in a particular profession in particular are still unknown to science. Nevertheless, there are quite understandable, simple well-known provisions, reflection on which is very useful for assessing the state of the problem of the formation of clinical thinking in the past, present and future.

1. The most intensive and effective human thinking is formed and developed at a young, more precisely at a young age.

2. It is also known that people at a young age are very susceptible to high spiritual and civic values ​​that determine the attraction of young people to medicine. In adulthood, as it is now generally accepted to consider from 21 years and older, fatigue arises and grows from the search for high ideals, there is a deliberate limitation of the young person's interest to purely professional and everyday issues, youthful enthusiasm passes and pragmatism comes to replace it. In that age period it is difficult to engage in the formation of clinical thinking, and to be frank, let's face it, it's too late. The fact that a person can develop at any age period is well known, however, the effectiveness of such development is less and is most likely known as an exception to the rule.

3. In any specific area of ​​human activity, professional thinking develops through direct communication between the student and the subject of study and with the teacher.

The considered 3 provisions help in complex problems of the specifics of clinical thinking to choose clear priorities in planning the education of a clinician. First, vocational guidance should be provided at school age. School age must not exceed 17 years. Secondly, it is better to admit well-oriented vocationally oriented children 15-16 years old to the university's medical faculties. The plan for the training of a doctor at the university, created by the founders of Russian clinical medicine M.Ya. Mudrov and P.A. Charukovsky is ideal. It traces the fundamentality and consistency. In the 1st and 2nd courses, the student is prepared to work with a sick person, and in the 3rd year, the propaedeutics of internal diseases is studied with a wide coverage of issues of general and private pathology, in the 4th year, the course of the faculty therapeutic clinic is studied in detail, or rather, the sick person in all its details , and then, at the department of a hospital therapeutic clinic, variations in the manifestation of diseases in life are studied again with a broad generalization of issues of general and particular pathology. Only after receiving a sufficient clinical education, including the study of many clinical disciplines, should the road to specialization in various areas of clinical and theoretical medicine be opened.

Dynamism in the formation of clinical thinking should provide an informal study of the theory of diagnosis, starting from the 3rd year. Classes with an experienced clinician-teacher in a small group of 5-6 students with the obligatory work of a student and a teacher at the patient's bedside are the best condition for the formation of clinical thinking. Unfortunately, modern social conditions have dramatically complicated the main link in the teaching of clinical disciplines. The opportunities for students to work with the sick have diminished sharply. In addition to this, the propaganda of the idea of ​​protecting the patient from the doctor was launched.

The return to free medicine and the restoration of the regulator of the doctor-patient relationship, based on high spiritual principles, can increase the credibility of the doctor and medical students in the eyes of patients. In such conditions, it is possible to solve the problem of effectively accelerating the formation of scientific clinical thinking.

Market relations turn a doctor into a seller of services, and a patient into a customer who buys services. In market conditions, teaching at a medical university will have to rely on the use of phantoms. Thus, instead of early formation of clinical thinking, the students of Hippocrates will “play with dolls” for a long time and are unlikely to be able to develop high-quality clinical thinking.

BIBLIOGRAPHY:

1. Botkin S.P. The course of the clinic of internal diseases. / S.P. Botkin. - M., 1950 .-- T. 1 - 364 p.
2. Diagnosis. Diagnostics // BME. - 3rd ed. - M., 1977 .-- T. 7
3. Tetenev F.F. How to learn professional commentary clinical picture... / Tomsk, 2005 .-- 175 p.
4. Tetenev F.F. Physical research methods in the clinic of internal medicine (clinical lectures): 2nd ed., Revised. and add. /F.F. Tetenev. - Tomsk, 2001 .-- 392 p.
5. Tsaregorodtsev G.I. Dialectical materialism and theoretical foundations of medicine. / G.I. Tsaregorodtsev, V.G. Erokhin. - M., 1986 .-- 288 p.

Bibliographic reference

Clinical thinking is the basis of medical knowledge, which often requires a quick and timely decision on the nature of the disease based on the unity of conscious and unconscious, logical and intuitive components of experience. (BME. T. 16).

