Is the teaching of the clinical method only exclusive for Medicine?
RESEARCH PAPER

 

Is the teaching of the clinical method only exclusive for Medicine?

La enseñanza del método clínico ¿exclusivo solo en Medicina?

 

Lucía del Carmen Alba Pérez1* https://orcid.org/0000-0001-9033-8440
Héctor Luis Gil Alba1 https://orcid.org/0000-0001-5280-3532
Jose Rogelio Pérez de la Paz1 https://orcid.org/0000-0003-0029-9914
Yinet Sosa Saborit2 https://orcid.org/0000-0002-1418-6294

 

1 Villa Clara University of Medical Sciences. Cuba.
2 "Martha Abreu" Central University of Las Villas. Villa Clara. Cuba.

 

*Author for correspondence. Email: liaqat@nauta.cu

 

 

ABSTRACT

Applying the clinical method based on the diagnosis is not exclusive to medical practice, every health professional, including psychology specialists, uses it in care work to establish the diagnosis-therapeutic relationship; but this method is complemented by the epidemiological one. Both are combined to optimize practice and medical teaching, with benefits in training. It is the objective of the authors to highlight the essence of teaching them in an integrated way in which the patient is valued as a biopsychosocial being.

MeSH: students, medical; Psychology; learning; education, medical.

RESUMEN

Aplicar el método clínico en función del diagnóstico no es exclusivo de la práctica médica, todo profesional de la salud, incluyendo los especialistas en psicología, lo utiliza en labores asistenciales para establecer la relación diagnóstico-terapéutica; pero este método se complementa con el epidemiológico. Ambos se combinan para optimizar la práctica y docencia médicas, con beneficios en el ejercicio formativo. Es objetivo de los autores destacar la esencia de enseñarlos de forma integrada en la que se valore al paciente como un ser biopsicosocial.

DeSC: estudiantes de Medicina; Psicología; aprendizaje; educación médica.

 

 

Submitted: 22/02/2019
Accepted: 17/03/2020

 

 

The clinical method consists of: "... the application of the scientific method to work with patients, considering it as a system of rules to order the procedures used by the doctor to obtain symptoms, signs and make diagnoses that represent the knowledge and name of a disease, achieving perfect medical practice, improving teaching and professional education".(1) The authors intend with this research paper to emphasize how the use of the clinical method is useful and in fact it is used not only by the doctor, but also by other health professionals such as psychologists, whether they are specialists in Clinical Psychology, Medical Psychology or Health Psychology.

There are epistemologies that criticize the so-called: "... particularization of the scientific method in the field of clinical sciences, establishing analogies between the procedures: reason for consultation, clinical examination, clinical diagnosis, diagnostic confirmation, medical diagnosis and those that correspond to the problem: information gathering, hypothesis, verification and checking of the scientific method";(2) this position is considered positivist, reductionist and simplistic due to the homologation of the procedures of the scientific method with the clinical method without considering the cultural aspect.

We speak of the clinical method based on the medical diagnosis, although, as it has already been stated, it is not exclusive to doctors, since all health professionals in care work establish a diagnostic-therapeutic relationship when using it. Professionals who attend to the health-disease process also need the epidemiological method, because the practice and theory of medicine and clinical psychology are nourished by epidemiology and vice versa.

The clinical psychologist uses the clinical method based on some details: its objective is to understand the health-disease process of the patient; it not only involves the clinical but also epidemiological and social knowledge, and it analyzes the biopsychosocial context to analyze a disease,(3) which expresses the importance of psychology when the psychological state or individual behavior constitute the central problem. This conception unites health and clinical psychology and includes the concept of mental health, which, according to Knapp,(4) it is another component of human health with no real distinction between somatic and mental.

Clinical Psychology has evolved in the professional field from its insertion in the Cuban national health system (1968-1969). Until now, it has been continuously developed in Health Psychology. In the development program of the specialty, it is defined as the discipline that collects the set of contributions of psychology to put them at the service of the promotion, maintenance and health care, prevention, diagnosis, treatment and rehabilitation of disease, identification of the factors that characterize the state of health and well-being and the lifestyles that tend to perpetuate them.

