Blog #57 - Roadmap to Clinical Reasoning- Why are you doing that?

Ever caught yourself as a graduate asking certain questions of your clients, without knowing the value of the response. Are you just asking because it is on the sheet in front of you or because university taught you to ask it? What value does it give you or the client?


It is important to only ask and complete the most valuable from here on in. Too much unnecessary information will cloud your judgement and overwhelm your decision making.


Many graduates struggle to get a diagnosis for their clients because they have been bombarded with so much information that is unnecessary during a consult that they can’t put the pieces of the puzzle together.

All of our clients want a diagnosis or a reason for why they have their condition. If you can not get a clear diagnosis, at least offer the reason why they are experiencing this problem.


Being able to get to the why will guide your treatment pathway.

Things to consider during an assessment:

(1) What next history question should you ask? What does an answer tell you?

(2) What next part of the physical examination would you perform? Why?


Don’t do anything just to check a box or fill a gap in your clinical notes. Everything must have rationale and value from here on out, a good mentor will be questioning your why.


Take small bite sized bits of information from the objective assessment and use this information as treatment. You don’t need to reinvent the wheel. Treat the symptoms and then become the detective to work out why this problem is occurring. Assessed a tight posterior capsule in the shoulder, stretch the posterior capsule to relieve symptoms. Demonstrated tenderness of L5S1 PAVIMs, mobilise this area to give symptom relief. Then build upon this treatment roadmap to uncover the source of the problem. This will allow you to work towards a long term solution.


Every patient has a question of help:

“Why do I have ………. How did I get………….What is……………?”



Every patient wants symptom relief first and then a long- term solution second. Work in that order and you should never have an unhappy client.

Be logical in your thinking. Take each part of the process step by step. You can’t jump to the end and you cannot do everything all at once. Each session can build upon the last. Clinical reasoning is a like a muscle. The more you use it the stronger and faster it will become. Like many skills we learn it takes practice of over 100+ times to become automatic, so be patient with yourself as a graduate, you still have the training wheels on in this area.


Advice:

- Be practical with your assessments

- Always ask why am I doing this and is this the best use of my time with a client

- Have I answered my client’s question of help?

- If you can not explain to another colleague why you are doing something, then you probably should not be doing it.

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