Clinical thinking of the doctor. International Journal of Experimental Education Physician's Technological Thinking

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 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 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 available for scientific understanding, although obvious, for example, extrasensory perception, bioenergetics. So far, the individuality of a person cannot find a concrete expression in a clinical diagnosis, although all clinicians, thinkers from time immemorial, have been talking about the significance of this component of the diagnosis.

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 would be a sign of only one disease. Any symptom may or may not be present in a patient with a particular 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 with 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 the 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 according to different reasons. This may be an allergy to diagnostic manipulations, diagnostic measures should not harm the patient. Any way to diagnose medical institutions do not possess, 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 associated with the damaging effects of free radicals. The mechanism, previously considered as classical compensatory, is now considered predominantly pathological. Many examples could be given.

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

Despite the fact that human thinking is one, as already 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 place the accents of significance 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. A style is a feature of a method that depends on the epoch. For example, in ancient medicine, the main thing in diagnosis was the definition of prognosis. By the end of the 19th century, a doctor's work style had developed, which consisted in observing patients, studying him according to the traditional scheme: first a survey, then a physical examination, and then a paraclinical study.

Following the requirements of this style was the protection of 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 have appeared, the diagnosis of the disease has increasingly become 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 promptness in providing medical care required correspondingly greater efficiency of clinical thinking. The style of clinical thinking, which consists in monitoring the patient, is fundamentally preserved, however, the need for prompt diagnosis and therapeutic intervention greatly complicates the work of the clinician.

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

These 7 provisions, to a certain extent revealing 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 particular 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. The most intensive and effective thinking of a person is formed and developed at a young age, 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 it is now generally accepted to consider 21 years and older, fatigue arises and grows from the search for high ideals, there is a conscious limitation of interest young man purely professional and everyday issues, youthful enthusiasm passes and is replaced by pragmatism. In that age period it is difficult to engage in the formation of clinical thinking, and to be frank, it is 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 particular 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, professional orientation should be carried out at school age. School age must not exceed 17 years. Secondly, it is better to accept well-professional-oriented children of 15-16 years old at the university for medical faculties. The plan for the preparation of a doctor at the university, created by the founders of the national clinical medicine M.Ya. Mudrov and P.A. Charukovsky is ideal. It shows fundamentality and consistency. In the 1st and 2nd courses, 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 particular pathology, in the 4th year, the course of the faculty therapeutic clinic is studied in detail, or rather, a sick person in all its details , and further, 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 particular pathology. Only after receiving sufficient clinical education, including the study of many clinical disciplines, should the road to obtaining specialization in various sections of clinical and theoretical medicine be opened.

Dynamism in the formation of clinical thinking should be provided by an informal study of the theory of diagnostics, 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 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. Opportunities for students to work with patients have drastically decreased. In addition to this, propaganda of the idea of ​​\u200b\u200bprotecting the patient from the doctor began.

A return to free medicine and the restoration of a doctor-patient relationship regulator based on high spiritual principles can increase the authority of the doctor and medical students in the eyes of patients. Under 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 who buys services. Under market conditions, teaching in a medical school will be forced to rely on the use of phantoms. Thus, instead of the 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 in themselves.

BIBLIOGRAPHY:

1. Botkin S.P. Clinical course 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 clinical commentary. / Tomsk, 2005. - 175 p.
4. Tetenev F.F. Physical research methods 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 the theoretical foundations of medicine. /G.I. Tsaregorodtsev, V.G. Erokhin. - M., 1986. - 288 p.

Bibliographic link

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

1. Principles determined by the scientific factor

They include, in turn,

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

a) Pre-scientific theories

b) Scientific theories

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

a) Uncontrolled observations

b) Controlled observations

The second class of principles that determine the clinical thinking of a doctor are:

2. Humanistic thinking, including:

2.1. The empathic component arising from the understanding of 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”.

KM doctor on the one hand. It relies on theories, summing up clinical under them. Data (deduct. comp.), and on the other side. Distribution Experienced data obtained from the observation of past clinics. Cases per new patients (inductive component) is an example of an interaction. Theories and facts in a single integral structure of scientific knowledge

KM can't. effect, if it does not rely on the empathic component (the doctor's sympathy for the patient,) formir. In res. Long prof. Experience.

The humanitarian component is connected with the ethical. Imagine and morality. Norms, defined. "Bad" and "good" esp. Important in the light of biomed. Ethics.

