Alberto J. Muniagurria
Lord... "Make me modest in everything except the desire to know the art of my profession. Do not let the thought that I know enough already fool me. On the contrary, grant me the strength, the joy and the ambition to know more every day. For art is endless, and the mind of man can always grow. "
(Fragment of the "Prayer of Maimonides")
"We are all filmmakers, our eyes are the best camera in the world; our ears are the best microphones and our brain is the best editing machine"
Claude Lelouch (1937 - )
"Semiology is the science of medicine"
Umberto Eco (1932 - 2016)
"The practice of medicine needs only knowledge of semiology and pathological anatomy"
José Emilio Burucúa (1918 - 1995)
"There are symbols, signs and icons everywhere, everything that transfers information, all signifiers, will carry a meaning".
Victoria Monserrat Stangler
Semiology (semion-sign, logo-study) is a science and an art that develops from the interpretation of subjective or objective data in order to establish or build knowledge.
The methodology that this science follows can be applied in numerous areas of activities, such as literature, painting, music, photography and cinema or theater, as well as social issues, architecture and medicine to cite some examples that they feed off their structural forms.
Ferdinand de Saussure, (1857-1913) of Swiss origin, defined a new science that studied marks or symbols "in the bosom of social life" and called it semiology, from the Greek semeion ("sign").
Later another linguist, the Danish Louis Hjelmslev , in 1931 was one of the creators of the Copenhagen Linguistic Circle and collaborated with Hans Jørgen Uldallin the study of glossaries with a scientific approach similar to that of mathematical calculation. He advanced in this theory and elaborated its systematic formalization within the structural paradigm, which he baptized as glossematic (this theory attributes, therefore, a central role to form, purged of all semantic or phonic reality, relegating function to the background). Above all, it describes the fundamental role that language plays in communication, since it is linked to substance (form). In his Prolegomena to a theory of language (1943), he lays down a set of principles that will serve as a theoretical and epistemological foundation for further developments of the semiotic structure.
Other specialists were added to these authors, the Russian Roman Jakobson (1896 –1982) who showed the factors of communication. He deduced the existence of six functions of language: the expressive, the appellative, the representative, the factual, the poetic and the metalinguistic, thus completing the model of Karl Bühler and the German Ludwig Wittgenstein , (1889 -1951) who contributed his vision to the declare that "the meaning is in the use."
In Medicine, (a profession dedicated to the art of maintaining health, promoting, preventing and curing diseases), the use of the semiotic structure of construction of medical knowledge is, in essence, its own science , understanding by this that set of knowledge ordered, obtained in an examination of the patient, in a systematic way from which hypotheses are built, and reasoning, deduction are stimulated and eventually a diagnosis is reached (so que I know).
The semiological science used in medicine can also be considered an art, understood as an activity developed with professional knowledge, which follows an order in a communicative purpose, which implies a sensitivity. (Art can also be defined as the ability to perform a specific task).
The language and communication are part of the same structure or frase of science and art of semiotics in medicine. It should not be understood that it is only a language with a system of signs for intercommunication, it is a language without grammar that combines and organizes words, languages, images, gestures, forms, situations, sounds and movements. and interrelationships between the whole.
Communication both between professionals and with patients. Therefore, to work in this science it is necessary to know the medical words, which not only homogenized the terms and their meaning, but also made it essential to understand each other. Many of these terms maintain their original Latin roots.
The necessary communication, (the exchange of feelings, opinions, or any other type of information through speech, writing or other types of signals), in medicine implies a relationship between the doctor and the patient (doctor-patient relationship). Interactive social, horizontal, spoken relationship, including reading-writing and attitudinal exercise.
To comply with the semiological forms, a method or order of procedures or steps followed to collect the information and process it is necessary. This method called clinical (in allegory of the scientific method) starts from the data (symptoms or signs) that are obtained from the patient through interrogation and physical examination, and which is then completed with laboratory studies, imaging techniques and special, and that lead to establishing a specific diagnosis. (*)
The instrument for filing (to register) the information obtained is known as the Clinical History or database. The setting where the doctor-patient encounter takes place (doctor-patient interview) is usually the office, but it can also take place in the hospital room, at home, etc. etc.
Thus, Medical Semiology or Clinical Semiology , (etymologically clinical is reasoning at the bedside of the patient) (*) is an intellectual work, a construction of information that arises from communicational dialogue, from spoken and / or attitudinal expressions , from the observation of shapes, sizes, limits, surfaces, colors and contexts, and from the interpretation of findings, with knowledge and skills that interact with each other, and feed back in a constant increase in their interpretive dimension that through the science make sense. There is also talk of Semiotechnics that would have a less comprehensive interpretation implying only an ordered activity (Skill).
French schools classically defined medical activities according to their form of intervention or approach in the treatment of diseases as Medical Clinics and Surgical Clinics, and these branches were divided into successive specialties. Thus arise Gynecology, Gastroenterology, Traumatology, Cardiology and many others ( Flexner ) and each of them with its own semiological techniques. Thus, it is possible to speak of cardiological semiology, pneumonological semiology, dermatological semiology, trauma, etc., etc.
The name of Clinical Semiology is intended to be comprehensive because in its principles it includes knowledge, skills and attitudinal behaviors. Therefore, her approach to the patient is comprehensive and holistic. Laying the foundations for different options offered by the different specialties. Each specialty will provide its own descriptive interest, with a more circumscribed, partial and deep action.
It is also of interest to recognize that just as the grouping into specialties deepens the knowledge of each area of medicine, bringing together scientists in the space of language, communication, the doctor-patient relationship establishes a space for the construction of inherent knowledge, skills and attitudes the very being of the doctor with a comprehensive look.
The incorporation of their study in the medical curricula (*) must be vertical in each new step of its construction, year after year in a progressive and increasing way, both in the undergraduate and postgraduate space in what is called continuous training (maintenance and updating).
That in the end science and semiological art is the daily activity of the doctor, his main tool. Of the doctor who is claimed, in all medical School of the world
(*) Diagnosis =so I know
(*) FCM of UNR, FCM of UBA. FCM de Córdoba
(*) F. de Saussure, Curso de lingüística general, éd. Payot, (1913) 1995
(*) Hjelmslev, Louis (1943). Fundamental principles of language
(*) Muniagurria and Libman: Clinical Semiology: Reasons for Consultation, Editorial UNR ISBN # 950-673-170-5
(*) Muniagurria and Libman: Physical Examination, Editorial UNR ISBN # 950-673-390-2
(*) Muniagurria y Libman: Los sindromes, Editorial UNR ISBN # 978-950-673-809-9
(*) On the dominance of the Greek humoral theory, which was the basis for the practice of bloodletting, in medieval Islamic medicine see Peter E. Pormann and E. Savage Smith, Medieval Islamic medicine, Georgetown University, Washington DC, 2007 p. 10, 43-45.