La clinique base de l'éthique dans la pratique médicale

Patient, disease, medicine and disability form a homogeneous container which interactions receive constantly important updates. They are influenced by the development of new technical aides used for diagnoses and treatments. One of the negative results of this process is the downgrading of clinic and of the role played by a close relationship with the patient, himself deeply involved in the diagnose process and the therapeutic decisions. As we are facing this situation, it is time to push for a fresh insight into the history of the invention of clinic medicine from Hippocrates to Osler, stopping by with Maïmonide, Sydenham and Boissier de Sauvages. This look back allows us to organise the future of clinic by enriching it with an understanding of the suffering of humankind both more global and more social. We propose an evolution of the future of Health based on the human personality, linking between them harmoniously and positively body injuries, diseases, functional and situational consequences of disabilities. This will trigger a necessary evolution of medial semiotic, which is considered as impossible to understand by some semioticians such as Barthes. This anthropological approach in four dimensions brings a coherence in clinic and will only improve the communication between a patient and his physician. The Ehlers-Danlos syndrome, a hereditary disease frequent (2 % incidence) causing a widespread affection of the connective tissue, represents today a real challenge, difficult to address in the current environment of medical practice. The diagnoses are entirely based on clinic as no biological tracer exists. A recent study has however evidenced the superiority of clinic through a mathematical model gathering the data collected from 626 patients. These considerations allow for an evolution of the concept of health, as defined in 1947 by the WHO proposing the concept of a state of balance between the capacity of an individual and the obligations coming from his environment (René Dubos).