The clinical thinking of a doctor has passed 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 and prescientific, and elements of natural and humanitarian knowledge. The general trend in the development of clinical thinking should be, it seems, its gradual liberation from pre-scientific components and ever closer interpenetration and development of the natural science and humanitarian components of medical knowledge.

In many ways, medicine 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 the living differs from the non-living. In this kind of problematics, the qualitative specificity of one type of being - life - in relation to another type of being - non-life comes to the fore. The relation of these states is realized in many respects as the relation of logical negation, ie the relation of A and not-A, expressing the qualitative difference of the states.

As for medical knowledge, it refers primarily to the internal sphere of the living, assuming its internal, more quantitative differentiation in degrees. In this case, the main category of medicine is the category of “measures 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 being differentiated within itself into quantitative degrees-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 increase and decrease, increase and decrease, continuing to be life as one and the same quality, despite these quantitative gradations. In this case, we call health a sufficiently strong life, and disease a weakened life. 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 values ​​of temperature, 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, we can introduce such a concept as the survival volume 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 - ceteris paribus - the amount of survival of the organism, the greater the measure of life it has. In mathematical ecology, close to the concept of survival volume is the concept of ecological niche. In this case, the so-called well-being function is introduced, which is a certain integral assessment of the organism's vital activity. 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 in the ecological space. Something similar can be imagined for a more general case, when the measure of the life of an organism could be determined on the basis of some well-being function of this organism in a certain space of possible situations of the organism's existence.

The well-being function is one example of the so-called optimality criteria, which have been increasingly used in recent years to solve various kinds of problems in the biomedical sciences. For example, one might try to figure out why fish have a particular body shape. Help in solving this problem can be considerations related to the evaluation of the form in terms of, for example, resistance to the oncoming flow of fluid when moving in water. Such a problem can be represented quite strictly, within the framework of a certain mathematical model. It is possible to consider various possible spatial forms and set a certain function on them, the value of which will express, for example, the resistance value of this form when it moves in a liquid medium. Then you can try to find such forms that give the minimum values ​​of the specified function. It often turns out that mathematically found forms with minimal resistance are quite close to the real forms of 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 problem for the maximum can always be reformulated as a problem for the minimum, if we take as a new function the function used in the same problem with opposite 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 - violation of the normal functioning of the body, due to functional and / or morphological changes. The occurrence of the disease is associated with the impact on the body of harmful environmental factors.

sanogenesis - (sanogenes; lat. sanos - health + Greek genesis - origin, development) - a dynamic complex of protective and adaptive processes that occur when an extraordinary stimulus is exposed to the body 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 refers to the doctrine of the mechanisms of development of diseases and pathological processes. In this doctrine, general and particular pathogenesis are distinguished. The subject of general pathogenesis are general patterns inherent in the main features of any disease process or certain categories of diseases (hereditary, infectious, endocrine, etc.). Particular pathogenesis explores the mechanisms of development of specific nosological forms. Representations 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.

Clinical thinking is a kind of activity of a doctor, involving special forms 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 refer to the specific professional thinking of a practitioner 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 worldview and epistemological positions.

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

In general, the thinking of a doctor 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 a special work - work with people. The diagnosis, as well as the perceptual side of the activities of a teacher, psychologist and lawyer, is fundamentally different from scientific and theoretical knowledge.

Unlike 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 correct diagnosis is usually influenced by psychological features personality of the patient, the level of his intellectual development.

That is why a careful study of the conscious activity of the patient, the psychological side of his personality, has a very importance in both diagnostic and therapeutic processes. The thinking of the patient, 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 individual approach to the patient, taking into account his personal, constitutional, genetic, age, professional and other characteristics, often determining not only clinical features 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 the 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 important for characterizing the clinical thinking of a doctor.

Level modern medicine, various technical means of examining a patient ( CT scan, electroencephalography, electrocardiography and many other paraclinical methods) make it possible to almost accurately establish an accurate diagnosis, but not a single computer is able to replace an individual approach to the patient, taking into account his psychological and constitutional characteristics, and most importantly, replace the clinical thinking of a doctor.

