The Clinical Reasoning Series - Do clinicians think like scientists? With Dr Roger Kerry
Feb 10, 2022
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Dr Roger Kerry, clinical reasoning specialist, discusses how evidence-based practice shapes clinical reasoning and the similarities between clinicians and scientists. They explore the challenges in communication and decision-making in clinical practice, as well as the lack of substantial changes in clinical practice. They reflect on the slow progress of changes in empathy and communication.
Evidence-based practice provides a framework for clinical reasoning, shaping the way healthcare professionals think, reason, and interact with patients.
Healthcare professionals must navigate the complexities of translating research into practice, taking into account individual patient values, preferences, and the nuances of the clinical context.
Deep dives
The role of evidence-based practice in clinical reasoning
Evidence-based practice provides a framework for clinical reasoning, shaping the way healthcare professionals think, reason, and interact with patients. It involves utilizing systematic research findings to inform decision-making. However, there are still unresolved questions and challenges surrounding evidence-based practice. Healthcare professionals need to be sensitive to different types and weights of knowledge and evidence, and they must navigate potential conflicts. While evidence-based practice guides reasoning, it is important to integrate patient values, preferences, and clinician expertise into the decision-making process.
The complexities of evidence-based practice
Evidence-based practice is a framework for healthcare that aims to use research findings to guide decision-making. However, there is complexity in applying evidence to individual patient cases. The challenge lies in the tension between population-level evidence and the uniqueness of each patient's needs. Healthcare professionals must navigate the complexities of translating research into practice, taking into account individual patient values, preferences, and the nuances of the clinical context. It is important to critically evaluate and integrate multiple sources of evidence, recognizing the limitations and trade-offs involved.
Integrating scientific thinking into clinical reasoning
Clinical reasoning involves the thoughtful and logical process of data collection, hypothesis formulation, hypothesis testing, and reasoning to arrive at a diagnosis or treatment plan. This process shares similarities with scientific thinking, as healthcare professionals collect data, generate hypotheses, and test them through further questioning and examination. This scientific approach should be integrated into clinical reasoning, empowering healthcare professionals to critically evaluate information, reflect on their decisions, and make evidence-informed choices. Embracing this scientific mindset helps ensure that clinical reasoning is based on the best available evidence and promotes more effective and ethical healthcare.
Challenges and complexities in clinical reasoning
Clinical reasoning is a complex process that involves integrating various forms of knowledge and evidence with patient preferences. It requires healthcare professionals to manage the cognitive burden of decision-making while embracing the complexities of individual patient interactions. Clinical reasoning models, such as those proposed by Mark Jones, provide scaffolding for this complex process. However, effectively implementing clinical reasoning requires ongoing development of critical thinking skills, self-reflection, and staying abreast of the latest evidence. While clinical reasoning can be challenging, it is an essential skill for healthcare professionals to ensure patient-centered care and improve treatment outcomes.
Welcome to another episode of The Words Matter Podcast.
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I’m taking a break from the Outsider episodes to explore the area of clinical reasoning, and to kick off the series I’m speaking with Dr Roger Kerry, whom I chatted with on the podcast last year in episode 35 where we discussed causation in relation to evidence based practice (EBP) as part of the CauseHealth Series.
Roger is an Associate Professor in the Division of Physiotherapy and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham. He specialises on risks and adverse events of manual therapy, neck pain and headache as well as clinical reasoning (see his research here). He holds a PhD in Philosophy with the doctoral dissertation Causation and Evidence-Based Medicine (see here).
So on this episode we talk about:
How EBP offers a backdrop to our clinical reasoning. The framework is now omnipresent across healthcare and Roger talks about how it should or could shape clinicians’ thinking, reasoning and interaction with patients.
Some of the main developments, issues and questions resolved and those un-resolved around EBP.
What it means to clinically reasoning within a EBP.
How EBP makes us sensitive to the different sorts (and weighting) of knowledge and evidence and we discuss the implication of this with our clinical reasoning and the potential conflicts.
Whether clinicians think like scientists and whether clinical reasoning is sciency?
The similarities and differences between the scientific method and diagnostic reasoning such as data collection, hypotheses formulation, testing and inductive and deductive reasoning.
It’s always an absolute pleasure speaking with Roger; his laid-back style defies the intense consideration he has given to the deep philosophical problems of EBP which while as clinicians we may never fully appreciate (nor necessarily are required to) they help keep us on our toes and be aware and alive to how complex clinical practice is which should motivate us to ensure that our thinking and reasoning remains sharp and purposeful.