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Logic of medical language

Abstract

Atm1 sclerodermia.jpg

"The document 'Logic of Medical Language - Masticationpedia' addresses the complexity of medical language, highlighting how its ambiguity can lead to misinterpretations and diagnostic errors. Through the analysis of a clinical case, it explores the need for formal logic to correctly interpret medical terms, emphasizing the importance of context and intention in term interpretation. Here is a more detailed synopsis, enriched with some key paragraphs from the document:

Medical Language Ambiguity: The text begins by discussing how medical language, a mix of technical terminology and natural language, can generate ambiguity, with specific examples demonstrating how different interpretations of the same medical condition can lead to diverse and sometimes conflicting diagnoses.

The Clinical Case of Mary Poppins: The case of a patient, Mary Poppins (hypothetical name), who has received care from various medical specialties for over a decade is presented. Her clinical history is used as an example to discuss the challenges posed by linguistic ambiguity in the diagnostic process, showing how medical terms such as "orofacial pain" can be interpreted differently by dentists, neurologists, and other specialists.

Encrypted Machine Language and Brain Communication: The document introduces the concept of "encrypted machine language" to describe communication between the human brain (both the patient's and the observer's) and medical professionals, comparing this communication to computer cryptography. This analogy serves to highlight how the incorrect understanding of medical signals can lead to wrong diagnoses.

Meaning and Ambiguity of Medical Terms: The complexity of meaning in medical terms is explored, highlighting how the understanding of a term can vary significantly depending on context and the user's intention. This in-depth look at the semantic aspects of medical terms underscores the need for more accurate interpretation to prevent diagnostic errors.

Final Considerations: The conclusions reaffirm the importance of logical and adaptive thinking in the medical diagnostic process. A paradigm shift is suggested, shifting focus from the symptom to "encrypted machine language" in order to gain a more complete understanding of the disease and improve the diagnostic process by involving more actors.

These key points emphasize how the document questions the effectiveness of current medical language and proposes innovative approaches to overcome its limitations, thereby improving the accuracy of diagnoses and the quality of healthcare."

 

Masticationpedia

 

Medical language is an extended natural language

Language, essential in the medical field, can sometimes be a source of misunderstandings and errors due to its semantically limited nature and lack of coherence with established scientific paradigms. The discrepancy between the use of language and the scientific context is highlighted in the ambiguity of terms like "orofacial pain," whose meaning can significantly vary if interpreted through classical logic rather than formal logic.

The transition from classical to formal logic is not merely an additional detail but requires meticulous and accurate description. Despite extraordinary advances in medical and dental technology, with the development of advanced instruments such as electromyographs, cone beam computed tomography (CBCT), and digital oral scanning systems, there remains a need for refinement of medical language.

It is crucial to distinguish between natural languages (such as English, German, Italian, etc.) and formal languages, for example, mathematics. The former emerge spontaneously within communities, both social and scientific, while the latter are artificially created for specific applications in fields such as mathematics, logic, and computer programming. Formal languages are characterized by their well-defined syntax and semantics, unlike natural languages, which, despite having a grammar, often lack in terms of explicit semantics.

To ensure that the analysis remains dynamic and engaging, avoiding turning into a dry philosophical dissertation, an exemplary clinical case will be proposed for examination. This will be analyzed through the application of different language logics:

Clinical case and logic of medical language

The patient, Mary Poppins (a fictitious name), has benefited from multidisciplinary medical attention for over a decade, receiving care from dentists, general practitioners, neurologists, and dermatologists. Her medical history is summarized as follows:

At the age of 40, Mrs. Poppins first noticed the appearance of small spots of abnormal pigmentation on the right side of her face. After ten years, a series of significant developments occurred in her condition. During a hospitalization in dermatology, she underwent a skin biopsy, which revealed a diagnosis of localized facial scleroderma, commonly called morphea. Following the diagnosis, she was prescribed corticosteroids. At 44, she began to experience involuntary contractions of the right masseter and temporal muscles, which over time increased in frequency and duration. She described these episodes as blocks, both daytime and nighttime. At her first neurological evaluation, although the discoloration was less marked, her face showed significant asymmetry, with a retraction of the right cheek and a noticeable hypertrophy of the right masseter and temporal muscles. She received various diagnoses, reflecting the challenges posed by the limitations of medical language.

