Clinical reasoning

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The term Clinical Reasoning (CR) is used in medicine and the therapeutic sciences. Literally translated it means "clinical reasoning, conclusion, evidence". This refers to processes of thought, action and decision-making that clinically active persons (doctors, nursing staff, therapists, etc.) encounter either alone or in discussions with colleagues and / or the patient concerned.

At the same time, the term stands for a wide variety of scientific approaches to investigate, understand, classify and improve CR processes. The aim of CR is the best possible procedure for the individual patient / client in the context of recognizing and naming a disease ( diagnostics ), its treatment ( therapy ) and possibly also during a long-term rehabilitation and follow-up process.

CR pillars

According to Klemme & Siegmann, the knowledge (cf. also evidence-based medicine , empiricism ) of the respective profession and of the clinician working in this profession is one of the most important pillars of the CR process. B. from biomedical factual knowledge, from knowledge of the course of action and last but not least from personal experience. However, it is not just the amount of knowledge that is decisive, but the ability to apply it profitably in the specific clinical situation.

A second pillar in the CR process is cognition . The information acquisition and processing as well as thinking about the current situation, the patient's problem and the measures to be derived from it can take place chronologically before, during and after the patient / client contact. Depending on the type of reflection and the situation, this process takes place implicitly (rather unconsciously, not directly verbalized) or explicitly and thus consciously. Clinical decision making can be done in a number of ways. It may assumptions ( hypotheses ) are developed on possible causes or contexts (hypothetical-deductive reasoning), and this in many different ways (tests and assessments , laboratory findings, etc.) confirmed ( verified ) or again rejected - considered wrong ( falsified ) - are.

Depending on the background of experience, patterns of known typical symptoms can be recognized and an adequate procedure can be assigned to them. Ideally, the practitioner will reflect on his own thinking and keep reviewing it critically. This process - the third pillar in CR - is known as metacognition . CR processes can be learned, trained and specified depending on the task and area of ​​activity.

CR forms

Feiler distinguishes between six types of CR:

  • Scientific reasoning : includes logical and factual thinking or the scientific side.
  • Interactive reasoning : thinking guided by feelings, perception and observation, the level of relationships.
  • Conditional reasoning : thinking guided by the therapist's imagination and interpretation.
  • Narrative reasoning : thinking in and through stories.
  • Pragmatic reasoning : objective thinking and the ability to act according to pragmatic points of view.
  • Ethical reasoning : thinking determined by attitudes, attitudes and values.

Individual evidence

  1. ↑ R. Hagedorn: Implementation of models in practice. In: C. Jerosch-Herold, U. Marotzki, BM Hack, P. Weber (eds.): Ergotherapy reflection and analysis - conceptual models for practice . Springer, 1999.
  2. ^ MA Jones, DA Rivett: Clinical Reasoning in Manual Therapy. Basics and 23 case studies from well-known therapists . Urban & Fischer, Munich / Jena 2006.
  3. ↑ a b B. Klemme, G. Siegmann: Clinical Reasoning. Learning therapeutic thought processes. Thieme, Stuttgart 2006.
  4. ↑ Clinical Reasoning. ( Memento from September 28, 2007 in the Internet Archive ) at: physio-akademie.de.
  5. ↑ www.patient-als-partner.de
  6. ↑ Assessment. ( Memento from August 3, 2011 in the Internet Archive ) at: physio-akademie.de
  7. ↑ M. Feiler: Clinical Reasoning in Occupational Therapy. Considerations and strategies in therapeutic action. (= Occupational therapy - reflection and analysis). Springer, 2003, ISBN 3-540-67698-8 .

Sources and further reading

  • E. Hengeveld: Clinical Reasoning in Manual Therapy - A Clinical Case Study. In: Manual Therapy. 2, 1998, pp. 42-49.
  • JC Rogers: Eleanor Clarke Slagle Lecturship. Clinical reasoning: the ethics, science and art. In: American Journal of Occupational Therapy. 37, 1983, pp. 601-616.
  • DA Schön: The reflective practitioner. How professionals think in action. Basic Books, New York 1983.
  • DA Schön: Educating the reflective practioner. Jossey-Bass, San Francisco 1987.
  • U. Beushausen: Basics of therapeutic decision-making. In: Beushausen, U. (Ed.): Therapeutic decision-making in speech therapy. Basics and 15 case studies. Ernst Reinhardt Verlag, Munich, 2020, pp. 15–41.