Let us give just one example of the possibility of clinical thinking in professional activity doctor. With the help of paraclinical methods of examination, 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, whether the tumor is subject to surgical removal or it is necessary to carry out conservative treatment what comorbidities the patient has, what method of treatment is most acceptable, 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 issues). 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 process of self-knowledge, self-improvement, based on the desire for professionalism, raising the level of doctor's claims, mastering deontological and psychological approaches when communicating with a patient.

People of different professions are constantly faced with a certain reality, they constantly use certain knowledge. Therefore, a certain type of professional thinking is also formed in them: for representatives of the exact sciences - mathematical, for writers - verbal, for musicians - rhythmic-sound, etc.

The professional thinking of a doctor differs from that of representatives of other professions in the specifics of the tasks facing him. After all, the object of study for the doctor veterinary medicine is a pathological process, a disease of an animal, provision of qualified assistance to a patient, prevention further dissemination illness.

Due to the dynamism of the pathological process, the state of the sick animal is constantly changing. Therefore, medical understanding of the clinical signs of the disease makes it possible to reveal such features of the pathology that cannot be determined by any other methods.

According to V.T. Katerova, medical thinking is a set of general fundamental views on the disease, its course, namely: it is a set of rules that have not been written down anywhere and have not yet been formulated by anyone, which tell the doctor how to act in each individual case when solving practical problems - making a diagnosis, determining prognosis and development of treatments; it is thinking, scientifically substantiated and logically constructed; This is a creative process, which consists in the constant resolution of various practical issues, reminiscent of mathematical, chess, etc.

G. Heglin believes that clinical thinking helps the doctor, as if with an inner look, to cover the entire clinical picture as a whole and to coordinate it with similar yesterday's data.

A doctor of veterinary medicine, when communicating with his patients, without having such connections with them, relies only on his knowledge, on his medical thinking. He deals with animals in whose state of health certain shifts have taken place. The results of treatment largely depend not only on the level of knowledge, but also on the ability to “penetrate” your patient and find these deviations in him: i.e. its strength lies in the ability to use knowledge. Based on clinical signs, it represents the changes that develop in various organs. After all, a clinical diagnosis is not only and not so much a set of specific signs of a disease. This is the result of mental activity. Therefore, after examining the patient, the doctor ponders the facts obtained, evaluates them taking into account not the disease, but the sick animal. It is this study that makes it possible to make a pathogenetic diagnosis or diagnosis of the patient, to prescribe pathogenetic treatment, which will be incorrect if the symptoms of the disease are incorrectly assessed.

If we analyze the journal of outpatient appointments of a veterinary doctor on a farm or in a zonal hospital, we can see that with the same diagnosis, he prescribes various treatments. It is the result of a combination of clinical and logical data. Those. studies of a sick animal, clinical data with their subsequent analysis help the doctor to synthesize, imagine the development of the disease in this particular animal, make the correct diagnosis, work out and study the effectiveness of treatment, checking the correctness of the previously made diagnosis.

Medical thinking is also the logical activity of a doctor, which allows him to find the features of the pathological process that are characteristic of this particular animal. This is the ability to analyze your personal impressions, to find objective facts in them. As I. P. Pavlov pointed out, "when studying, observing, experimenting, do not remain on the surface of facts, do not turn into an archivist of facts, try to penetrate the mystery of their occurrence, urgently seek the laws that guide them."

In his work, a doctor often encounters not only indisputable facts, but also phenomena that are difficult to explain. In this case, the idea of ​​the organism as a single whole will help him, and then he will find the link in which this whole is broken.

Representations are called the ancient living flame of the brain, in which creativity is hidden. It helps to combine life experience, the results of observations and actions of the doctor.

A good doctor should be able to fantasize to some extent, get carried away with his idea and at the same time be a person with critical thinking. Otherwise, one-sidedness in diagnosis can lead to incorrect actions.

Consequently, direct observation of a sick animal and its study, combined with medical thinking, enables the doctor to better understand the characteristics of the disease.

As you know, the highest stage of the diagnostic process is the formulation of a pathogenetic diagnosis. After all, it reveals the essence of the pathological process in a particular animal, its cause, as well as pathogenetic factors that determine the characteristics of the course of each stage of the disease.

Treatment requires recognition of the disease and the characteristics of its course, knowledge of ways to influence the animal organism. Miscellaneous diseases can be manifested by similar signs, which can and should be assessed only by a doctor. Therefore, it is no coincidence that doctors are often reminded of the ancient Roman aphorism: he heals well who diagnoses well.