The clinical context is condensed as follows: the patient, using her natural language, communicates the psychophysical discomfort that has long tormented her. After conducting a series of investigations, such as anamnesis, stratigraphy, and computed tomography of the temporomandibular joint (Figures 1, 2, and 3), the dentist formulates a diagnosis of "Temporomandibular Disorders" (TMD).[1][2][3] On the other hand, the neurologist opts for a diagnosis of organic neuromotor pathology, called "Neuropathic Orofacial Pain" (nOP), excluding or minimizing the TMD component as the primary cause. In order to adopt an unbiased approach, we will consider the patient's condition as "TMDs/nOP", thus not favoring either of the two interpretations.

«But who will be right?»

We are obviously in front of a series of topics that deserve adequate discussion because they concern clinical diagnostics.

Unlike formal languages used in mathematics, logic, and computer programming – characterized by artificial systems of signs governed by strict syntactic and semantic rules – most scientific languages evolve as an extension of natural language, enriching it with a set of technical terms. Medical language falls into this intermediate category: it arises from the expansion of everyday language by incorporating specific terminologies such as "neuropathic pain," "Temporomandibular Disorders," "demyelination," "allodynia," etc. This evolution does not involve the adoption of syntax or semantics distinct from those of the natural language from which it derives. Take, for example, the term "disease" in the context of patient Mary Poppins: a key word in medicine, essential for nosology, research, and clinical practice. Although it represents a fundamental concept in the field, its definition remains remarkably vague and not fully outlined. This ambiguity underscores the intrinsic complexity of medical language, which, despite being enriched with technical terminology, maintains the flexible and sometimes indeterminate characteristics of the natural language from which it originates.

The exact meaning of the term "disease" eludes unanimous understanding, primarily interesting some philosophers of medicine, while most professionals in the field seem unconcerned with its precise definition. The fundamental question is whether the concept of "disease" should be associated with the subject or patient in individual terms, or whether it should refer to the System, that is, the living organism as a whole. This raises a further question: is it possible that a patient, who is not considered sick at time , might actually coexist with a system that was already in a state of structural damage at an earlier moment, indicated as ?

This reflection leads to deep discussions on the dynamic nature of health and disease, proposing that disease should not be seen simply as an instantaneous state or a static condition, but as an evolutionary process, influenced by temporal factors and the interaction between different biological and pathological systems within the organism. This perspective requires a more sophisticated and probably quantitative interpretation of health, taking into account the temporal variations and dynamics between various biological and pathological systems.

The use of the term "language without semantics," treated as if it were irrelevant or devoid of consequences, and its derivatives share the same lack of semantic clarity. This statement underscores a deep criticism of the assumption that language can exist in a purely structural or formal form, lacking semantic content that defines its meaning. In this way, the essential interdependence between semantics and language for understanding and effective communication is highlighted.[4]

In short,

The question of whether the patient, identified as Mary Poppins, is suffering from a pathology, or if it is her masticatory system exhibiting pathological symptoms, calls for a detailed analysis from a medical standpoint. The distinction between an individual disease and a dysfunction of a complex system like the masticatory system requires a holistic approach that considers the interrelations between the various anatomical and functional components involved.

Medically, the condition could be interpreted as a pathology of the "System," that is, of the masticatory system as a whole. This system is comprised of multiple subsystems, including sensory receptors, both peripheral and central nervous tissue, jaw bones, teeth, tongue, and skin, each playing a critical role in the harmonious functioning of the entire system. A disorder in any of these components can therefore negatively affect the health of the masticatory system as a whole.

Alternatively, the issue could be considered as a specific pathology of the "organ," in this context, the temporomandibular joint (TMJ), which plays a crucial role in mastication and phonation. Dysfunctions or pathologies of the TMJ can lead to complex symptoms that affect not only masticatory functionality but also the patient's quality of life, highlighting the importance of accurate diagnosis and targeted therapeutic approach.

This discussion emphasizes how the ambiguities and limitations of natural language can complicate communication and understanding in the medical field, especially when attempting to describe and diagnose complex conditions. The use of precise medical terminology, along with the analysis of specific clinical cases, thus becomes essential to overcoming these challenges, facilitating clear dialogue and a better understanding of pathologies within the medical community.


Clinical approach

(hover over the images)


Understanding of Medical Terminology

Exploring what "meaning" actually signifies enters us into a complex and multifaceted territory. The Cambridge Dictionary defines it as "what something expresses or represents."[5]However, this explanation, intuitive as it may be, leaves the question open since the understanding of "meaning" remains broad and not universally agreed upon. Various theories, each with their strengths and weaknesses, seek to address this question, leading to heated debates without a definitive answer.[6][7].

