clinical reasoning Flashcards
what is clinical reasoning?
thinking and decision making process associated with clinical practice
shared decision
importance of clinical reasoning in pharmacy?
clinical reasoning enhances care quality - supports effective decision making and improved patient outcomes
misjudgement = therapeutic errors and patient harm
key elements that contribute to effective clinical reasoning? (7)
communication skills
use and interpretation of diagnostic tests
understanding cognitive biases and human factors
critical thinking
person-centred care
evidence based practice
shared decision making
what is the relationship between critical thinking, clinical reasoning, and clinical decision making?
critical thinking involves analysing info, questioning assumptions, reflecting on evidence
clinical reasoning involves interpreting + synthesising info critically to make a diagnosis or Tx plan (integrate patient data - how does this affect patient?)
clinical decision making = outcome of clinical reasoning + weighing risks and benefits + patient preference
what is the dual process theory?
how we think in clinical practice
system 1: intuitive thinking
fast, automatic, pattern recognition - past experience
system 2: slow, analytical thinking,
careful evaluation of data + evidence - used in unfamiliar settings
what is the relevance of dual process theory in clinical reasoning?
system 1 allows for rapid decisions but can lead to more errors if unchecked
system 2 reduces error likelihood but is slower
effective clinical reasoning combines the 2
what is the conscious competence model?
the journey we go through when learning something new:
unconsciously incompetent - new prescribers w limited clinical reasoning –> (assess) –>
consciously incompetent –> (learn) –> consciously competent –> (experience) –> unconsciously competent –> (lapse) –> unconsciously incompetent
unconscious stages are system 1 thinking
the conscious stages are system 2 thinking
what are the consequences of poor clinical reasoning? (6)
- skipping info gathering or problem refinement risks missing key details
- rushing through system 2 thinking = bias/misjudgement
- over-relying on system 1 thinking - not knowing when to switch between systems = mismanagement of cases
- failure to complete info gathering: poor reasoning can skip critical steps in applying up-to date evidence = suboptimal care
- insufficient time for deliberate analytical reasoning = diagnostic errors: inconsistent application of evidence-based medicine
what is an independent prescriber?
pharmacist legally accountable for prescribing any condition within their clinical competence
does “independent” mean working alone?
no - it means accountability, but prescribing should be done collaboratively
how does IP align with collaborative reasoning?
IPs involve patients in decisions, consult colleagues, and follow protocols (e.g. PGDs, Pharmacy First)
what is diagnostic uncertainty?
the inability to be 100% certain of a diagnosis; it’s a normal part of clinical practice
what is a working diagnosis?
provisional diagnosis based on current findings used to guide management
what is a differential diagnosis?
a ranked list of possible conditions explaining the patient’s symptoms
what’s the difference between risk aversion and risk management?
risk aversion = over-referring due to fear of negative outcomes
risk management = appropriate referral based on clinical reasoning and safety
why might foundation pharmacists struggle with uncertainty?
due to limited supervised clinical exposure and fear of error
what is the relationship between diagnostic uncertainty and risk aversion?
diagnostic uncertainty
what are human factors?
environmental, organisational, and personal factors that affect how we make clinical decisions
what framework helps us understand human factors?
SEIPS – System Engineering Initiative for Patient Safety
name the 5 categories of human factors in SEIPS
organisational
internal/external environment
tools & technology
personal
task
how do human factors influence decision making?
they influence how safely and accurately healthcare decisions are made
what is cognitive bias?
a mental shortcut that can cause diagnostic or prescribing errors
what is availability bias?
choosing a diagnosis based on recent cases you’ve seen
impact: may overlook more likely or evidence-based causes
what is confirmation bias?
seeking only information that supports your initial thought
impact: skews assessment, ignoring contradictory but important data