From the standpoint of philosophy, clinical thinking is a classic example of abstract thinking, known as induction - cognition from a particular to a general inference (a type of generalization associated with anticipating the results of observations and experiments based on data from past experience), in the form of a hypothesis, which form the basis of knowledge of the surrounding reality leading to inventions and discoveries, the emergence and development of art, science, technology and philosophy.
Therefore, clinical thinking should be viewed as an extremely complex cognitive abstract thinking from the patient's problems - by searching for causal relationships (based on the unity of conscious and unconscious, logical and intuitive components of experience) to a creative general inference that forms the basis of a clinical decision for making a diagnosis.
However, to tell or describe the results of inductive cognition in a clinical decision (still unknown for science), we only by comparing the still unknown, with already known data - this is cognition from the general to the particular, which corresponds to the classical method of cognition known as deduction, which is quite complex and not always complete, because to obtain new knowledge by deduction, a complex combination of already known ones is needed.
Therefore, the process of making a clinical decision and justifying it with the help of deduction is an extremely complex creative process of abstract thinking, which combines the opposite methods of cognition - inductive and deductive.
The very formulation of the diagnosis of the disease is the most illustrative example of such a combination of the adopted clinical decision, regarding a particular patient, with diseases already known to science.
In these conditions of inductive search for a solution to a problem and a deductive explanation of the search results, the basis for the reliability of the results are two principles:
1. The principle of causation, which is irreversible and is the basis of traditional (allopathic) medicine;
2. The principle of sufficient reason known as Occamo's Razor (William of Occam 1285-1349). "What can be explained by less should not be expressed by more" (Latin Frustra fit per plura quod potest fieri per pauciora), which today is a powerful tool of scientific critical thought.
In clinical medicine, these two principles, when making a diagnosis, formed the basis of the pathophysiological analysis, for pathophysiology: "Studies and describes the specific causes, mechanisms and general patterns of the onset and development of diseases. Formulates the principles and methods of their diagnosis, treatment and prevention" ( Leading pathophysiologist of Russia, professor P.F.Litvitsky).

This was the case throughout the history of medicine, until the emergence of "evidence-based medicine", which, as the embodiment of deduction, is based on an additional randomized study to improve the accuracy of statistical processing of the results obtained, which, in principle, does not change the decision.
.
The term Evidence-Based Medicine was coined by clinicians and epidemiologists at McMaster University in Canada in 1988.
Since the term "evidence-based medicine" was developed for the sake of the pharmaceutical business, it was already obviously of an advertising nature, which naturally led to a reassessment of the statement about its special evidence, since it was intended only for statistical testing of drugs.
While statistical drug testing was carried out in the processing of clinical observations (which are the result of the induction of clinical thinking), the advertising term "evidence-based medicine", being a classical deduction, did not claim to evaluate the induction of clinical observations.
However, under pressure from the pharmaceutical business, to accelerate and simplify drug testing, using long-term clinical observations and in large quantities, the advertising reevaluation of the evidence of the term "evidence-based medicine" was used to replace concepts from the evidence of statistical data to the evidence of clinical observations themselves, so that demand the necessary farm mafia, the results of clinical observations.
Although such a substitution of concepts, clearly violating the irreversibility of the cause-and-effect relationship, is absurd, it allows deductive "evidence-based medicine", on a formal basis, not to recognize as reliable any novelty of a clinical solution that is undesirable to it, because any new clinical solution will differ from the already known novelty , which, by virtue of deduction, has nothing to compare from those already known.
The emergence of such an opportunity for the pharmaceutical mafia, with the help of deductive statistics, to restrain all the inconvenient new, coming from the inductive cognition of clinical thinking, was actively adopted by administrative structures, also based on deductive statistics.
As a result, the commercial efforts of advertising "evidence-based medicine" with the active support of administrative resources, have led to the fact that today the most common and widely cited clinical researches recognized as proven only by recognition of advertising "evidence-based medicine".
And medicine based on pathophysiological analysis to identify the pathogenesis of the disease is recognized by "evidence-based medicine" as "unsubstantiated", since it is not confirmed by randomized deduction and obedience to the dominant "evidence-based medicine". This is understandable, since it is difficult to compare pathophysiology with statistics.
The harm of evidence-based medicine is already widely discussed on the Internet.

Some proponents of this "evidence-based medicine" have even fondly called it "scientific medicine", although, even according to their data, only about 15% of medical interventions are based on strong scientific evidence recognized as "evidence-based medicine".
In the opinion of clinicians, the dominance of "evidence-based medicine" in the clinic and in communication is becoming dominant and begins to decide everything and everyone in methodological guidelines and standards, to dominate in the reasoning and in the minds of doctors.
So, according to the requirements of "evidence-based medicine", in order to always be at the level in their field, doctors must read up to 20 articles a day and must think and act according to the developed standards (ie, deductively, instead of clinical thinking).
As a result, widely experienced clinicians began to object, pointing out the harm done by "evidence-based medicine", since the whole history of medicine is a history of observation and clinical experience, and statistics are only additional, when analyzing the results obtained, and necessary, only in terms of auxiliary validation tests on large samples.
The harm of "evidence-based medicine" has become so obvious that
most doctors do not pay attention to it, believing that the name "evidence-based medicine" is a typical example of an error in terminology that leads to a substitution of concepts.
Today, clinicians view "evidence-based medicine" as a misnomer, a typical example of an overrated statement of evidence driven by the pressure of the pharmaceutical business.
There is even an opinion that the term "evidence-based medicine" was coined in order to slow down the development of the theory and practice of medicine at the request of the pharma mafia, which exploits the broad masses of workers around the world. It should be recognized as harmful and its use in the media and the open press should be prohibited.

