The importance of pathology for the formation of clinical thinking. Advances in modern natural science

1. Induction, deduction. Different levels of generalization in diagnosis

All clinical and instrumental studies conducted in the clinic are aimed at making the correct diagnosis. This is a very difficult and responsible task, since the nature of the prescribed treatment and, ultimately, its result depend on the diagnosis.

Induction- a method of processing information when they move from the general to the specific. This means that the doctor, examining the patient, identifies some symptoms. A number 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 expects to confirm his hypothesis by detecting other symptoms of this disease in the patient, thereby confirming his hypothesis and making a final diagnosis.

For example, when examining a patient’s abdomen, the doctor noticed the presence of dilated veins on the anterior abdominal wall as the abdomen increased in size.

The symptom of dilated veins of the anterior abdominal wall is typical of cirrhosis of the liver, and an enlarged abdomen suggests ascites.

Ascites is not a specific sign and occurs in various diseases, but since liver cirrhosis is suspected, ascites can also be considered in favor of a presumptive diagnosis. Subsequently, clinical and instrumental research methods are used to confirm this diagnosis.

This method has a big drawback: such a crude approach to diagnosis does not allow one to fully assess the patient’s condition taking into account all the features of the process, determine the cause of the disease, and identify concomitant diseases.

Deduction– this is a logical method that allows you to move from the specific, identified details to the general, to draw the main conclusion. To do this, the doctor, having carried out a complete clinical and instrumental examination, evaluates the results and, based on an assessment of all (even minor symptoms), makes a presumptive diagnosis.

It goes like this. All possible symptoms are identified and syndromes are identified on their basis. Based on the totality of the identified syndromes, various diseases are assumed.

Sometimes a set of syndromes does not raise doubts about the diagnosis, in other cases the main syndrome can occur in various diseases.

Then there is a need for a differential diagnosis. For example, a patient’s main syndromes have been identified: jaundice, hemorrhagic, dyspeptic syndrome, laboratory cholestasis syndrome, general inflammatory syndromes. Based on these syndromes, it is assumed that the liver is involved in a pathological, presumably inflammatory process.

However, these syndromes can occur as a manifestation of other diseases of the hepatobiliary tract or other organ systems. In addition, these syndromes may partially occur as part of a competing disease. Within the framework of the main syndrome - jaundice - hemolytic and mechanical variants are excluded. After this, the diagnosis of hepatitis becomes more likely. Having determined its nature, a final diagnosis can be made.

2. Clinical reasoning, definition, specificity. Style of clinical thinking and its changes at different stages of development of medicine

Clinical Reasoning represents one of the cognitive functions performed by a doctor in order to achieve a certain result.

This result can be a correct diagnosis and a competent choice of the necessary treatment.

The doctor continues to study after receiving his diploma, and studies throughout his life. Every physician should strive to master the principles of clinical thinking as the highest level of development of his abilities. Necessary components of clinical thinking are the analysis and synthesis of incoming information, and not a simple comparison of data obtained by comparison with a standard.

Clinical thinking is characterized by the ability to make an adequate decision in each individual situation in order to achieve the most favorable result. A doctor must be able not only to make a decision, but also to take responsibility for making it, and this will become possible only with full theoretical training of the doctor, when decision-making will be determined by his knowledge, will be thoughtful and conscious, and will be aimed at achieving a very specific goal.

A doctor with the ability for clinical thinking is always a competent, qualified specialist. But, unfortunately, a doctor with extensive experience cannot always boast of the ability to think in this way. Some call this property medical intuition, but it is known that intuition is a constant work of the brain aimed at solving a specific problem.

Even when the doctor is busy with other issues, some part of the brain goes through possible solutions to the problem, and when the only correct option is found, it is regarded as an intuitive solution. Clinical thinking allows us to assess the patient’s condition as a whole organism, taking into account all its characteristics; considers the disease as a process, elucidating the factors leading to its development, its further evolution with added complications and concomitant diseases.

This approach allows you to choose the right treatment regimen. Taking into account the principles of dialectics, clarifying the cause-and-effect relationships between processes occurring in the body, and using the principles of logic when solving problems allow thinking to reach a qualitatively new level of development.

Only a specialist with clinical thinking can adequately and effectively carry out his main task - to treat people, relieve them of suffering, and improve the quality of their life.

3. Methodology of clinical diagnosis. Diagnostic hypothesis, definition, its properties, hypothesis testing

After performing an examination and a complete clinical and instrumental examination, the doctor thinks about how the information received can be processed to achieve the main goal - determining a clinical diagnosis. To achieve this goal, various techniques are used. One of the methods is less difficult to use, but its effectiveness is also low. In this case, when examining a patient, various symptoms are identified; the diagnosis is established by comparing the resulting picture of the patient’s disease with the classic picture of the suspected disease. In this way, successive comparisons are made until the diagnosis is clear; The symptoms detected in the patient must form a picture of the disease.

