Clinical reasoning Flashcards
what are the 2 methods of clincal reasoning?
- Pattern recognition, illness scripts
- Problem-based clinical reasoning
Often dual-process reasoning i.e. a combination of the above
problem based clinical reasoning is inductive what does this mean?
uses data to reach conclusion
what questions are typically asked in problem based clinical reasoning?
- What is the problem?
- Which body system is involved and how?
- Where in the body system is the problem located?
- What is the lesion?
what is the first step to inductive clinical reasioning?
1a) Construct a problem list
Identify and clarify problems eg vomiting v regurgitation;
weight loss – appetite normal or reduced?
b) Prioritise the most specific problem(s)
eg jaundice v lethargy.
Focus your diagnostic or therapeutic plans on these.
Don’t forget the other problems – may or may not be related!
May help you narrow down your differential diagnosis list OR may need assessing separately.
once a problem list is created what is the next step in inductive clinical reasioning?
2a) Which body system is responsible for this clinical sign?
b) How is it involved?
- Primary (structural) problem eg infection, neoplasia
- Secondary (functional) problem – body system affected by other factors.
E.g. Vomiting: Body system = GIT.
- Primary problem eg foreign body, inflammation
- Secondary to eg renal, pancreatic, liver dysfunction
how do you differentiate between primary and secondary problems and why does this matter?
- History and clinical exam, further tests
- Primary (structural) problem – investigation often requires imaging.
- Secondary (functional) problem – haematology and biochemistry often helpful.
Saves time and client’s money
once body system is identified what is the next step?
- Define the location
E.g. Problem = Vomiting
Body system = GIT
History and clinical exam suggest primary problem.
If history and clinical exam suggest:
- gastric lesion – endoscopy may be appropriate (if available)
- lower small intestinal lesion, endoscopy would not be appropriate.
What does DAMNIT-V stand for?
- Degenerative,
- Anomalous,
- Metabolic,
- Neoplastic,
- Nutritional,
- Inflammatory, and Idiopathic,
- Toxic, and Traumatic,
- Vascular
how do you go about the final step of clinical reasioning - defining the lesion?
- DAMNIT-V
- sign time graph
- balance of probabilities - common things are common
what are the steps involved in shared decision-making (SDM)?
(9)
- Define or explain problem
- Present options
- Discuss pros and cons (benefits/risks/costs)
- Assess clients’ values or preferences
- Discuss client ability or self-efficacy (practicalities)
- Provide information or recommendations
- Check or clarify understanding
- Make or explicitly defer decision (thinking time, talk to family)
- Arrange follow-up.
what owner considerations need to be taken into account in SDM?
- Expectations of the client
- Prior knowledge - have they consulted Dr Google?
- Sentimental/financial value of animal
- Owner values and preferences
What options are available for treatment?
For each -
rate and likelihood of return to normal function
aftercare required – are they able to medicate, lift etc
costs (time and money)
probability of complications - are they prepared for additional cost etc if necessary?
Acceptability of euthanasia as a treatment option
Case vet’s preferred option for animal
what are some of the benefits of SDM?
- Decisions tailored to the individual client and patient
- Informed consent
- Greater client + vet satisfaction
- Improved treatment adherence
- Improved outcome for patient
- Strengthens vet-client relationship
- Fewer repeat consultations
- Less likely to ask for second opinion
- Complaints less likely
what is the disadvantage of SDM?
could be more time consuming
