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Philosophy and deontology of medical practice

di V. Tambone, Giampaolo Ghilardi


Medicine is a particular discipline, not exactly a science, not technically an art, but a “practice” that has at its core the patient, the doctor, the family, the nurse… being a multidimensional reality, like all human realities. This clinical practice consists primarily in the ability to lean competently over the patient.
The particular mixture of action and theory, science and practice, ethics and epistemology that animates the clinical action is difficult to classify under a single descriptive lens, which is why we have chosen the prism of philosophy and deontology as an instrument of investigation. Just as science is not only method, but also creativity, interpretation and relationship, and can therefore be narrated following all these aspects.
Clinical practice can be illustrated in its fundamental components from a broad perspective that avoids, as far as possible, the shallows of last century’s reductionism; however, aware that every analysis is basically a reduction, we have tried to temper its effects through awareness and cooperation with other disciplinary areas.


The choice to profess Medicine may have several reasons, but it should always be driven by a sincere interest both in knowledge and in the human condition. This well-founded interest could overcome the future difficulties of the profession, however serious they may be. Clinical reasoning is the essential element of Medical Methodology, the procedure commanded to reach knowledge or, at least, to seek it, and which aims, is specifically, to train a professional able to combine scientific knowledge and ability to act, always in respect of human values and, therefore, in the true interest of civil society.

Observation and reasoning, from Plato and Aristotle onwards, are the two fundamental moments of the seeking for knowledge and the “method” of clinical reasoning allows to a rational approach, systematic and neat, of medicine in the difficult decisions that characterize professional action, in other words, the ability to properly proceed without losing sight of the priority objective, namely the ethical dimension of the clinical act. «The clinical way of proceeding is influenced by ethical, anthropological, historical and sociological, economic and literary
components, but also by factors such as information and communication».

In this text the Authors report on the historical and philosophical foundations of the scientific method that conceived Science as a methodology, but also as interpretation, creativity and relationship. The various chapters contain valuable reflections oriented towards practical solutions and critical aspects of the main steps of the clinical procedure, from the application of the Evidence Based Medicine to observation, anamnesis and objective examination, to the identification of problems and the subsequent generation of interpretative hypotheses, to the diagnostic and therapeutic path that is today increasingly burdened by the problems of effectiveness and cost of health care intervention.

A large part of the discussion was dedicated to the relational and communicative aspects of medical practice, from the transmission of the diagnosis and prognosis, to the consensual decision – more important than the informed consent – to the compliance, essential prerequisites for therapeutic efficacy as well as for a deontology firmly originated and justified by moral conscience.

The text is the result of the experience of integrated teaching that has developed, under the initial impetus of a shared and prestigious teacher, Professor Aldo Torsoli, in the Faculty of Medicine of the Bio-Medical Campus in Rome and, also, of the real passion for teaching of the authors who, with wisdom, precision and collaborative spirit, have dedicated to this work much of the little spare time from other commitments.

I am sure that the young students will be able to draw from these pages precious elements and a reliable guide, whatever the specific future path may be, in the difficult and fascinating profession of physician.

Michele Cicala
Full Professor in Gastroenterology
at the University Campus
Bio-Medico in Rome

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Ottobre 2020









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