Traditionally, a term is considered a linguistic label representing an object, whether concrete or abstract. In this model, the term acts as an intermediary between language and the object it represents, as in the case of the word "apple," which evokes the image of the fruit known to everyone, regardless of their culture or age. However, terms like "orofacial pain" acquire different meanings depending on the context: for a neurologist, for a dentist, or for Mary Poppins herself, the meaning will vary considerably, reflecting different perspectives and knowledge bases.

These expressions do not derive their meaning merely from representing something "out there" in the world, but rather from how they interact with other terms within their specific world or context. For Mary Poppins, pain takes on a particular meaning in relation to her personal experience and consciousness, independent of any quantifiable external expression such as attempting to assign it a value on a scale from 0 to 10, which may prove to be meaningless without an internal or normalized context.

Similarly, a neurologist will interpret "pain in the right half of the face" based solely on his professional context, involving concepts like synapses, axons, ion channels, and action potentials. Conversely, a dentist will frame the meaning through a lens focused on teeth, the temporomandibular joint, masticatory muscles, and occlusion, demonstrating how meaning is intrinsically linked to the reference context.

Considering concepts is crucial in formulating a "differential diagnosis," as their misunderstanding can lead to clinical errors. It is therefore essential to explore the modern philosophy of "Meaning," introduced by Gottlob Frege,[8] which articulates the meaning of a term through the notions of "extension" and "intension."

The "extension" of a concept includes all entities that share a certain characteristic, while "intension" refers to a set of attributes that outline that idea. Taking "pain" as an example, this term is generically applied to a wide range of human experiences, showing high extension but low intension. However, analyzing specific pain in contexts such as dental implants, inflammatory dental pulpitis, and neuropathic pain (atypical odontalgia),[9] we observe that:

  • The increase in mechanical and sensory perception threshold follows the activation of C fibers.
  • In cases of atypical odontalgia, somatosensory abnormalities such as allodynia, decreased mechanical perception, and reduced pain modulation emerge.
  • After the insertion of an implant, no significant somatosensory alterations are noted, although mild pain in the affected area is reported.
  • In general, "pain" has a wide extension and limited intension, but focusing on specific types of pain, we notice that greater intension leads to a reduction in extension.

The "intension" of a concept indicates the distinctive aspects that separate it from others, reducing the concept's extension as the specificity of the intension increases. This allows us to distinguish, for example, TMJ pain from neuropathic pain.

In conclusion, the meaning of a term in a given language can be considered as an ordered pair of extension and intension, within a "context."

Specifically, in the dental context, "pain in the right half of the face" embraces a wide extension and an intension delineated by clinical characteristics and radiological or EMG investigations. In the neurological context, however, such pain is associated with an extension and intension defined by specific clinical and diagnostic parameters.

This analysis highlights the vulnerability of medical language to causes of semantic and contextual ambiguity, showing how terms such as "nOP" or "TMD" can assume markedly different meanings depending on the context.[10]

Ambiguity and Vagueness

Beyond the specific language used, the meaning of a medical term is strongly influenced by its originating context, which can lead to phenomena of "ambiguity" or "polysemy." A term is considered ambiguous or polysemic when it has more than one meaning. Linguistics and philosophy have paid considerable attention to these phenomena of ambiguity and vagueness;[11][12][13]however, despite the negative impact that ambiguity and vagueness can have on adherence to and implementation of Clinical Practice Guidelines (CPGs),[14] these concepts have not yet been fully investigated and distinguished in the medical context.

Doctors' interpretations of vague medical terms can vary significantly,[15]leading to less uniformity and greater variations in clinical practices compared to CPGs. Ambiguity is classified into syntactic, semantic, and pragmatic.[16]

As previously mentioned, a simple linguistic expression like the one referring to Mary Poppins can acquire at least three different meanings depending on the context. The ambiguity and vagueness associated with the term "orofacial pain" can thus become a source of diagnostic errors, highlighting a certain inefficiency of medical linguistic logic in decoding the "machine message" transmitted by the System in real-time.

We delve deeper into this fascinating topic of "encrypted machine language," from which the subsequent chapters will develop.