Great difficulty in making a diagnosis is caused by pathomorphosis diseases, i.e. the appearance of variants of the course of the disease that differ from the classic ones. In addition, this method does not allow for a comprehensive assessment of the patient’s condition, taking into account concomitant, background diseases, complications, or to consider the disease not as a stationary phenomenon, but as a process in development.

Another option for processing information is made using the principles of induction. At the same time, on the basis of bright, specific, typical symptoms for a particular disease, an assumption about the diagnosis is made. Based on the classical picture of the disease and the symptoms found within it, they begin to search for similar symptoms in the picture of the disease of the patient being examined. The assumption that arises during the diagnostic process is called hypothesis. When putting forward a certain hypothesis, the doctor looks for confirmation of it, and if there is not enough evidence to turn the hypothesis into a statement, then this hypothesis is rejected. After this, a new hypothesis is put forward and the search is carried out again. It must be remembered that a hypothesis, although based on objective data obtained from a clinical trial, is still an assumption and should not be given the same weight as proven facts. In addition, the formulation of a hypothesis must be preceded by a clinical examination and obtaining reliable facts. After this stage, the hypothesis must be tested by analyzing known facts.

For example, the assumption of liver cirrhosis, which arose on the basis of dilated veins of the anterior abdominal wall and an increase in abdominal volume, must be confirmed.

To do this, it is necessary to determine the fact and nature of liver damage. Data from anamnesis, palpation, percussion, and laboratory research methods are used. If these data are sufficient and the presence of liver cirrhosis is considered established, the presence of possible complications, the degree of organ failure, etc. are determined. Based on the main symptom of jaundice, skin itching and dyspeptic complaints, the presence of hepatitis can be assumed. The presence of viral hepatitis involves identifying its markers, determining positive sediment samples, identifying liver transaminases and other characteristic changes. The absence of typical changes rejects the assumption of viral hepatitis. A new hypothesis is put forward, research is carried out until the hypothesis is confirmed.

1

Clinical thinking is a content-specific 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 uniform in any form of intellectual activity, in any profession, in any field of knowledge. At the same time, the definition also emphasizes the specificity of clinical thinking, the significance of which must be taken into account when considering the problem of its formation and development. The specificity of clinical thinking, which 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 accessible to scientific understanding, although obvious, for example, extrasensory perception, bioenergetics. A person’s individuality cannot yet find a concrete expression in a clinical diagnosis, although all clinicians and thinkers have spoken about the significance of this component of the diagnosis since time immemorial.

2. During the diagnostic process in medicine, nonspecific symptoms and syndromes are discussed. This means that in clinical medicine there are no symptoms that are a sign 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. So as not to frighten the reader by the fact that all medical diagnoses are the essence of hypotheses, let us explain. A medical diagnosis can only be accurate relative to those criteria that are currently accepted by the scientific community.

3. In clinical practice, it is impossible to use all research methods from their huge arsenal for various reasons. This may be an allergy to diagnostic procedures; diagnostic procedures should not cause harm to 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 understanding. 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 effects of free radicals. Mechanisms previously considered classical compensatory are now considered predominantly pathological. Many examples can be given.

5. Clinical medicine began to be called clinical from Burgaw. Its defining feature is that clinical thinking is cultivated in the process of communication between a student, a doctor-teacher and a patient at his bedside (at the patient’s bedside). This explains why any kind of correspondence study in medicine is unacceptable. The patient cannot be replaced by a trained artist, a phantom, business games, or theoretical mastery of the subject. This position needs justification from another side.

Despite the fact that human thinking is united, 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 will place the emphasis of significance in the subject being studied in his own way. 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 and its development and changes in the near future. Style is an epoch-specific feature of a method. For example, in ancient medicine, the main thing in diagnosis was determining the prognosis. By the end of the 19th century, a doctor’s work style had developed, which consisted of observing patients and examining them 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 errors, excessive examination and excessive therapy. In the second half of the twentieth century, significant changes occurred in clinical medicine. New research methods have appeared, the diagnosis of the disease increasingly became morphological during life (biopsy, radiological, ultrasound methods of examination). Functional diagnostics has made it possible to approach the preclinical diagnosis of diseases.

