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physicians use both objective cognitive components (knowledge of the basic sci-
ences used in Medicine) and subjective components provided by their personal 'ex-
perience' and 'perception', the latter mediating how 'objective' medical knowledge
is put into practice. Just like scientific researchers, physicians use certain theories
to analyse the data and facts they are presented with. However, unlike scientific
researchers, their analyses also incorporate their prior professional experiences and
information related to what they are working on, factors which can also mediate
how the problem is perceived and diagnosed.
For example, it would be unlikely for a first world physician to diagnose that a
regular patient had a tropical disease like leprosy because it would be highly unusual
for an individual from the first world to contract it and, therefore, the doctor would
tend to discard it in an initial diagnosis. During the time of year when there is
a great deal of pollen in the air it is easy to see why a physician could mistakenly
attribute rhinitis caused by a viral or bacterial infection to an allergic reaction. When
a significant number of patients are suffering from an outbreak of gastroenteritis, it
is possible that a case of appendicitis could be misdiagnosed, as the symptoms are
very similar to gastroenteritis. These are not examples of malpractice, but rather
simple examples of how perception and prior experience mediate the way experts
apply their knowledge, which is related to their ability to consider previous clinical
histories as relevant.
“Once we understand why the originally simple relation between representation
and the world is problematic and notice that a concept like 'signification' may offer
insights in clinical practice, we begin to see the force of the pragmatist's claim that
knowledge is tied to praxis-doing things. Ways of signifying serve certain ways of
acting and obscure others.” ([4], p. 730.) On the other hand, in addition to the data
that can be obtained from blood tests, x-rays and other analyses, which allow a diag-
nosis to be put forth based on objective data, there is an accumulation of imprecise
information with which physicians must work. The initial source of information
on which a diagnosis is based comes from the perceptions that patients themselves
have on their condition. However, it must be pointed out that what exactly a patient
means when claiming to feel a 'strong pain' cannot be understood in an objective
manner because the perception of pain is constructed subjectively and depends on
the threshold for pain that an individual possesses. Similarly, information like 'dis-
comfort' cannot be considered objectively because its meaning depends on what
an individual considers to be 'normal' in daily life and the degree of variation that
they understand to an altered state. At the same time, this initial source of infor-
mation must be 'translated' by the physician according to previous experiences in
order to identify a possible physical disorder and its aetiology. In other words, be-
yond the objective evidence presented by the symptoms (skin rashes, fevers, muscle
pain, fatigue, etc.), the patient transmits information that must be interpreted by
the physician, who then evaluates what must be considered, what could be consid-
ered and what can be directly discarded in order to make a diagnosis. This process
includes uncertain factors that must be taken into account when considering the
epistemological statute of Medicine.