The term "orofacial pain" does not gain its meaning so much from its purest lexical expression as from the context in which it manifests, evoking a wide range of clinical domains, related symptoms, and interactions with other neuromotor systems, the trigeminal nerve, dental districts, etc. This machine language does not translate directly into verbal language but into an encrypted code based on its own alphabet, which must be deciphered to be converted into natural language. The focus then shifts to the linguistic logic employed to decode this message. To better illustrate this concept, let's consider some practical examples.

Imagine that Mary Poppins complains of "orofacial pain," thus communicating her condition to the referring healthcare providers:

«Doc, 10 years ago I started with a widespread discomfort in the jaw, including episodes of bruxism; these worsened so much that I was accusing ‘diffuse facial pain’, in particular in the area of the right ‘TMJ’ with noises in the movements mandibular.
During this period, ‘vesicular lesions’ formed on my skin, which were more evident in the right half of my face.
In this period, however, the pain became more intense and intermittent»

The healthcare provider, whether a dermatologist, dentist, or neurologist, picks up certain verbal messages in Mary Poppins' dialogue, such as "widespread facial pain" or "TMJ" or "vesicular lesion," and establishes a series of hypothetical diagnostic conclusions that have nothing to do with encrypted language.

However, in this context, we should move away from patterns and preconceived opinions to better understand the concept of "encrypted language." Let's assume, then, that the System is generating and sending the following encrypted message, for example: "Ephaptic."

Now, what relation does "Ephaptic" have with nOP or TMD?

Nothing and everything, as we will see better at the end of the chapters on the logic of medical language; we will then devote time to the concepts of cryptography and decryption. Perhaps we've heard about them in spy movies or in information security, but they are also important in medicine, as you will see.

Encryption

Let's take as an example a common encryption and decryption platform. In the following example, we will illustrate the results of an Italian platform, but we could choose any platform, as the conceptual results do not change:

We type our clear message; the machine converts it into something unreadable, but anyone who knows the "code" will be able to understand it.

Let's assume, then, that the same happens when the brain sends a message in its machine language, made of wave trains, ion field packets, and so on; and that this carries a message to be decrypted, such as "Ephaptic."

This message from the Central Nervous System must first be translated into verbal language, to allow the patient to give meaning to the linguistic expression and the doctor to interpret the verbal message. However, in this process, the machine message is polluted by the linguistic expression: both by the patient, who is unable to convert the encrypted message into the exact meaning (epistemic vagueness), and by the doctor, who is conditioned by the specific context of his specialization.

The patient, in fact, by reporting symptoms of orofacial pain in the region of the temporomandibular joint, virtually combines the set of extension and intension into a diagnostic concept that allows the dentist to formulate the diagnosis of orofacial pain from temporomandibular disorders (TMD).

Very often, the message remains encrypted at least until the system is damaged to such an extent that signs and clinical symptoms so obvious emerge to facilitate diagnosis.

Understanding how encryption works is quite simple (go to the decryption platform, choose and try):

  1. Choose an encryption key from those selected;
  2. Type a word;
  3. Obtain a code corresponding to the chosen key and the typed word. For example, if we enter the word 'Ephaptic' into the platform's encryption system, we will get an encrypted code in the three different contexts (patient, dentist, and neurologist) that correspond to the three different algorithmic keys indicated by the program; for instance, key A corresponds to the patient's algorithm, key B to the dental context, and key C to the neurological context.

In the case of the patient, for example, by typing "Ephaptic" and using the A key, the "machine" will return a code like:

The key can be defined as "Real Context."

Let us continue with our example:

Let us take a common encryption and decryption platform. In the following example we will report the results of an Italian platform but we can choose any platform because the results conceptually do not change:

«Why do you say that the patient's "key" is defined as the REAL one?»
(difficult answer, but please observe the Gate Control phenomenon and you will understand)


First and foremost, it must be considered that only the patient is unconsciously aware of the disease afflicting their system, but lacks the ability to translate the signal from machine language to verbal language. This process draws upon "Systems Control Theory," in which a dynamic control procedure known as "State Observer" is designed to estimate the system's state from output measurements. In control theory, observability is a measure of how much the internal state of a system can be inferred from knowledge of its external outputs.[17]While in the case of a biological system, stochastic observability of linear dynamic systems is preferred,[18] Gramian matrices are used for the stochastic observability of nonlinear systems.[19][20].

However, this concept brings our attention to an extraordinarily explanatory phenomenon called Gate Control. When a child is hit on the leg while playing soccer, in addition to crying, the first action they take is to rub the painful area extensively, to alleviate the pain. The child acts unconsciously, stimulating tactile receptors and closing the "gate" to the nociceptive entry of C fibers, thus reducing the pain; this phenomenon was discovered only in 1965 by Ronald Melzack and Patrick Wall.[21][22][23][24][25].