The saturation of diagnostic tools and the requirements for efficiency in the provision of medical care required correspondingly greater efficiency of clinical thinking. The style of clinical thinking consists of observing the patient, while fundamentally retained, but the need for prompt diagnosis and therapeutic intervention greatly complicates the work of the clinician.

7. Modern clinical medicine confronts the doctor with the task of acquiring clinical experience as quickly as possible, since every patient has the right to be treated by an experienced doctor. The clinical experience of a doctor remains the only criterion for the development of his clinical thinking. As a rule, a doctor gains experience in his mature years.

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

Science still does not know the mechanisms for the development of human thinking in general and in a specific profession in particular. 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. A person’s thinking is formed and developed most intensively and effectively at a young age, or 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, which determine the attraction of young people to medicine. In adulthood, as is now generally accepted as those from 21 years of age and older, fatigue arises and grows from the search for high ideals, a young person’s interest is consciously limited to purely professional and everyday issues, youthful enthusiasm passes and is replaced by pragmatism. In this 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. It is well known that a person can develop at any age, 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 3 provisions considered help in complex problems of the specifics of clinical thinking to choose clear priorities in planning the education of a clinician. Firstly, vocational guidance should be carried out at school age. School age should not exceed 17 years. Secondly, it is better to admit well-professionally oriented children aged 15-16 years to university medical faculties. The plan for training a doctor at the university, created by the founders of domestic clinical medicine M.Ya. Mudrov and P.A. Charukovsky is ideal. It shows fundamentality and consistency. In the 1st and 2nd years, the student is prepared to work with a sick person, and in the 3rd year, propaedeutics of internal diseases is studied with a wide coverage of issues of general and specific 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 the hospital therapeutic clinic, variations in the manifestation of diseases in life are studied again with a broad generalization of issues of general and specific pathology. Only after receiving sufficient clinical education, including the study of many clinical disciplines, should the road open to specialization in various areas of clinical and theoretical medicine.

Dynamism in the formation of clinical thinking should be ensured by informal study of diagnostic theory, starting from the 3rd year. Classes with an experienced clinician-teacher in a small group of 5 - 6 students with mandatory work of the student and 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 teaching clinical disciplines. Opportunities for students to work with patients have sharply decreased. In addition to this, propaganda began to spread the idea of ​​protecting the patient from the doctor.

A return to free medicine and the restoration of a regulator of the doctor-patient relationship, based on high spiritual principles, can increase the authority 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 relationships turn the doctor into a seller of services, and the patient into a client buying services. In market conditions, teaching at a medical university will be forced to rely on the use of phantoms. Thus, instead of early formation of clinical thinking, Hippocrates’ students 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. Internal medicine clinic course. /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 on a clinical picture. /Tomsk, 2005. - 175 p.
4. Tetenev F.F. Physical methods of research in the clinic of internal diseases (clinical lectures): 2nd ed., revised. and additional /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 link

Tetenev F.F., Bodrova T.N., Kalinina O.V. FORMATION AND DEVELOPMENT OF CLINICAL THINKING IS THE MOST IMPORTANT TASK OF MEDICAL EDUCATION // Advances in modern natural science. – 2008. – No. 4. – P. 63-65;
URL: http://natural-sciences.ru/ru/article/view?id=9835 (access date: 12/13/2019). We bring to your attention magazines published by the publishing house "Academy of Natural Sciences"

Clinical thinking is a unique activity of a doctor, 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 practicing physician, aimed at diagnosing and treating a patient. At the same time, it should be noted that understanding the essence of clinical thinking largely depends on the initial data of ideological and epistemological positions.

Clinical thinking is a complex, contradictory process, mastery of which is one of the most difficult and important tasks of medical education. It is the degree of mastery of clinical thinking that primarily 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 a teacher, psychologist and lawyer, differs from the mental processes of other specialists due to their special work - working with people. Making a diagnosis, as well as the perceptual side of the activities of a 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 discover 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 and 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 the diagnostic and therapeutic processes. Today, the patient’s thinking is increasingly used in psychological counseling, psychotherapy, hypnosis, and auto-training, where words influence the activities of certain organs and the entire organism.

A feature of a doctor’s activity that 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 the clinical characteristics of the patient, but also the essence of the disease. It should also be noted that the quality of clinical thinking of each individual doctor depends on his consistent development of diagnostic and therapeutic skills and techniques, on the nature of logical techniques and intuition. The ethical side of medical work, his personality and general culture are important for characterizing the clinical thinking of a doctor.

The level of modern medicine, various technical means of examining the patient (computed tomography, electroencephalography, electrocardiography and many other paraclinical methods) make it possible to establish an accurate diagnosis almost without error, but not a single computer can replace an individual approach to the patient, taking into account his psychological and constitutional characteristics, and the most important thing is to replace the clinical thinking of the doctor.

