Chapitre 12. La médecine factuelle et les rapports de cas
- Par Olivier Steichen
Pages 225 à 245
Citer ce chapitre
- STEICHEN, Olivier,
- FAGOT-LARGEAULT, Anne,
- Steichen, Olivier.
- Steichen, O.
- A. Fagot-Largeault
https://doi.org/10.3917/edmat.fagot.2012.01.0225
Citer ce chapitre
- Steichen, O.
- A. Fagot-Largeault
- Steichen, Olivier.
- STEICHEN, Olivier,
- FAGOT-LARGEAULT, Anne,
https://doi.org/10.3917/edmat.fagot.2012.01.0225
Notes
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Remerciements. Pour leurs nombreuses remarques et suggestions, toute ma gratitude va aux Professeurs Loïc Capron, Gilles Grateau, Joël Ménard et Jean Mosconi, aux Docteurs Laurent Bonnardot, Isabelle Colombet, Christel Daniel-Le Bozec, Pierre Durieux, Hervé Mentec, Brigitte Ranque et Renaud Snanoudj, et enfin à Julie Nies.
Les rapports de cas détaillent une ou plusieurs observations cliniques, rarement plus de dix, dont le contenu ne relève pas d’une analyse statistique. Ils occupent une place importante dans l’histoire de la médecine et ont contribué à la constitution et à la transmission du savoir et des pratiques.
La Collection hippocratique (iv-iiie siècles av. J.-C.) rassemble pour la première fois une centaine de cas indépendants rapportés en suivant une structure uniforme. Ces descriptions servent de fondement empirique à une démarche clinique fondée sur l’observation raisonnée des symptômes. Les rapports de cas connaissent leur apogée avec la méthode des confrontations anatomocliniques, systématisée par Jean-Baptiste Morgagni. Ses Recherches anatomiques sur les sièges et les causes des maladies (1761) contiennent environ 700 rapports de cas, détaillant chacun l’histoire d’un patient pour la mettre en relation avec les lésions découvertes à l’autopsie.
Les comparaisons statistiques de groupes de malades font leur apparition au xixe siècle et s’imposent très progressivement comme fondement factuel des pratiques médicales. Leur rôle devient largement dominant après la première publication d’une étude contrôlée en double aveugle avec allocation aléatoire du traitement, qui démontre en 1948 l’efficacité de la streptomycine contre la tuberculose pulmonaire. Aujourd’hui, la médecine factuelle (Evidence-Based Medicine, EBM) encourage l’utilisation consciencieuse et judicieuse des meilleures données contemporaines issues de la recherche clinique pour la prise en charge personnalisée de chaque patien…
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