Similarly to computers, encryption and decryption also occur in biology. In recent research, authors examined the influence of molecular mechanisms of the "long-term potentiation" (LTP) phenomenon in the hippocampus on the functional importance of synaptic plasticity for information storage and the development of neuronal connectivity. It is not yet clear whether activity modifies the strength of individual synapses in a digital (on-off) or analog (graded) manner. The study suggests that individual synapses appear to have an "all-or-nothing" potentiation, indicative of highly cooperative processes, but with different thresholds for undergoing potentiation. These results raise the possibility that some forms of synaptic memory may be digitally stored in the brain.[26]

Decryption

Now, assuming that the machine language and assembler code are well-structured, let's insert the encrypted message from the Mary Poppins system into the 'Mouth of Truth':[27]

Imagine we are Martians in possession of the right key (algorithm or context), key A, which corresponds to the 'Real Context'. We would be able to perfectly decrypt the message, as you can verify by entering the code in the appropriate window:

«Ephaptic»

But we're not Martians, so we will use, in conjunction with the information acquired from the social and scientific context, the dental key corresponding to key B. By entering the code in the decryption window, we would obtain:

The key B returns the decrypted message.

«5GoI49E5!»

Using the C key that corresponds to the neurological context, the decryption of the message would be:

«26k81n_g+»

These concepts highlight very interesting aspects of the logic of medical language. It's crucial to note that the encrypted message in the real context of the "meaning" of "disease," using key A, is entirely different from that encrypted through keys B and C. These messages are generated in conventionally different contexts, although they reflect a single reality. Such discrepancy suggests the possibility of diagnostic errors.

This means that the logics of medical language, based primarily on the extension of verbal language, might not be optimal for making rapid and detailed diagnoses, especially differential ones. This is due to the distortion caused by the ambiguity and semantic vagueness of linguistic expression, known as "epistemic vagueness" or "epistemic uncertainty," which directs the diagnosis towards the specialist context of reference rather than the absolute truth.

These concepts highlight the complexity of communication in the medical field and underscore the importance of considering not just verbal language but also the contexts and nuances of meaning associated with the diagnosis and treatment of diseases.

«Why, then, are we relatively successful in diagnostics?»
(An entire separate encyclopedia would be needed to answer to this question, but without going too far, let's try to discuss the reasons.)

The basic diagnostic intuition represents a process of rapid, non-analytical, and often unconscious reasoning. Although little is known about how expert physicians understand this phenomenon and how they apply it in clinical practice, a small body of evidence indicates the ubiquity and utility of intuition in generating diagnostic hypotheses and in assessing the severity of diseases. Most studies on physicians' diagnostic intuition have highlighted the connection of this phenomenon with non-analytical reasoning, emphasizing the importance of experience in its development and in its application to effectively integrate analytical reasoning in the interpretation of clinical evidence. In a recent study, the authors concluded that clinicians perceive clinical intuition as a useful tool for correcting and advancing the diagnosis of both common and rare conditions.[28]It's important to note that the biological system sends out a uniquely integrated encrypted message. Each piece of code has a precise meaning if taken individually, but only when matched with all the other pieces does it generate the complete code corresponding to the actual message, such as "Ephaptic."

However, a single instrumental report or a series of them is not sufficient to decrypt the machine's message in a way that fully corresponds to reality. If we hypothesize that the message is decrypted using 2/3 of the code, perhaps corresponding to a series of laboratory investigations, we would obtain the following decryption result:

«Ef+£2»

The result of the decoding comes from the deletion of the last two elements of the original code, namely , thus obtaining the partial code (Ef) from the original . In this process, a part of the code is decrypted, while the rest remains encrypted.

This situation highlights the fact that it is not sufficient to identify a series of specific tests; it is equally important to know how to link them specifically to complete the actual concept and formulate an accurate diagnosis.