However, this problem is much more complex than it seems at first glance. Indeed, diagnosis is a prerequisite for appropriate treatment. It is based on generally accepted criteria, as if not difficult (if the disease does not have an atypical course) for recognition. For example, signs of pneumonia or dyspepsia in calves have been known for a long time, and the doctor does not encounter any particular difficulty in diagnosing. The whole difficulty lies in the treatment. Of course developed general principles treatments for certain diseases are beyond doubt. But after all, the doctor does not deal with the disease, but with a sick animal in which this disease has entailed a number of other changes in various body systems. Therefore, generally accepted treatment regimens often do not give the desired results and require additions.

Common disadvantage university graduates is their lack of practical training. And if for specialists of another profile (engineer, agronomist) it manifests itself simply as a lack of technical or organizational skills, then a veterinarian, in addition to those noted, must have many technical skills in examining and treating a patient, and also, most importantly, the skills of independent medical thinking . The latter help him analyze the results of the patient's study, evaluate his subjective data and give them an objective justification. Therefore, the doctor constantly thinks, analyzes and synthesizes, revealing his strengths and weaknesses at the same time. He needs to add observation to the knowledge gained at the institute. He constantly combines diagnostic and medicinal products necessary for the recovery of animals, selects from the arsenal of numerous drugs the most appropriate for a given patient, at a given stage of the pathological process.

Medical thinking in the process of professional activity of a doctor is gradually improved and depends primarily on the doctor, his knowledge and experience, on the conditions in which he works. In its content, it is aimed at revealing the essence of the pathological process in general and in this particular animal in particular; covers all forms of direct and indirect communication between a doctor and an animal; helps to correctly classify the disease and prescribe adequate treatment. It is known, for example, that with phlegmonous processes at the stage of serous infiltration, reliable medicines are novocaine blockades and warming compresses. With serous-necrotic phlegmon, such treatment worsens the condition of the animal. BUT Clinical signs both phlegmons, as you know, are similar in many respects, and only medical thinking helps to avoid mistakes.

It would seem that a textbook on operative surgery describes in detail the schemes of surgical intervention for many animal diseases. But during the operation, they are constantly changing for each doctor, because due to the development of the disease, both the innervation and vascularization of the affected tissues change, and adhesive processes develop. And only medical thinking will help the doctor avoid mistakes during the operation.

It would be erroneous to assume that only those departments that deal with the treatment of animals (therapy, surgery, obstetrics) instill medical thinking in students. It is also formed in the study of infectious diseases. It is his absence from the doctor that often leads to the emergence of some infectious animal diseases. We can cite cases of erysipelas in pigs, emkar, anthrax, etc., which arose as a result of the doctor's lack of such thinking.

Such cases are not isolated, students should be more widely acquainted with them in the educational process. Therefore, it is desirable to call clinical thinking, which is widely described in medicine, professional medical thinking, more suitable for a veterinary medicine doctor.

Medical thinking is an element of scientific research, but it is somewhat more complicated. Science summarizes the facts obtained through observation. In experimental conditions, scientists most often seek to study individual functions. Medical thinking is also a generalization of facts, but in the conditions of the body as a whole with a variety of relationships and interdependent functions of individual organs. The doctor does not discover scientific hypotheses based on his observations, does not form new theories and does not describe new diseases. Its main task is the prevention of diseases and the treatment of patients. But since practical veterinary medicine in its work uses the achievements of science and technology, the work of a doctor can be equated with scientific.

Medical thinking helps to reveal new patterns in the course of the disease. There are cases when clinical thinking was a harbinger of scientific discovery. The original essence of medical thinking is to find and feel the laws of nature. The doctor is constantly faced with a picture of complex relationships between organs, about which we sometimes know far from everything and therefore sometimes make practical mistakes. And in order to avoid them, it is necessary to always strive to expand knowledge and form professional thinking. The pursuit of this may open the way for new scientific research.

Science without practice also makes mistakes. In some cases, scientists argue that the clinic, course, treatment for a particular disease is well-established, unchanged. But these statements do not agree with practice, which is the criterion of truth.

Finally, the doctor, who seeks to recognize the disease and cure the patient, carries out important research, analytical and synthetic activities, develops various methods treatment and gives them a practical assessment. Therefore, the work of a doctor always contains elements of scientific research.

