Scientific/paradigmatic/clinical prelude; under tab to ”Urgent needed knowledge …”

Prelude from ”urgent knowledge needed …” above
”Realizing that not one of us have access to absolute (100 % secure) knowledge but more or less well approaching it based on well-articulated knowledge-based paradigms (see below), requires awareness of the prerequisite for a serious scientific/clinical work. To believe that you present thinking concerns absolute truth is to misunderstand education and epistemology. Thus, we do not work with 100% or 0 % knowledge but different degrees of certainty. This mean, e.g. we cannot “do” a “stamp set in stone diagnosis” but a diagnosis working hypothesis, at best operationalized and a priori predicted.

Before going on into an important consideration in general and especially here concerning multifaceted different kind of Tinnitus dysfunctions:

What initiate a dysfunction can be one but usually more than one as well as multidisciplinary levels as biological, psychological and social factors. But also over time additional ones can be emerging and may increase in significance while some other become less dominant. One typical such case is hypocapnea, where over time compensatory systems are gradually losing their functional energy and thereby develop dysfunctionality.

To just construe an “one-factor diagnosis” can be misleading, especially if it is based on not very effective examination, which is not unusual, sometimes related limited knowledge as well as the individual clinician’s knowledge base and experiences.

Such a stamping/imprinting diagnosis may result in a number of problems which not always is check for or even considered. Misleading diagnoses not only result in e.g. wrong interventions but also “no more examination concerns” and no follow up. Perhaps people are pleased to have a diagnosis, which even sometimes pay off in profits provided by the authorities.

Many have criticized such kind hypotheses, as e.g. George Kelly (1955) was arguing that (a) a working hypothesis diagnosis may be the most effective while our knowledge base is limited, especially at ideographic level, not forgetting a very careful meticulous multidisciplinary clinical examination which can refined the working hypothesis diagnosis, which then need to be careful followed over time! Also, the dependent variables may vary in quantity as well as in quality at least concerning real world lifestyle related dysfunctions/diseases/problems/…

Not always the above is even considered in many empirical clinical studies, and therefore of limited clinical use.

Summarizing so far concluding*: Without a careful, thorough biopsychosocial examination, we can question whether we have a professional clinical mandate to construe a diagnosis hypothesis with an a priori prediction (repeated measurement single case design) of outcome of our suggested interventional toolboxes. To solve the above we have to make priority for development of effective biopsychosocial examination instruments as well as associated intervention tool box including (I suggest) patients´ group education in terms of e.g. “patient as an educated reasonable competent resource and co-worker in own rehab” (title of our 30 years old manual).

* An impossible argument/demand of course based on to-days knowledge- and practice levels but can be regarded as an urgent argument in terms of an update of George Engel´s (1977) “The need for a new medical model: a challenge for biomedicine – The dominant model of disease today is biomedical, and it leaves no room within this framework for the social, psychological, and behavioral dimensions of illness. A biopsychosocial model is proposed that provides a blueprint for research, a framework for teaching, and a design for action in the real world of health care”, now as a real world multidisciplinary approach where human and artificial intelligence integration are needed (as more than I see as the only way ahead).

With the above in our mind we can proceed into a very complex multifaceted dysfunction – see further