Riassunto
Per definire le prospettive, gli scenari e i ruoli della Medicina di Laboratorio nell’ambito della crisi economica e culturale odierna e nel prossimo futuro, è necessario alzare lo sguardo per individuare, seppur sommariamente, i caratteri del quadro culturale ed economico del nostro tempo: il Postmoderno.
Negli ultimi quindici anni anche nelle riviste mediche si è dibattuto molto di “medicina postmoderna” e, in particolare, in riferimento alla medicina interna e alla medicina generale che più hanno a che fare con il soggetto malato piuttosto che con la parte malata, mostrando una progressiva penetrazione della cultura postmoderna nel castello della medicina scientifica. Potremmo definire la crisi della medicina contemporanea come una crisi di “disillusione” rispetto alla visione positivista della disciplina come interprete delle “magnifiche sorti e progressive” delle scienze a essa ancillari e della sua capacità guaritrice e financo salvifica rispetto a tutti i problemi del “male”. Il drammatico mutamento odierno del rapporto medico-paziente può essere visto come l’epitome della crisi della Medicina, “una robusta arte di una debole scienza”.
Per quanto riguarda la Medicina di Laboratorio, essa è immersa nell’humus culturale della medicina contemporanea ed è influenzata, per la sua natura biomedica, in modo particolare dalla crisi delle certezze biologiche fondanti le due rivoluzioni della medicina moderna, dalla crisi metodologica che coinvolge anche la evidencebased medicine e dagli impatti sociali del mutamento dei concetti di salute/malattia e di medicina come cura. In questo quadro complesso la Medicina di Laboratorio ha alcuni compiti precisi: gestire l’incertezza delle misure, dell’interpretazione e della comunicazione; fondare e disseminare le evidenze col loro valore probabilistico; vivere il suo ruolo sociale, contribuendo a riconciliare lo hiatus postmoderno tra scienza e società.
Summary
To understand the present and the future of Laboratory Medicine, we must understand the contemporary cultural environment: the Postmodern Culture. Since ten or twenty years ago, medical journals have written seminal articles about the Postmodern in Internal Medicine and in General Practice, highlighting some aspects of contemporary crisis of Medicine, “a robust art of a soft science”. The positivistic and reductionist view of the “scientific” Medicine is challenged by increased uncertainty about the “truth” of science, the robustness of methods (mainly the evidence-based medicine), basic concepts (health/disease; what Medicine is) and general theories, built during the centuries from Hippocrates to molecular and genomic revolution. The dramatic changing of patient-physician relationship can be seen as the epitome of the crisis of Medicine.
Laboratory Medicine is involved by the fall of certainty of biologic and methodological truths. In this complex framework, it has some precise duties: managing the uncertainty of measurements, interpretation and communication; building and disseminating evidence and its probabilistic value; living its social role closing the gap between science and society.
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Cappelletti, P. Medicina di Laboratorio e Postmodernità. Riv Ital Med Lab 8, 1–15 (2012). https://doi.org/10.1007/s13631-012-0036-1
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DOI: https://doi.org/10.1007/s13631-012-0036-1