It is known that the disease develops according to a certain plan, "drawn up" by the body itself with its defense system. And since the immunobiological status of animals varies, this "plan" cannot always be the same. Therefore, clinical thinking develops such aspects of pathology that cannot be revealed by any other means in the experiment.

But the thinking acquired by the doctor can never be exhaustive, he constantly works in conditions of relative lack of knowledge. In addition, the doctor's ideas are dynamic, in the course of the study of the animal, he acquires new data, and, consequently, new opportunities for treating the patient.

A real clinician is not limited by his knowledge and his own thinking. Often he uses the acquisitions of human culture and knowledge, i.e., everything that society has achieved in the field of veterinary medicine. And then, in difficult situations, the doctor begins to act on a universal human thought, and not just his own. Professional thinking allows, on the basis of knowledge, to see a sick animal, find the place of localization of the pathological process, unravel the cause of its development and work out the most adequate medicinal and preventive measures.

For a doctor, it is not so much the facts themselves that are important, but their relationship, which forms a certain system, as well as the doctor's attitude towards them with a mandatory sense of proportion and tact. The work of a clinician is a mandatory comparison of facts. Let the attitude towards them be subjective, not yet proven, but its resonance is even greater than from the well-known.

In practice, there are cases of divergence of thoughts of two doctors in the treatment of one and the same animal or the diagnosis of a disease. This is normal. After all, making a diagnosis and prescribing treatment is a creative activity. And where there is creativity, there are observed both different approaches and not the same solutions.

Often a doctor is proud of his accumulated knowledge, they become a factor of prestige and respect. It is believed that the more knowledge a person has, the more talented, smarter, brighter as a person. Is that so? Life shows that not always. Competent and smart are different concepts. The latter skillfully uses his knowledge in practical work. The power of knowledge largely depends on how we possess it, whether we can think creatively on its basis and turn our knowledge into practical deeds. That's why good doctor it is not the sum of accumulated knowledge that distinguishes, but their system, in which this knowledge is brought and which provides them with new qualities, contributes to the formation of new knowledge, new spiritual and material values. Those. the acquired knowledge needs to be creatively processed and more trained thinking, if you want what you read in books and heard in lectures in your student years not to remain dead baggage, you should develop your thinking. This means not to perceive everything as something unconditional, but to pose questions to oneself and others, to look for contradictions in the acquired knowledge, to foresee, to be able to bring to a common the most contradictory, outwardly dissimilar, but internally related facts.

Hence, the concept of medical thinking includes not only the explanation of phenomena, but also the doctor's attitude towards them. This is the clinician's wisdom, which is based on knowledge, imagination, memory, fantasy, intuition, skill and craftsmanship.

A doctor must have a certain amount of knowledge, be able to use it in the process of work, master a variety of methods, medical skills. And, of course, only the one who does his work with pleasure, does not divide it into simple and complex, but performs the one that should be done right now, is considered a master. And he performs the most complex as simple: quickly and professionally.

Medical thinking requires a doctor to love his profession, knowledge, erudition and professional skills. But the main thing is that one should easily carry the burden of erudition and professional skill, not be too attached to the same methods, standards, stereotyped conclusions and actions. A qualified doctor must concentrate ability, erudition and talent in himself.

In matters of skill, some people understand the technique of work, knowledge of various techniques. But we should not forget about the creative nature of the doctor's work: we are talking about the ability, which, in the presence of certain knowledge, predetermines his high qualification.

A veterinarian must be a master of his craft, be able to think, analyze and make appropriate decisions, according to which he is evaluated as a specialist. After all, his knowledge, experience and creativity often decide the fate of the animal. In the nature of the disease, no matter how much you study it, sooner or later you encounter some kind of surprise. The most experienced doctor cannot always solve all the problems that arise before him. But he will be able to figure it out, to formulate his position regarding the sick animal. And for a doctor whose clinical thinking has not been formed, there is only one way out in such cases - to kill and sell the meat after a laboratory study.

Medical thinking is closely related to work experience, which should be constantly improved. At one time, Paracelsus rightly pointed out the role of experience in medicine, considering it an important component of diagnostic and practical activities.

The doctor does not immediately become experienced. Observing, experiencing and studying real phenomena, he gradually improves his skills. And with a combination of personal and literary data, the experience becomes more significant, if the doctor loves his job and constantly strives for the active accumulation of knowledge and skills, he is provided with high qualifications.