Let us give just one example of the possibility of clinical thinking in the professional activity of a doctor. Using paraclinical examination methods, the patient was diagnosed with a brain tumor.

The doctor immediately faces dozens of questions (the reason for its occurrence, the topic of its location, the structure and nature of the tumor - there are more than a hundred varieties, whether the tumor is primary or metastatic, which parts of the brain are affected, which functions are impaired, whether the tumor is subject to surgery removal or conservative treatment is necessary, what concomitant pathology does the patient have, what method of treatment is most appropriate, what method of pain relief, anesthesia to use during surgery, what medications the patient may be allergic to, what psychological profile of the patient 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 clinical thinking of the doctor, the only correct solution is found.

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

28.01.2015

Source: Search, Natalya Savitskaya

The study of the history of medicine should be based on questions of the evolution of the scientific method

In Russia, the publication of the works of the famous Roman physician and philosopher Galen (II–III centuries) in new translations has been undertaken. The first volume has been released. NG columnist Natalya SAVITSKAYA talks about the beginnings of philosophical thinking among doctors with the editor, author of an extensive introductory article and comments to the first volume, Doctor of Medical Sciences, Doctor of Historical Sciences, Professor, Head of the Department of History of Medicine, History of the Fatherland and Cultural Studies of the First Moscow State Medical University named after I.M. Sechenov Dmitry BALALYKIN.

– Dmitry Alexandrovich, let’s first deal with the subject itself. As far as I understand, the department of history of medicine does not work in all medical institutes today?

– The subject “History of Medicine” exists in all institutes. The only question is how it is structured within a particular department. We, strictly speaking, are not a department of the history of medicine, but a department of the history of medicine, history of the Fatherland and cultural studies. That is, this is a comprehensive humanities department. The history of medicine takes up half of the department's time, but it is a specialized subject and is offered in all medical universities. And moreover, this is a required subject for graduate students in the history of the philosophy of science section, in our case, the history of the philosophy of medicine.

– Today there is an opinion that the history of medicine has not yet developed as a science. Is it so?

– I would say this: yes and no. It, of course, has developed as a science from the point of view of pages of scientific research. We have both candidates and doctors working and defending new ones. There are a lot of significant, controversial and highly discussed issues. Therefore, it has developed as a tradition of scientific research. If we are talking about science that solves all problems, then, of course, no. Well, clinical disciplines are also constantly evolving.

– Do you think this subject should be compulsory?

- I think yes. But it must be mandatory from the point of view of absolutely clear methodological approaches. What is the task facing the history of the sciences of physics, chemistry, and any other natural science discipline? Independence of thinking. Agree that a scientist and any doctor today, due to technical difficulties, due to the tasks of the specialty, must have the skills of scientific thinking, otherwise how will he be able to treat correctly using the technical and pharmaceutical capabilities that exist today.

Critical thinking skills, in general the skills of scientific criticism of a test, judgment, polemics - this is not the kind of education that is obtained at the clinical department. These fundamental skills must be instilled in school. But taking into account what high school students are doing today (preparing for the Unified State Exam), we see that the testing system “zombifies” the student.

I am talking about the fact, without assessing whether the Unified State Exam is good or bad. The point is that the test system configures the brain to work in the form of searching for a ready answer. A good doctor must have critical thinking (interpret symptoms, recognize diseases, etc.). Clinical thinking is based on a critical analysis of the obtained data and symptoms.

In this sense, the specialty “History of the Philosophy of Science,” which is based on goal setting, is mandatory. Who doesn't need a critical mind? Do we want doctors like this?

– The history of medicine is about people, their contribution to medicine? Or is it the events and their significance?

– The first thing is that this is a Soviet tradition. Good or bad – I don’t judge. But I’m personally interested in something else: how, why and at what stage was this or that solution, this or that technique developed? Is it correct? How and why does the paradigm change in clinical thinking? For example, how and when did clinics come to the idea of ​​organ-preserving treatment methods?

It seems to me that the basis of interest in the history of medicine should be questions of the evolution of the scientific method. And in post-Soviet times, the history of medicine turned into one continuous toast: to the health of our respected name, congratulations on the anniversary of our respected academician... We have an institute that prints a whole list of who will have what anniversaries. I do not diminish the importance of this work. But at the same time, this is completely uninteresting to me. What happened before the hero of the day? What after? There is no unconditional knowledge.

– Which period in the history of medicine do you find most interesting?