The problems of psychology are not confined to mental health; they include attention to all health problems, from education to rehabilitation. The practices of clinical psychology stand out in diagnostic-therapeutic actions in which the clinical method is used with the variants of questioning or psychological interview, psychological examination, presumptive and required diagnosis, depending on the -psychopathological, pathopsychological, and europsychological case, tests and general and specialized psychological techniques - to confirm the diagnosis and management to be followed with patients and families, according to Knapp.(4)

The authors of this research paper insist on the practice of the clinical method in clinical psychology: in the interview not only the therapist speak, but also the patient and the family living with its disease are listened to;(5) even following different psychotherapeutic models, the criteria of the patients are respected in psychological and medical interviews. Dialogue is substantial in its educational and therapeutic condition, without iatrogenic or imposing signs.

On the other hand, the clinic is not scientific without the epidemiological contribution; for this reason the behavior of health problems is of interest to guide clinical behavior, and the clinic in turn provides information to epidemiological studies, for example on the following topics: "The individual epidemiology of anxiety and depression", "The epidemiological diagnosis of attention deficit and hyperactivity disorders". These studies allow knowing about the incidence and prevalence of health problems and report on declared morbidity expressed in the clinical horizon of the epidemiological iceberg. Professional teaching emphasizes the scientific method and its application to the clinic as a clinical method, and to the field of health as an epidemiological method.

In Medicine, the clinical method consists of ordered steps that every doctor must apply for the definitive diagnosis, with an adequate threshold of certainty equivalent to the scientific method, applied to the area of clinical sciences. It is a systematic process where a disease is diagnosed, relying on adequate questioning for clinical diagnosis and therapeutic guidance".(3)

Professor Fernández Sacasas asks: (6) "What is the strategy to adopt to achieve the training of a health professional in contemporary times?" whether to emphasize the theoretical training inherent to the scientific disciplines involved or to prioritize the student's participation in medical practice and medical and social work as a source of learning and education, complemented with congruent study activities. The essence, according to the aforementioned professor, both in Medicine and in the other medical sciences including psychology, it is the interaction of the student with the object to be known, evaluated and transformed in the context of the reality of services and with the use of clinical and epidemiological methods.

 

BIBLIOGRAPHIC REFERENCES

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2. Vicente Odio E, Almaguer Delgado A, García Rodríguez R. Consideraciones de la enseñanza del método clínico en la formación médica superior. Educ Med Super [Internet]. 2015 [citado 20/12/2018];29(1):[aprox. 9 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-21412015000100017

3. Frómeta Guerra A, Sánchez Figueredo S, Maya Castro M, Jara Lalama J, Valarezo S. El método Clínico: perspectivas actuales. Bionatura [Internet]. 2017 [citado 22/12/2018];2(1):[aprox. 6 p.]. Disponible en: https://www.researchgate.net/publication/330899936_El_metodo_Clinico_Perspectivas_actuales/link/5c5a5e4da6fdccb608ab05a4/download

4. Knapp E. Psicología de la Salud. La Habana: Universidad de La Habana; 2005.

5. Niño Rodríguez DC, Abaunza León N. Relación entre dependencia emocional y afrontamiento en estudiantes universitarios. Rev Electron Psyconex [Internet]. 2015 [citado 18/12/2018];7(10):[aprox. 26 p.]. Disponible en: https://revistas.udea.edu.co/index.php/Psyconex/article/view/23127

6. Fernández Sacasas J. El principio rector de la Educación Médica cubana. Educ Med Super [Internet].2013 [citado 08/12/2018];27(2):[aprox. 14 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=s0864-21412013000200011

 

 

Declaration of interests

The authors declare no conflict of interest.

 

 

Contribution of the authors

Lucía del Carmen Alba Pérez and Héctor Luis Gil Alba: conceived the original idea, participated in the review of the bibliography and wrote the article
Jose Rogelio Pérez de la Paz and Yinet Sosa Saborit carried out the literature review.
All the authors agreed with the final version.

 

 

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