Scientific Methodology in Clinical Medicine

IV. Acquisition of Clinical Data

  1. ALVAN R. FEINSTEIN, M.D., F.A.C.P.
  1. Requests for reprints should be addressed to Al van R. Feinstein, M.D., Associate Professor of Medicine, Yale University School of Medicine,
    333 Cedar St., New Haven, Conn.

Excerpt

The following paper is the last of four parts of Dr. Feinstein's cogent analysis of scientific methodology in clinical science. The preceding parts appeared in the September, October, and November issues of the ANNALS.—Ed.

OUTLINE OF CONTENTS: PART IV INTRODUCTION

IMPROVEMENT OF ART HISTORY TAKING PHYSICAL EXAMINATION

Concern for the Patient

Focus and Emphasis in Teaching

IMPROVEMENT OF SCIENCE

OBJECTIVITY

History Taking

Physical Examination

PRECISION

Communication

History Taking

Physical Examination

Specification

History Taking

Physical Examination

CONSISTENCY

UNIFORMITY

History Taking

Physical Examination

RELIABILITY

History Taking

Physical Examination

THE DOMAIN OF THE INVESTIGATIVE CLINICIAN SUMMARY

EPILOGUE

INTRODUCTION The traditional dispute whether clinical

Summario in Interlingua

Ben que progressos technologic ha grandemente meliorate le qualitate del datos laboratorial in le contemporanee medicina clinic, pauc meliorationes de character comparabile ha occurrite in le obtention de datos clinic (symptomas e signos) per medio del procedimentos traditional de facer le protocollo anamnestic e de effectuar un examine physic. In tanto que illos es actos de arte e de scientia, iste procedimentos contine numerose antiquate, non-recognoscite, e auto-perpetuante fontes de defecto e de error. Multes de iste debilitates pote esser corrigite per prestar meticulose attention al maniera in que le clinico audi, vide, senti, e pensa quando ille functiona como le apparato que collige datos clinic.

Le arte de iste procedimentos es meliorabile per plus frequente demonstrationes del obtention de protocollos anamnestic pro le beneficio de studentes, per le re-evalutation del contento del examine physic con le objectivo de sublinear le aspectos que es importante e utile, e per un plus grande interesse in le benesser del patiente durante e post le examine.

Le scientia del methodologia pote esser meliorate per augmentar in le clinico le qualitates de (1) objectivitate, (2) precision, (3) constantia, (4) uniformitate, e (5) fidelitate.

(1) Objectivitate require que le clinico recognosce le diverse configurationes de symptomas correspondente al diverse morbos e que ille evita fixe pre-conceptiones quando ille face le protocollo anamnestic. Consulentes deberea examinar le areas de lor specialitate ante que illes recipe informationes associate que ha possibilemente le capacitate de corrumper lor impression initial.

(2) Precision require attention al distinctiones rational inter evidentia e inferentia in establir observationes, al medios verbal con le quales le observationes es communicate, e al specificitate con que le observationes es describite.

(3) Constantia require le uso de definite criterios formal como base del inferite judicamento que es usate in evalutar le observate evidentia e in formular conclusiones de interpretation o de diagnose.

(4) Uniformitate require un renate pre-occupation con le qualitate, le contento, e le mantenentia del protocollo medical. Le protocollos es objectos unic in le scientia clinic proque usualmente illos es le sol medio pro preservar le observate evidentia clinic pro objectivos de revistas ulterior.

(5) Fidelitate require un augmentate surveliantia del studentes e le subjection de illes a tests con respecto a lor capacitate de effectuar examines clinic, un meliorate uso de fontes additional pro confirmar le information historic, e le disveloppamento de technicas pro standardisar le examinatores qui executa le examines physic, tanto individualmente como etiam in gruppos.

Iste meliorationes es rendite necessari per le crescentemente importante rolo del datos clinic, non in le diagnose pathologic (que frequentemente pote esser attingite plus precisemente a base de tests laboratorial que a base de inferentias clinic), sed in le prognose e in le therapia. Le prognose e le therapia es le major desideratos le quales es cercate per le patiente qui demanda attention medical e le quales distingue le clinicos ab omne altere observatores de morbos human. Le arte e le scientia del acquisition del evidentia clinic requirite pro iste activitates constitue le problema central del "recercas fundamental" in le contemporanee medicina clinic.

Article and Author Information

  • From the Department of Medicine (Clinical Biostatistics Section), Veterans Administration Hospital, West Haven, Conn., and the Department of Medicine, Yale University School of Medicine, New Haven, Conn.

  • This work was supported in part by a teaching grant from the Lillia Babbitt Hyde Foundation.

    • Received July 2, 1964.
    • Accepted July 30, 1964.
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