Healthcare and Medicine Reference
Any “impressions,” our first working ideas about further exploration, diag-
nosis, and treatment, are already a set of claims or conclusions of some type
of argumentative process:
1. Grounds are provided by the patient interview and completed by further
clinical and paraclinical examinations and workups.
2. Such observations are supported or not by backing stemming from gen-
eral and our personal past or present experience.
3. Warrants give a meaning based on the connection between grounds
and their backing.
4. From this picture, we can see how certain we may be in our conclu-
sions: such qualifiers as probabilistic expressions cannot always be
satisfactorily quantified, given the biological nature of health problems
with which we deal.
5. Ethical considerations, complications, adverse effects, multiple morbidi-
ties (comorbidities), and treatments both for the main problem and for
the cotreatments of comorbidities may all underlie the rebuttals of our
conclusions and recommendations.
6. Our diagnostic and therapeutic conclusions or claims resulting from the
argumentative process represent either new hypotheses or their confir-
mation to which correct dialoguing with the patient must contribute.
Such argumentation relies heavily on our communication with the patient.
This type of communication should also be a fallacy-free process. Some
illustrations will follow in Section 5.4.
In any kind of communication with the patient, interviewing and communi-
cation relies on the a priori establishing of confidence and mutual understand-
ing regarding how and why patient-physician interactions are created and what
should be achieved by understanding and solving patient problem(s). Several ad
hoc titles address very effectively this crucial element of clinical practice. 51-55,57,58
Bickley and Szilagyi 51 recommend following these steps in the first
◾ From what you heard during the interview and saw at the physical
examination, identify abnormal findings.
◾ Localize these findings anatomically.
◾ Assess the nature and quality of data (findings), their time-space
relationship as webs of causes and webs of consequences.
◾ Make hypotheses about the nature of the patient's problems.