The same is already observed by the administrative leadership abroad, for example, in England - the ancestor of "evidence-based medicine", where its dominance has led to the fact that "most of the scientific literature is a lie" (Lancet and the New England Journal of Medicine ) - these are two of the most prestigious medical journals in the world, although they regard this phenomenon as "Corruption of interests that destroys science."

And here, the indignation of clinicians with "evidence-based medicine" has come down to harsh criticism of the International Classification of Diseases (ICD), actively imposed by the deductive administration. As a result, the urgent question about the absurdity of the situation is discussed: "how to formulate the diagnosis, in a medical way or statistically"?
Yes, these ICDs were not written by us at all and were not written for us. International classification diseases- "have" all who depend on it.
With its help, statistics are greatly distorted. Want to reduce mortality by cardiovascular pathology is not a question, let's write old age.
Do not respect yourself as a doctor - write diagnoses from the ICD
So don't worry, dear colleagues, and mind your own business.
Yes, these ICDs were not written by us at all and were not written for us.
So, let these encryptions be done not by doctors, but by statisticians and economists, and doctors should be left with the obligation to expose competent clinical and not statistical diagnoses and treatment of patients.
What do they want from a simple local doctor? Therefore, at the end of the week, I entered into a special form the FIRST NUMBERS THAT COME INTO MY HEAD, without wasting a second on thinking -….!
Medicine was turned into a branch of production. Medical institutions- these are no longer hospitals, but factories for the production medical records... Doctors no longer treat, but provide medical services. Medical activity is now in tenth place. In the first place among doctors - financial and economic, accounting, statistical, commercial, etc. activity …… And try differently - you will lose your place of work - the chief will quickly send you ……!

Conclusions:
1. The imposition of the "evidence-based medicine" prevailing today,
destroys the theory and practice of medicine, which deprives her of the future - making her sterile, like same-sex marriage;
2. There is a need to protect clinical thinking from "evidence-based medicine";
3 .. It's time to return medicine to pathophysiology with
pathophysiological analysis and control with Occam's Razor.

According to the author of the textbook "Philosophy of Medicine", renowned physician and medical historian H.R. Wulff, the clinical thinking of the physician plays an important role in the clinical decision-making process (diagnosis, selection and prescription of treatment), which is influenced by the following two class of factors.

1. Principles Driven by Science

They include, in turn,

1.1. Deductive component: conclusions from theoretical knowledge about the mechanisms of development of the disease, based on

a) Prescientific theories

b) Scientific theories

1.2. Empirical (inductive) component: conclusions from the experience of similar patients, based on

a) Uncontrolled observations

b) Controlled observations

The second class of principles that govern the clinical thinking of a physician are:

2. Humanistic thinking, including:

2.1. The empathic component resulting from understanding the patient as a friendly human being,

2.2. An ethical component arising from ethical norms and an understanding of what is “good” and what is “bad”.

CM of the doctor from one side. Based on theories, bringing clinics under them. Data (deducted. Comp.), And from the other side. Distributed Experiential data obtained from the observation of past clinics. New patient cases (inductive component) is an example of interaction. Theories and facts in a single integral structure of scientific knowledge

KM is not m. effect, if it does not rely on the empathic component (sympathy of the doctor to the patient,) formir. In res. Duration prof. Experience.

The humanitarian component is related to ethics. Imagine morality. Norms, def. "Bad" and "good" Important in the light of biomed. Ethics.

The clinical thinking of a doctor has gone through a long and difficult path of development, constantly strengthening its scientific component, and today it has acquired a complex complex character, combining both elements of scientific-pre-scientific and elements of natural and humanitarian knowledge. The general trend in the development of clinical thinking should be, as it seems, its gradual liberation from pre-scientific components and an ever closer interpenetration and development of the natural science and humanitarian components of medical knowledge.