However, not everyone evaluates experience correctly. They even admit that in the future, with the development of science and technology, with a more complete study of all the details of the pathological process, experience may become superfluous. We cannot agree with this. Given the variety of causes and ways of developing the disease, as well as the characteristics of its development in various kinds animals, it is hardly possible to foresee such a change in experience even with the widest technicalization of the diagnostic process. In the life of a doctor, modern technology helps him in many ways, but it will always play an auxiliary role, like, for example, a typewriter when writing a scientific treatise.

It is known that the activity of a doctor is not isolated from traditions, he relies on them in his work, adopts them and often follows them. Later he will give them to humanity, but already somewhat different, changed and enriched. A qualified doctor, honoring traditions, takes all the best from them and discards what has become unnecessary for creative work today.

Thus, success in medical work is explained by the ability to examine the animal, to critically evaluate the data obtained. At the same time, it is not the quantity of such data that is important, but the quality. The ability to notice the typical and characteristic in phenomena, to combine disparate phenomena into a convincing unity - this is what the skill of a doctor consists of. Only then is the road to mastery open to the doctor when he works simultaneously with his mind, heart, and muscles. And mastery, as pointed out, is not just technical virtuosity in the use of professional knowledge and skills. This is a deep ability to analyze and implement what the doctor feels is the only possible and necessary in a given situation.

The work of a doctor is complex, and in order to get used to it, one should love it, truly love one's job.

The foregoing allows us to conclude that drug thinking is a specific mental activity of a practitioner, which provides the most effective use theory data and personal experience to resolve diagnostic and therapeutic problems in relation to a particular patient. Its most important feature is the ability to mentally recreate a dynamic internal picture of the disease.

From the many symptoms and signs to make a complete picture of the disease. Knowledge, experience and clinical thinking help the doctor to save the patient from the disease: a correct diagnosis is the basis for a successful fight against pathology.

A clinically minded doctor is capable of much

Clinical Thinking - what is it?

Medical protocols for all diseases are good in standard cases, when there are no difficulties in identifying the diagnosis - having assessed the situation, prescribe the right medicine and get the optimal effect from the treatment. Much more difficult in non-standard situations when a lot of symptoms and signs hide the cause of the disease: even Dr. House from the series does not always make an accurate diagnosis the first time, but in practical medicine the specialist has to deal with unusual clinical cases on a regular basis. Clinical thinking is the ability to see beyond the palisade of symptoms true reason disease, which is based on the following abilities of the doctor:

1. Accumulated knowledge;
2. Years of experience;
3. The presence of observation and intuition;
4. Ability to think logically.

Any doctor needs to gain experience - immediately after medical school it is impossible to become a master of his craft, even if special knowledge has been accumulated during training. A doctor always learns - sometimes from his mistakes, more often from his positive experience, medical literature and the experience of colleagues. But much more important is the ability to think clinically: to put together a complete picture of the disease from small details.

Medical thinking

The whole history of the development of medicine is an example of the formation of the mental activity of a specialist (from Hippocrates to a modern polyclinic doctor - knowledge is needed, but it is much more important to be able to notice the imperceptible, think logically, turn on intuition and see a person in a patient). In ancient times and in modern times, clinical thinking helps to diagnose and cure the patient. The basis of successful therapy are:

1. Observation (assessment of external manifestations of the disease);
2. Attention to detail (correct interpretation of the complaints of a sick person);
3. Examination (checking for symptoms characteristic of diseases);
4. Additional studies (analyzes and hardware methods).

In some cases, it is possible to suspect the presence of a serious pathology by the complexion. Based on the patient's complaints, suggest the cause of the disease. On examination, notice important clues leading to a diagnosis. Most often, the appointment of tests and additional studies by a doctor is required to confirm the thoughts of a specialist: medical thinking and experience have formed a presumptive diagnosis, which will become the basis for future successful treatment of the disease.

Standards, protocols, ministerial orders and requirements kill clinical thinking - the doctor gradually stops thinking in the right direction. Why think and search, compare symptoms and assess the situation, diagnose and treat: the main thing is to follow all the instructions, do all the examinations that are indicated in the protocols, and prescribe therapy regulated by ministerial orders. And all this within the framework of financial resources limited by the insured event. Dr. House lives in the virtual world of cinema, and in real life, the doctor becomes a clerk providing medical services.