– The most intense and the most interesting are two different things, because in terms of event intensity, the second half of the 20th century has no equal. That is, any history of a clinical specialty (my first doctorate was on the history of gastric surgery) is a history of extreme intensity of events that have occurred in the last 50–60 years.

But from the point of view of the significance of the origin of the fundamental foundations of modern specialties, this is the 19th century (Pirogov’s anatomy, anesthesiology, aseptic and antiseptic, etc.). It was during this period that the rock on which modern medicine stands, directly technological, emerges.

But I personally find Galen’s period of medicine much more interesting. It is interesting what happened there precisely because there were no such technical capabilities. And when you read the description of the clinical picture, interpreted in the same way as today, you are amazed at his providence. But it was much more difficult for him to come up with all this. One should not discount the fact that Galen developed his theories at the moment of the birth of rational science, at the moment of the break with magic. And on the one hand, we see surprisingly friendly relations with Christianity, and at a certain stage with Islam (IX-XIII centuries). On the other hand, it attracts knowledge of the natural in connection with the supernatural.

– Do you consider the issue of Orthodoxy and medicine in the context of your subject as a separate course of lectures?

– The question of Orthodoxy and medicine exists in the context of bioethics, or rather even social practice. But I understand what you are saying. Here it is necessary to separate the religious issue from the scientific issue. We are talking about the second one. The question is about the relationship between the natural sciences and the monotheistic model of the world, represented, for example, by the religious and philosophical system.

– Are your students interested in this topic?

- Surprisingly, yes. It’s even more interesting for graduate students.

– Can you give a forecast for the development of the medical industry as a science?

– It’s difficult to give a forecast. In the field of bioethics, for example, such issues come to the fore as abortion, euthanasia, patient rights, the relationship between the rights of the doctor and the patient...

- Well, just the Hippocratic Oath in its purest form! Why is it disputed?

– For the same reason why the institution of marriage, traditional values, sexual orientations, etc. are contested. Today, essentially all social discourse is a contestation of absolute assessment. Speaking about the structure of civilizational thinking, we talk about the relevance and irrelevance of values. The essence of traditional values ​​consists of the fact that there is an absolute value, an absolute category of good and evil. That’s why we have traditional and neoliberal bioethics today.

There is serious debate about this issue in the American professional community. Not because there is such a loose society there. No. There is a serious scientific debate going on there. The output is very important results. We are just beginning to have a system of ethical committees that deals with these topics (such a committee was recently created in the Ministry of Health, but they still do not exist in all institutions). In the USA, such committees have become a public institution that deals with these issues.

- Do we need this?

– In fact, American legalism really irritates me. But they are so used to it, this is their way of life. Nevertheless, we also need it. Do you have patient rights? Eat. Do they need to be protected? Need to. Do we need to develop medicine? Necessary. Should we do experiments? Necessary. And new pharmaceuticals need to be created. This means that some kind of compromise is needed.

– Your example only once again confirms that modern science is at the intersection of sciences...

– You hit the nail on the head, today interdisciplinary research is interesting. Surgery and immunology. Transplantology and immunology. Surgery and microbiology... And all this requires adequate training of a doctor.

Medical thinking, based on common sense and benefit, which does not rely in its development on general laws, the development of man and humanity, on the natural historical, social and biological foundations of health and disease, ceases to be thinking that fertilizes practice.

A carpenter, as a professional, as a technician and an expert in his field, of course, does not need knowledge of the laws of physics and physiology, which underlie his own movements, the movements of an axe, a plane, a chisel and a chisel. The professional thinking of a fire brigade employee also does not require knowledge of Lavoisier’s discoveries, i.e., the chemical law of combustion. A doctor with purely professional thinking and skills is close to this.

One could justify it by saying that we live in a time when technology can be used to solve an increasing number of problems, including in medicine. Moreover, we are on the threshold of discovering the physicochemical and cybernetic systems inside cells, as well as in the activity of the brain.

If one of the main goals of cybernetics is the study of ways and means of reproducing in technology the principles of the functioning of living systems, natural principles, and, obviously, the most economical and effective ones, then it is obvious that medicine could not remain aloof from these trends of modern science and technology. And yet it does not follow from this that technology and technicalism are ahead of, much less replace, thinking, which in itself can guide experience and even sometimes outstrip it.

In addition, it is not technology, but only correct thinking that can overcome the “resistance of materials and traditions” (A. M. Gorky), especially the latter, since they delay the overall development of medicine.

Only natural scientific, biological thinking, and philosophical analysis of phenomena guarantee genuine progress of certain special knowledge in the field of medicine. Perhaps the most central place in the theory of medicine is occupied by the idea of ​​compensation for adaptation. Let us consider some human diseases from these positions.

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