Integration of knowledge.
Prof. Dr. Roberto M. Cataldi Amatriain (Buenos Aires, Argentina).
Article of the book, Current Medicine: Conflicts and Dilemmas. Internal Medicine, Bioethics, Clinical Research, Medical Education and Public Health. ICIM, Buenos Aires, 2011
TAPA DEL LIBRO
Medicine was not born as a scientist’s discipline, as in the beginning of humanity Magic was king. Many diseases and their therapies or mitigations were interpreted from a magic vision. This also can be seen at present in certain situations, today when wizards, magicians, shamans and quacks try to compete with the doctors, promoting their activity across the press and television, in many occasions successfully. But Magic and Science always coincided in that they sought to dominate Nature. Clearly the difference between both is methodological, as Magic does not accept neither experience nor tests (unavoidable steps in scientific methodology).
The myth and the ritual, were always present. The myth, being transmitted from generation to generation without self-criticism. The cosmovision of the myth is pre-scientific and its attitude is receptive thought . Today we know that when we try to demythologize, the situation becomes very complicated.
In ancient Babylonia there existed a medical caste that had penal and civil responsibilities, according to the reading of Hammurabi’s Code. In this document which has a strong constitution, a clear demonstration exists of how 3700 years ago already there existed a juridical regulation of the medical act (medical right).
The relation between the doctor and the patient was always paternalistic (classic model). An asymmetric relation, since the doctor would represent the role of father and the patient the son’s role. The doctor´s justification is: the individual when sick turns into an ” incompetent mulberry bush “. This model has not disappeared, though from the 1970´s a change has given place to a increasing degree of autonomy.
Today the doctor must report, must answer – within his abilities – all the questions that the patient ask them. The patient can accept what has been proposed to him, or can refuse, or even request the opinion of another doctor (second opinion). The patient therefore is seen as an adult, mature and in a responsible relationship, though it is not free from conflict. The symmetry of this relationship is not perfect, because the relationship is established between a sick man, that looks for professional help and, the doctor, who is qualified, has expertise, and is trained to help.
The search for precision and for efficiency has been driving force behind the introduction of mathematics in Medicine and, lately, the introduction of algoritmia, though we must not forget that it was Hipocrates who introduced numbers into Medicine. Algoritmia constitutes the symbolic expression of logical investigation of reason. Algorithms were created to solve arithmetical problems. The graphical representation is the flowchart, which allows the separation into elements of a problem in its fundamental steps and this enables us to perform a detailed analysis, with a view towards looking for the best way to find a solution. The computer has turned into an important tool for producing these algorithms, but we must not overlook that the microprocessors were made to solve mathematical problems rather than logical problems.
Algorithmic thought, when applied to Medicine, is useful to take decisions in emergency situations. However the axis of methodology – from the times of hipocratics – continues to be the method of hypothetical-deductive thought.
Aldous Huxley, when referring to integral education, mentioned the experience of his grandfather as the head of the University of London at the end of the 19th century. His grandfather tried to add humanistic information to specialized scientific information and, across a historical vision, he tried to coordinate both the scientific studies with the humanistic ones. Besides, there were related programs wich included the hundred most important books. The experience failed. Huxley realised that the ideal integrated education, demanded that it be based on human basic problems. The treatment of the integral education demands the assembly of information from different disciplines that are isolated and its necessary to construct “bridges” between all these disciplines.
The problem of integrating knowledge has not yet been solved. There is a divorce between both the scientific and the humanistic culture. It is necessary that they articulate, complement and reach an integrated synthesis. Neither the decision to separate the theory from the practice, nor the establishment of compartments between the different disciplines constitute a coherent idea. If the education does not encourage good interdisciplinary relations it will be difficult for the student once graduated to integrate the knowledge and, they will have serious difficulties at integrating his reality as a doctor and his own.
Specialization is a consequence of the Renaissance, since it derives from the “Discours de la Methode” of René Descartes. From the Middle Ages up to the present there is an increasing interest in the specialisation in all the fields of knowledge. Concerning Medicine, the complexity of the technologies for diagnosis and treatment has divided the work, which has become professionalized. After the Second World War, specialisation is prioritised in the organisation of Medicine. Many authors have criticised the excessive specialisation, the fragmentation of Medicine, and the lack of synthesis in the vision of doctors.
The first copy went to the Library of Alexandria (Egypt)