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What’s Going to Happen to Me? Prognosis in the Face of Uncertainty

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Abstract

Reasoning in medicine requires the critical use of a clinical methodology whose validity must be evaluated as well as its limits. In the last decade, an increasing amount of evidence has shown severe limitations and flaws in the conduct of prognostic studies. The main reason behind this fact is that prognostic judgments are at high risk of error. In this paper we investigate the pragmatic and illocutionary aspects of different forms of linguistic acts and judgments involved in clinical practice. More specifically, we analyze the role of (fundamental) uncertainty with regard to ‘particular’ clinical judgments and its relation with ‘general’ evidence. Focusing on how prognostic judgments are formulated and justified, our main purpose is to highlight the explication, the structure and the limits of prognosis from a linguistic and epistemological perspective.

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Notes

  1. However, also mechanistic knowledge may be fallacious or at least not optimal when clinical phenomena assume a systemic structure.

  2. On the connection between the speech act of assertion and diagnostic judgment, see Schulz (2006).

  3. However, some exceptions to this are also contemplated within EBM as we will see in the case of the best evidence required for prognostication.

  4. An explication is inteded to capture the core meaning of a notion, ruling out the less relevant part of it. Put it in a different way, an explication is a procedure of conceptual clarification of a vague concept, the explicandum, with a precise concept, the explicatum, so that the explicatum must be: (i) similar to the explicandum; (ii) more exact and informative than the explicandum; (iii) simple in order to be easily formalized, and finally (iv) the explication connects the explicatum with a rigorous system of scientific concepts (Carnap 1950). A different sense of explication is the Kantian one for which explication does not require condition (iii), i.e. the condition of formalization. See, Boniolo (2003).

  5. The question of fundamental uncertainty is also investigated by Keynes (1948) and the neo-Keynesian school.

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Acknowledgements

We thank Pierdaniele Giaretta, Fabrizio Macagno and Carlo Martini, as well as two anonymous referees for their suggestions. The work of Daniele Chiffi was supported by the Project PTDC/MHC-FIL/0521/2014 of the Portuguese Fundação para a Ciência e a Tecnologia and by the “Dipartimento di Eccellenza” project “Fragilità Territoriali” (MIUR 2018-2022). The work of Mattia Andreoletti was funded by ERC Starting Investigator Grant No. 640638.

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  1. DAStU, Politecnico di Milano, Milan, Italy

    Daniele Chiffi

  2. Department of Philosophy and Educational Sciences, University of Turin, Turin, Italy

    Mattia Andreoletti

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  1. Daniele Chiffi
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  2. Mattia Andreoletti
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Correspondence to Daniele Chiffi.

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Chiffi, D., Andreoletti, M. What’s Going to Happen to Me? Prognosis in the Face of Uncertainty. Topoi 40, 319–326 (2021). https://doi.org/10.1007/s11245-019-09684-z

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