Medicine in many ways can be considered as one of the aspects of biological knowledge - the science of the phenomenon of life. The main category of biology is the category of "life", and biology tries to comprehend the logos of the living, including in the form of its structural expressions. The main problem of biology is the problem of the essence of life, the problem of how living things differ from non-living things. In this kind of problematic, the qualitative specificity of one type of being - life - comes to the fore in relation to another type of being - non-life. The relationship of these states is realized in many ways as the relationship of logical negation, that is, the relationship between A and not-A, which expresses the qualitative difference between states.

As for medical knowledge, it refers primarily to the inner sphere of the living, suggesting its internal, more quantitative differentiation by degrees. The main category of medicine in this case is the category of "measure of life", which assumes that the phenomenon of life is not only given as an independent relatively autonomous quality, but also as a state capable of differentiating within itself into quantitative degree-measures, forming a stronger or weaker life ... In other words, there is not just life, but also degrees of life - life is strong and life is weak. Life is characterized by its degrees, having the ability to strengthen and weaken, increase and decrease, continuing to be life as one and the same quality, despite these quantitative gradations. In this case, we call a sufficiently strong life health, and a weakened life as illness. Movement along the quantitative scale of life turns out to be at the very core of medical knowledge.

72. The concepts of "volume of survival" and "function of well-being (optimality)" as possible ways expressions of the measure of life.

One of the most important parameters of the measure of life is the degree of adaptive plasticity of a living organism. An organism can find itself in different - more or less favorable - conditions for its existence (for example, in situations with different temperatures, amount of food, population density, etc.). In some situations, the body is able to adapt and survive, in other situations it dies. In this case, you can introduce such a concept as the volume of survival of an organism - the set of all those possible situations in which the organism can remain alive, having adapted to the conditions of these situations. The volume of survival is one of the important characteristics of the measure of life of a particular type of life. The more - all other things being equal - the volume of survival of an organism, the more measure of life it possesses. In mathematical ecology, the concept of an ecological niche is close to the concept of the volume of survival. In this case, the so-called function of well-being is introduced, which is a kind of integral assessment of the vital activity of the organism. This function determines not only the ecological niche, but also specific quantitative indicators of the well-being of the organism in each specific situation, i.e. at every point of the ecological space. Something similar can be presented for a more general case, when the measure of the organism's life could be determined on the basis of a certain function of the well-being of this organism in a certain space of possible situations of the organism's existence.

The well-being function is one of the examples of the so-called optimality criteria, which are increasingly often used in solving various problems in the biomedical sciences. For example, you might try to figure out why fish have a particular body shape. Considerations related to shape estimation from the point of view of, for example, resistance to the counter flow of liquid when moving in water can help in solving this problem. Such a task can be presented quite strictly, within the framework of a certain mathematical model. You can consider various possible spatial forms and set a certain function on them, the value of which will express, for example, the magnitude of the resistance of this form when it moves in a liquid medium. You can then try to find forms that give the minimum values ​​for the specified function. It often turns out that mathematically found shapes with minimal resistance are close enough to real shapes. aquatic organisms... Such problems are called extremum problems. When solving such problems, it turned out that many biological structures maximize or minimize certain functions that quantitatively express biologically significant parameters (note that the maximum problem can always be reformulated as a minimum problem if we take the function with reverse sign).

Basic concepts of medicine (health, disease, sanogenesis, pathogenesis) and their relationship with the methodology of optimality criteria.

Health - condition human body as a living system, characterized by its complete balance with the external environment and the absence of any pronounced changes associated with the disease.

Disease - disruption of the normal life of the body due to functional and / or morphological changes. The onset of the disease is associated with exposure to the body harmful factors external environment.

Sanogenesis - (sanogenes; Latin sanos - health + Greek genesis - origin, development) - a dynamic complex of protective and adaptive processes that arise when the body is exposed to an extreme stimulus and aimed at restoring impaired functions (i.e., protective, compensatory and restorative reparative reactions).

Pathogenesis - a set of processes that determine the occurrence, course and outcome of diseases. The term "pathogenesis" also denotes the doctrine of the mechanisms of development of diseases and pathological processes. In this doctrine, a distinction is made between general and particular pathogenesis. The subject of general pathogenesis is the general patterns inherent in the main features of any disease process or individual categories of diseases (hereditary, infectious, endocrine, etc.). Private pathogenesis examines the mechanisms of development of specific nosological forms.Conceptions of general pathogenesis are formed on the basis of the study and generalization of data on the mechanisms of development of individual diseases, as well as on the basis of the theoretical development of philosophical and methodological problems of general pathology and medicine in general. At the same time, the doctrine of general pathogenesis is used in the study and interpretation of the mechanisms of development of individual specific diseases and the characteristics of their course.