Therefore, the importance of a logical order in medical language becomes evident:

«A System Logic that integrates the sequence of the machine language code»
(true! we'll get there with a little patience)

Final Considerations

The logic of language is not a theme of exclusive interest to philosophers and educators; it concerns a crucial aspect of medicine, namely diagnosis. It's noteworthy that the International Classification of Diseases, in its ninth revision (ICD-9), includes 6,969 disease codes, a number that increases to 12,420 in the tenth revision, ICD-10, as reported by the WHO in 2013.[29] Based on data collected from a wide series of autopsies, Leape, Berwick, and Bates (2002a) estimated that diagnostic errors contribute to causing between 40,000 and 80,000 deaths per year.[30] Moreover, a recent survey conducted on over 6,000 physicians revealed that 96% of respondents believe diagnostic errors are preventable.[31] Charles Sanders Peirce (1839–1914) was a logician and scientist who progressively developed a triadic approach to the logic of inquiry.[32] He also distinguished between three forms of argumentation, types of inference, and methods of investigation used in scientific inquiry, namely:

  • Abduction, or hypothesis generation;
  • Deduction, or drawing conclusions from hypotheses;
  • Induction, or testing of hypotheses.

In the concluding part of the study by Donald E. Stanley and Daniel G. Campos, Peirce's logic is considered fundamental to ensuring the effectiveness of the diagnostic transition from populations to individuals. A diagnosis is based on the analysis of individual signs and symptoms of a disease. These manifestations cannot be extrapolated directly from the general population without a broad base of experience; it is precisely this extensive experiential context that provides significant clinical insights, strengthens the instinct in interpreting perceptions, and lays the foundation for the competence necessary to act. We acquire fundamental knowledge and validate experience in order to transform our observations into diagnoses.

In a further recent study, author Pat Croskerry presents the concept of "adaptive expertise in the medical decision-making process." According to Croskerry, more effective clinical decision-making can be achieved through adaptive reasoning, leading to advanced levels of competence and mastery.[33]

Adaptive competencies can be developed by emphasizing additional aspects of the reasoning process:

  • Being aware of the inhibitors and facilitators of rationality. Specialists, often unconsciously, tend to be anchored to their own scientific and clinical context.
  • Pursuing the standards of critical thinking. Specialists tend to exhibit self-referentiality and show difficulty in accepting criticism from other scientific disciplines or fellow specialists.
  • Developing a comprehensive awareness of cognitive and emotional biases and learning how to mitigate them. It's crucial to use arguments that reinforce the awareness of aspects that facilitate rationality.

Furthermore, it is essential to develop a deep understanding of logic and its potential errors through the use of metacognitive processes such as reflection and awareness. This topic is introduced already in the first chapter, titled "Introduction

In this context, factors of exceptional interest emerge that lead to a comprehensive synthesis of what has been discussed in this chapter. It is undeniable that the arguments of abduction, deduction, and induction optimize the diagnostic process, but they fundamentally rely on clinical semiotics, that is, on the interpretation of symptoms and/or clinical signs.[29] Similarly, the adaptive experience discussed by Pat Croskerry is refined and applied in diagnosis and in errors arising from clinical semiotics.[33]

It is, therefore, necessary to clarify that semiotics and/or the specific value of clinical analysis are not the subject of criticism, as these procedures have represented extraordinary innovations in diagnostics over time. In the current era, both due to the change in human life expectancy and the social acceleration we are experiencing, 'time' has transformed into a conditioning factor, understood not so much as a mere temporal succession but rather as a vehicle of information.

In this perspective, the medical language described so far, focused on symptoms and clinical signs, fails to prevent disease. This does not occur due to a lack of knowledge, technology, or innovation, but because the diagnostic contribution does not exploit the information conveyed by time. The 'Ephaptic' element was already known ten years ago but was not interpreted correctly.

This lack cannot be attributed to healthcare workers, nor to the Health Service or the political-industrial class, as each acts within the limits of the resources and knowledge available in the socio-epochal context in which they operate.

The problem lies, rather, in humanity's mentality, which prefers a deterministic reality to a stochastic one. These topics will be detailed in subsequent chapters.

In the following chapters, all focused on logic, we aim to shift the attention from symptom and clinical sign to encrypted machine language. The arguments of Donald E. Stanley, Daniel G. Campos, and Pat Croskerry are well received but need to be reinterpreted in light of the concept of 'time' (in terms of symptom anticipation) and of the message (as assembler and non-verbal machine language). This, of course, does not undermine the validity of the clinical history (semiotics), which is essentially based on a verbal language anchored in medical reality.

We are aware that our "Sapiens Linux" is perplexed and wonders:

«could the logic of Classical language help us to solve the poor Mary Poppins' dilemma?»
(You will see that much of medical thinking is based on The logic of the classical language but there are limits)



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