[Physiopathological reasoning in the clinical diagnosis]

It is generally acknowledged that the causal approach is used very seldom and only in the late stages of the diagnostic process, when hypotheses are refined and verified. The hypotheses generation is supposed to take place in the very first stage of the medical process, and the approach most frequently used is the probabilistic one. It is also believed that owing to its explanatory function, causal reasoning should be used only--and only sparingly--when solving intricate metabolic and endocrinological cases. The Authors refute this restrictive view of the causal approach's field of application, and examine the reasons that prevent its broader use, especially in the range of such pathologies. Amongst such reasons, the Authors highlight some present didactic trends: namely the fact that the basic teachings--which are also the necessary premise to the causal approach--are given too early, in the early years of the University syllabus, and remain therefore cut off from the actual medical teaching. On the basis of this analysis some alternative didactic methods are put forward.