11/10/2011

Clinical Reasoning
& Clinical
Definition:
Decision-Making “Process in which the
clinician, interacting with
significant others structures
meaning, goal and health
management strategies based
on clinical data, client
choices, and professional
Christian Rey D. Rimando, judgment and knowledge”
MSPT, PTRP
Instructor, UST-CRS

Evaluation &
Analysis Management
Examination

THINKING
PATIENT CARE
DECISION
MAKING
“The thinking skills and knowledge
used to make clinical decisions and
judgments through evaluations,
diagnosis and management of a
patient problem.”

“Thought processes associated with a

clinician’s examination and
management of a patient.”

A. Hypothetico-Deductive Model
B. Pattern Recognition
C. Knowledge-Reasoning Integration
 To promote expertise
D. Combined Models of Higgs and Jones
 EXPERTISE
E. Diagnostic Reasoning
 Combination of innate and learned features including F. Interactive Reasoning
intellect, personality, knowledge of organization, G. Narrative Reasoning
communications, manual skills and thinking skills.
H. Collaborative Reasoning
EXPERT = GOOD THINKER I. Predictive or Conditional Reasoning
J. Ethical / Pragmatic Reasoning
K. Teaching as Reasoning

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 Collecting information  Example:

 Analyzing information
 Generating hypothesis
Ankle Sprain
 Investigating the hypothesis History of Inversion Injury
 Determining the optimal diagnostic and
management decisions based on the data Pain on lateral ankle
obtained
Swollen ankle

(+) Ant Drawer’s test

 Aka INDUCTIVE REASONING  Example:

 “Educated guess” Swollen Ankle

 Involves
moving from a set of specific Painful Ankle Tender Ankle
observations to generalizations.
Ankle
Sprain

…but there is a possibility that it

is a case of FRACTURE

 Based on the premise that Clinical
Reasoning is not developed in isolation from
professional knowledge and other clinical
skills, but in fact, the interaction between
the knowledge and skills in reasoning.
Knowledge
Clinical
Reasoning
Skills
 Comprises the 3 core elements of Clinical
Reasoning:
 Cognition or Reflective inquiry
 Discipline or Specific knowledge base
 Metacognition to integrate between cognition
and knowledge

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 Reasoningwhich aims to reveal the client’s  Occur when dialogue in the form of social
impairment/s, disability/ies and handicap/s exchange is used deliberately to enhance or
and the underlying pathobiological facilitate the assessment / management
mechanisms. process

 Use of stories regarding past or present

patients to further understand and manage a
clinical situation.

 Refersto shared decision making that ideally

 E.g. Case Studies
occurs between practitioner and patient.

 Partof the practitioner’s thinking directed to  Alludesto those less recognized but
estimating patient responses to treatment frequently made decisions regarding moral,
and likely outcomes of management. political and economic dilemmas.

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 Occurswhen practitioners consciously use

advise, instruction and guidance for purpose
of promoting change in patient
understanding, feeling and behavior.

 Direct automatic retrieval of information  Thinking skills

 inductive reasoning  Inquiry strategies
 lacks the certainty of deductive reasoning  Synthesis and weighing of information
but is needed when the data is imprecise  Analysis and interpretation
 evaluation of data collected

 Cue Perception  Awareness, self-monitoring and reflective

 Data Evaluation processes =think about your thinking
 Problem Formulation  reflection in action

 Generalizing from Instances  reflection about action

 Instancing from Generalizations

 Hypothesis Generation and Testing

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 To monitor clinician’s thinking process and  Vagueness

conlusions  Narrowness
 To detect links/inconsistencies between  Rigidity
existing clinical patterns or expectations  Irrationality
based on prior learning
 Wastefulness
 To reflect on the soundness of observations
 Insensitivity
and conclusions
 Mystery
 critique the reasoning process itself

 Understanding the cause of dysfunction  Data Collection

 Data Analysis and Problem Identification
 Goal Setting
 Long Term Goals (LTG)
 Short Term Goals (STG)
 Designing the Treatment Plan

 Implementingthe treatment plan  “Clinical expertise involves more than the

 TreatmentOutcome evaluation
 Documentation and Communication
attainment of a certain level of clinical
competence; it involves a commitment to
learning as well”
Kamhi (1995)

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